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Mueller C, Thomas A, Amara AW, DeWolfe J, Thomas SJ. Effects of exercise on sleep in patients with epilepsy: A systematic review. Epilepsy Behav Rep 2024; 26:100675. [PMID: 38779424 PMCID: PMC11109323 DOI: 10.1016/j.ebr.2024.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Exercise interventions in epilepsy have been shown to improve seizure frequency, physical capacity, quality of life, mood, and cognitive functioning. However, the effectiveness of exercise in improving sleep in epilepsy is less clear. The purpose of this report is to identify the published literature regarding exercise interventions in people with epilepsy to determine 1) what proportion of published clinical trials assess sleep as an outcome, and 2) what benefits of exercise interventions on sleep have been observed. We searched the PubMed, PsycINFO, and SCOPUS electronic databases using the search terms "epilepsy AND [exercise OR physical activity]" and identified 23 articles reporting on 18 unique clinical trials. Nine studies were conducted in adults, five in children, and four in adults and children with active seizures, controlled seizures, or both. Exercise modalities included aerobic exercise, strength training, walking, and yoga, among others, and some also included educational and motivational components. Exercise effects on sleep were tested in four studies, two of which only included indirect measures of sleep- and rest-related fatigue, with mixed results. Of the two reports assessing sleep directly, one reported marginal non-significant improvements in subjective sleep quality and no improvements in objective sleep quality in children after twelve weeks of walking, and the other reported no benefits in subjective sleep quality after twelve weeks of combined aerobic, strength, and flexibility training in adults. Given the health benefits of sleep and detrimental effects of sleep deprivation in epilepsy, epilepsy researchers need to assess the effects of exercise interventions on sleep.
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Affiliation(s)
- Christina Mueller
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - Ashley Thomas
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - Amy W. Amara
- University of Colorado Anschutz Medical Campus, Fitzsimons Building, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Jennifer DeWolfe
- University of Alabama at Birmingham, Department of Neurology, 1720 University Blvd, Birmingham, AL 35233, USA
| | - S. Justin Thomas
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1720 University Blvd, Birmingham, AL, 35233, USA
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Li P, Li J, Xiao Z, Sheng D, Liu W, Xiao B, Zhou L. Genetic causal association between physical activities and epilepsy: A Mendelian randomization study. Brain Behav 2024; 14:e3463. [PMID: 38451009 PMCID: PMC10918602 DOI: 10.1002/brb3.3463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/10/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Despite numerous investigations into the relationship between physical activities (PA) and epilepsy, the causal effects remain contentious. Thus, we conducted a two-sample Mendelian randomization (MR) study to assess the potential causality. METHODS Single-nucleotide polymorphisms (SNPs) predisposed to self-reported moderate and vigorous physical activities (MPA and VPA) and overall acceleration average (OAA) calculated through wrist-worn accelerometers were selected as exposure instrumental variables. Five subtypes of epilepsy, including all epilepsy, focal epilepsy and generalized epilepsy (with or without each other), focal epilepsy-strict definition and generalized epilepsy-strict definition (without overlap), were chosen as the outcomes. The MR study utilized the inverse-variance weighted (IVW) method as the primary analytical tool, supplemented by MR-Egger, simple mode, weighted mode, and weighted median methods. Cochran's Q and MR-Egger intercept tests were employed to assess heterogeneity and pleiotropy, while MR pleiotropy residual sum and outlier and leave-one-out analyses were conducted to identify potential SNP outliers. RESULTS The study indicated that OAA was genetically linked to a decreased risk of both focal epilepsy (OR = 0.812, 95% CI: 0.687-0.960, p = .015, IVW) and focal epilepsy-strict definition (OR = 0.732, 95% CI: 0.596-0.900, p = .003, IVW; OR = 0.749, 95% CI: 0.573-0.979, p = .035, Weighted median). Genetically predicted MPA and VPA did not exhibit a causal association with all epilepsy or its subtypes (p>.05). No evidence of heterogeneity, pleiotropy, or SNP outlier was observed. CONCLUSIONS Our findings suggested that PA with accelerometer monitoring may potentially reduce the risk of focal epilepsy, while there is no evidence supporting causal association between self-reported MPA or VPA and either focal or generalized epilepsy.
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Affiliation(s)
- Peihong Li
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Jiaxin Li
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Zheng Xiao
- Department of PathologyFirst Hospital of ChangshaChangshaHunanChina
| | - Dandan Sheng
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Weiping Liu
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Bo Xiao
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Luo Zhou
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
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Soto Jansson J, Bjurulf B, Dellenmark Blom M, Hallböök T, Reilly C. Diagnosis, epilepsy treatment and supports for neurodevelopment in children with Dravet Syndrome: Caregiver reported experiences and needs. Epilepsy Behav 2024; 151:109603. [PMID: 38168600 DOI: 10.1016/j.yebeh.2023.109603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Dravet syndrome is a rare infantile onset epilepsy syndrome encompassing treatment resistant epilepsy and neurodevelopmental difficulties. There is limited data regarding caregiver experiences of diagnosis, treatment and supports for the associated neurodevelopmental problems. METHOD Semi-structured interviews were conducted with caregivers of 36/48 children (75% of total population in Sweden) with Dravet syndrome. Data was analysed using thematic analysis. RESULTS Regarding the diagnostic experience, themes were: Delays in diagnostic process, genetic testing not optimal, communication of Dravet syndrome diagnosis and support and information soon after diagnosis. Caregivers felt that delays in diagnosis and testing could have been avoided whilst experiences of communication of diagnosis and support after diagnosis varied. In terms of treatment for seizures, the themes were: Satisfied with treatment, emergency treatment, treatment with antiseizure medications, strategies to control seizures via temperature regulation/avoidance of infections and use of equipment and aids. Caregivers were in the main accepting that seizures in Dravet syndrome are very difficult to treat and that seizure freedom is often an unachievable goal. Many felt frustrated that they were expected to take responsibility with respect to choice of medication. They often employed strategies (e.g., avoidance of physical activity) to reduce seizures or their impact. In terms of supports for neurodevelopmental problems, the themes were: Struggled to access support, lack of integrated healthcare and satisfaction with school. Many caregivers felt that accessing necessary supports for their children and developmental and behavioural needs was a struggle and that the provision of support often lacked integration e.g., lack of collaboration between child's disability service and school. Caregivers also expressed a desire that there would be better knowledge of Dravet syndrome in emergency departments and schools, that care would be better integrated and that there would be more supports for assessment and interventions regarding the associated neurodevelopmental problems. CONCLUSION The responses of caregivers of children with Dravet syndrome highlight the need for supports from diagnosis for both epilepsy and neurodevelopmental problems. Good examples of provision were identified but parents often felt they lacked support and support often came from providers who lacked knowledge of the syndrome. Collaboration between medical, disability and school services was often lacking.
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Affiliation(s)
- Josefin Soto Jansson
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden
| | - Björn Bjurulf
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michaela Dellenmark Blom
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tove Hallböök
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Colin Reilly
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; Member of the ERN EpiCARE, 413 45 Gothenburg, Sweden; Dept. of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Domaradzki J, Walkowiak D. Caring for Children with Dravet Syndrome: Exploring the Daily Challenges of Family Caregivers. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1410. [PMID: 37628409 PMCID: PMC10453293 DOI: 10.3390/children10081410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
While Polish studies focus on the symptoms, causes and treatment of people suffering from Dravet syndrome (DS), much less is known about the situation of the family caregivers of DS children. This study was designed to explore the experiences, daily challenges and needs related to caring for DS children. An anonymous self-administered online questionnaire was developed. The survey was completed by 75 family caregivers affiliated with the Association for People with Severe Refractory Epilepsy DRAVET.PL on Facebook. Most caregivers felt burdened by their children's reduced mobility (57.3%), mood swings (57.3%), lack of access to rehabilitation and medicine (56%) and healthcare expenses (50.7%). Caregivers also complained of a lack of time to themselves (76%) and work restrictions resulting from caregiving (72%). They consequently reported experiencing fatigue (84%), a deterioration of mental health (60%) and intimacy problems with their spouse/partner (53.4%). An important source of strain was a prolonged diagnostic odyssey and the constant struggle over the healthcare services for DS children. Since DS caregivers' problems and needs are often overlooked, they may be described as the forgotten people in DS. Healthcare professionals should be educated about the challenges related to caring for DS child, psycho-social status and coping resources of DS caregivers, and should focus on identification, monitoring and supporting caregivers' physical and mental well-being and needs.
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 60-356 Poznań, Poland;
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Samsonsen C, Mestvedthagen G, Uglem M, Brodtkorb E. Disentangling the cascade of seizure precipitants: A prospective observational study. Epilepsy Behav 2023; 145:109339. [PMID: 37413785 DOI: 10.1016/j.yebeh.2023.109339] [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: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The management of epilepsy includes appropriate antiseizure medication (ASM) treatment and careful avoidance of seizure precipitating factors. Seizure precipitants may be multiple occurring with low intensity adding to each other, thus leaving essential elements unrecognized. The aim of this study was to reveal the patients' subjective perceptions of the most important factors and to compare them with standardized measurements. METHODS The study included 152 acute hospital admissions for seizures. The patients were asked to score the impact of various seizure precipitants as perceived by themselves on a visual analogue scale (VAS). The following items related to seizure occurrence were quantified: sleep deprivation by sleep diaries, ASM adherence by therapeutic drug monitoring, the Alcohol Use Identification Test, and the Hospital Anxiety and Depression Scale. Statistical analyses, including multiple regression, were performed to discover relationships between various parameters. RESULTS The interaction of the various factors was high. The association between lack of sleep and hazardous drinking and anxiety was highly significant. Perceived stress correlated well with anxiety and depression. Relatively low VAS scores for missed medication in patients with identified non-adherence suggest that insufficient patient awareness is common. Low VAS-scores for alcohol in patients with harmful drinking also suggest low acknowledgment of alcohol-related seizures. High alcohol scores were associated with sleep deprivation, anxiety and depression. CONCLUSION The circumstances leading to an epileptic seizure are complex. Stress, sleep loss, alcohol intake, and missed medication are among the most commonly reported seizure precipitants. They are often combined, and various facets of the same underlying cause may be at play. Their sequence and relative impact are often difficult to establish. Improved understanding of the cascade of events preceding a seizure can improve comprehensive personalized management of uncontrolled epilepsy.
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Affiliation(s)
- Christian Samsonsen
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Guro Mestvedthagen
- Faculty of Medicine and Health Sciences Norwegian University of Science and Technology, Trondheim, Norway.
| | - Martin Uglem
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Domaradzki J, Walkowiak D. Emotional experiences of family caregivers of children with Dravet syndrome. Epilepsy Behav 2023; 142:109193. [DOI: https:/doi.org/10.1016/j.yebeh.2023.109193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
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Domaradzki J, Walkowiak D. Emotional experiences of family caregivers of children with Dravet syndrome. Epilepsy Behav 2023; 142:109193. [PMID: 37028149 DOI: 10.1016/j.yebeh.2023.109193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Since the psychosocial implications of Dravet syndrome (DS) are much more serious and far-reaching than in other types of epilepsy, caring for a DS child seriously affects the entire family. This study describes the emotional experiences of family caregivers of DS children and evaluates the way caregiving affects their perceived quality of life. METHODS An anonymous, self-administered online questionnaire was sent to family caregivers of DS children through the online patient advocacy organization the Association for People with Severe Refractory Epilepsy DRAVET.PL. It focussed on the psychosocial impact of caregiving for DS children, the perceived burden of caregiving, caregivers' emotional experiences and feelings related to caregiving, and the impact of DS on the perceived quality of life. RESULTS Caregivers stressed that caring for a DS child is associated with a significant psychosocial and emotional burden that affects the entire family. Although most caregivers reported that it was the child's health problems and behavioral and psychological disorders that were the most challenging aspects of caregiving, they were also burdened by the lack of emotional support. As caregivers were profoundly engaged in caregiving, they experienced a variety of distressing emotions, including feelings of helplessness, anxiety and fear, anticipated grief, depression, and impulsivity. Many caregivers also reported that their children's disease disrupted their relationships with their spouses, family, and healthy children. As caregivers reported experiencing role overload, physical fatigue, and mental exhaustion, they stressed the extent to which caregiving for DS children impaired their quality of life, their social and professional life, and was a source of financial burden. CONCLUSIONS As this study identified specific burden domains affecting DS caregivers' well-being family carers often need special attention, support, and help. To alleviate the humanistic burden of DS carers a bio-psychosocial approach focusing on physical, mental, and psychosocial interventions should include both DS children and their caregivers.
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Affiliation(s)
- Jan Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland.
| | - Dariusz Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland
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Arida RM. Physical Exercise as a Strategy to Reduce Seizure Susceptibility. PHARMACORESISTANCE IN EPILEPSY 2023:453-477. [DOI: 10.1007/978-3-031-36526-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Catron MA, Howe RK, Besing GLK, St. John EK, Potesta CV, Gallagher MJ, Macdonald RL, Zhou C. Sleep slow-wave oscillations trigger seizures in a genetic epilepsy model of Dravet syndrome. Brain Commun 2022; 5:fcac332. [PMID: 36632186 PMCID: PMC9830548 DOI: 10.1093/braincomms/fcac332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Sleep is the preferential period when epileptic spike-wave discharges appear in human epileptic patients, including genetic epileptic seizures such as Dravet syndrome with multiple mutations including SCN1A mutation and GABAA receptor γ2 subunit Gabrg2Q390X mutation in patients, which presents more severe epileptic symptoms in female patients than male patients. However, the seizure onset mechanism during sleep still remains unknown. Our previous work has shown that the sleep-like state-dependent homeostatic synaptic potentiation can trigger epileptic spike-wave discharges in one transgenic heterozygous Gabrg2+/Q390X knock-in mouse model.1 Here, using this heterozygous knock-in mouse model, we hypothesized that slow-wave oscillations themselves in vivo could trigger epileptic seizures. We found that epileptic spike-wave discharges in heterozygous Gabrg2+/Q390X knock-in mice exhibited preferential incidence during non-rapid eye movement sleep period, accompanied by motor immobility/facial myoclonus/vibrissal twitching and more frequent spike-wave discharge incidence appeared in female heterozygous knock-in mice than male heterozygous knock-in mice. Optogenetically induced slow-wave oscillations in vivo significantly increased epileptic spike-wave discharge incidence in heterozygous Gabrg2+/Q390X knock-in mice with longer duration of non-rapid eye movement sleep or quiet-wakeful states. Furthermore, suppression of slow-wave oscillation-related homeostatic synaptic potentiation by 4-(diethylamino)-benzaldehyde injection (i.p.) greatly attenuated spike-wave discharge incidence in heterozygous knock-in mice, suggesting that slow-wave oscillations in vivo did trigger seizure activity in heterozygous knock-in mice. Meanwhile, sleep spindle generation in wild-type littermates and heterozygous Gabrg2+/Q390X knock-in mice involved the slow-wave oscillation-related homeostatic synaptic potentiation that also contributed to epileptic spike-wave discharge generation in heterozygous Gabrg2+/Q390X knock-in mice. In addition, EEG spectral power of delta frequency (0.1-4 Hz) during non-rapid eye movement sleep was significantly larger in female heterozygous Gabrg2+/Q390X knock-in mice than that in male heterozygous Gabrg2+/Q390X knock-in mice, which likely contributes to the gender difference in seizure incidence during non-rapid eye movement sleep/quiet-wake states of human patients. Overall, all these results indicate that slow-wave oscillations in vivo trigger the seizure onset in heterozygous Gabrg2+/Q390X knock-in mice, preferentially during non-rapid eye movement sleep period and likely generate the sex difference in seizure incidence between male and female heterozygous Gabrg2+/Q390X knock-in mice.
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Affiliation(s)
- Mackenzie A Catron
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Rachel K Howe
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Gai-Linn K Besing
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Emily K St. John
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robert L Macdonald
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Chengwen Zhou
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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He Z, Li Y, Zhao X, Li B. Dravet Syndrome: Advances in Etiology, Clinical Presentation, and Treatment. Epilepsy Res 2022; 188:107041. [DOI: 10.1016/j.eplepsyres.2022.107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
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Bjurulf B, Reilly C, Hallböök T. Caregiver reported seizure precipitants and measures to prevent seizures in children with Dravet syndrome. Seizure 2022; 103:3-10. [DOI: 10.1016/j.seizure.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/19/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022] Open
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Goisis RC, Chiavegato A, Gomez-Gonzalo M, Marcon I, Requie LM, Scholze P, Carmignoto G, Losi G. GABA tonic currents and glial cells are altered during epileptogenesis in a mouse model of Dravet syndrome. Front Cell Neurosci 2022; 16:919493. [PMID: 35936501 PMCID: PMC9350930 DOI: 10.3389/fncel.2022.919493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Dravet Syndrome (DS) is a rare autosomic encephalopathy with epilepsy linked to Nav1.1 channel mutations and defective GABAergic signaling. Effective therapies for this syndrome are lacking, urging a better comprehension of the mechanisms involved. In a recognized mouse model of DS, we studied GABA tonic current, a form of inhibition largely neglected in DS, in brain slices from developing mice before spontaneous seizures are reported. In neurons from the temporal cortex (TeCx) and CA1 region, GABA tonic current was reduced in DS mice compared to controls, while in the entorhinal cortex (ECx) it was not affected. In this region however allopregnanonole potentiation of GABA tonic current was reduced in DS mice, suggesting altered extrasynaptic GABAA subunits. Using THIP as a selective agonist, we found reduced δ subunit mediated tonic currents in ECx of DS mice. Unexpectedly in the dentate gyrus (DG), a region with high δ subunit expression, THIP-evoked currents in DS mice were larger than in controls. An immunofluorescence study confirmed that δ subunit expression was reduced in ECx and increased in DG of DS mice. Finally, considering the importance of neuroinflammation in epilepsy and neurodevelopmental disorders, we evaluated classical markers of glia activation. Our results show that DS mice have increased Iba1 reactivity and GFAP expression in both ECx and DG, compared to controls. Altogether we report that before spontaneous seizures, DS mice develop significant alterations of GABA tonic currents and glial cell activation. Understanding all the mechanisms involved in these alterations during disease maturation and progression may unveil new therapeutic targets.
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Affiliation(s)
- Rosa Chiara Goisis
- Department of Biomedical Science, University of Padua, Padua, Italy
- Neuroscience Institute, National Research Council (IN-CNR), Padua, Italy
| | - Angela Chiavegato
- Neuroscience Institute, National Research Council (IN-CNR), Padua, Italy
| | - Marta Gomez-Gonzalo
- Department of Biomedical Science, University of Padua, Padua, Italy
- Neuroscience Institute, National Research Council (IN-CNR), Padua, Italy
| | - Iacopo Marcon
- Department of Biomedical Science, University of Padua, Padua, Italy
| | | | - Petra Scholze
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Giorgio Carmignoto
- Department of Biomedical Science, University of Padua, Padua, Italy
- Neuroscience Institute, National Research Council (IN-CNR), Padua, Italy
| | - Gabriele Losi
- Department of Biomedical Science, University of Padua, Padua, Italy
- Neuroscience Institute, National Research Council (IN-CNR), Padua, Italy
- *Correspondence: Gabriele Losi
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Hood V, Berg AT, Knupp KG, Koh S, Laux L, Meskis MA, Zulfiqar‐Ali Q, Perry MS, Scheffer IE, Sullivan J, Wirrell E, Andrade DM. COVID-19 vaccine in patients with Dravet syndrome: Observations and real-world experiences. Epilepsia 2022; 63:1778-1786. [PMID: 35383912 PMCID: PMC9111612 DOI: 10.1111/epi.17250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Vaccination against the SARS-CoV-2 virus is a primary tool to combat the COVID-19 pandemic. However, vaccination is a common seizure trigger in individuals with Dravet syndrome (DS). Information surrounding COVID-19 vaccine side effects in patients with DS would aid caregivers and providers in decisions for and management of COVID-19 vaccination. METHODS A survey was emailed to the Dravet Syndrome Foundation's Family Network and posted to the Dravet Parent & Caregiver Support Group on Facebook between May and August 2021. Deidentified information obtained included demographics and vaccination status for individuals with DS. Vaccine type, side effects, preventative measures, and changes in seizure activity following COVID-19 vaccination were recorded. For unvaccinated individuals, caregivers were asked about intent to vaccinate and reasons for their decision. RESULTS Of 278 survey responses, 120 represented vaccinated individuals with DS (median age = 19.5 years), with 50% reporting no side effects from COVID-19 vaccination. Increased seizures following COVID-19 vaccination were reported in 16 individuals, but none had status epilepticus. Of the 158 individuals who had not received a COVID-19 vaccination, 37 were older than 12 years (i.e., eligible at time of study), and only six of these caregivers indicated intent to seek vaccination. The remaining 121 responses were caregivers to children younger than 12 years, 60 of whom indicated they would not seek COVID-19 vaccination when their child with DS became eligible. Reasons for vaccine hesitancy were fear of increased seizure activity and concerns about vaccine safety. SIGNIFICANCE These results indicate COVID-19 vaccination is well tolerated by individuals with DS. One main reason for vaccine hesitancy was fear of increased seizure activity, which occurred in only 13% of vaccinated individuals, and none had status epilepticus. This study provides critical and reassuring insights for caregivers and health care providers making decisions about the safety of COVID-19 vaccinations for individuals with DS.
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Affiliation(s)
| | - Anne T. Berg
- Department of NeurologyNorthwestern Feinberg School of MedicineChicagoIllinoisUSA
| | - Kelly G. Knupp
- Department of Pediatrics and NeurologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Sookyong Koh
- Department of Pediatric Neurology at University of Nebraska Medical CenterOmahaNebraskaUSA
| | - Linda Laux
- Epilepsy CenterDepartment of PediatricsAnn & Robert H. Lurie Children’s HospitalChicagoIllinoisUSA
| | | | - Quratulain Zulfiqar‐Ali
- Adult Epilepsy Genetics ProgramKrembil Brain InstituteToronto Western HospitalTorontoOntarioCanada
| | - M. Scott Perry
- Jane and John Justin Neurosciences CenterCook Children’s Medical CenterFort WorthTexasUSA
| | - Ingrid E. Scheffer
- Epilepsy Research CentreUniversity of MelbourneAustin Health; Royal Children’s Hospital, Florey Institute; Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
| | - Joseph Sullivan
- Departments of Neurology and PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Elaine Wirrell
- Child and Adolescent NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Danielle M. Andrade
- Dravet Syndrome FoundationCherry HillNew JerseyUSA
- Division of NeurologyKrembil Brain InstituteToronto Western HospitalUniversity of TorontoTorontoOntarioCanada
- Adult Genetic Epilepsy ProgramUniversity of TorontoTorontoOntarioCanada
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14
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Inherited Developmental and Epileptic Encephalopathies. Neurol Int 2021; 13:555-568. [PMID: 34842787 PMCID: PMC8628919 DOI: 10.3390/neurolint13040055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/13/2023] Open
Abstract
Epileptic encephalopathies often have a genetic etiology. The epileptic activity itself exerts a direct detrimental effect on neurodevelopment, which may add to the cognitive impairment induced by the underlying mutation (“developmental and epileptic encephalopathy”). The focus of this review is on inherited syndromes. The phenotypes of genetic disorders affecting ion channels, metabolic signalling, membrane trafficking and exocytosis, cell adhesion, cell growth and proliferation are discussed. Red flags suggesting family of genes or even specific genes are highlighted. The knowledge of the phenotypical spectrum can indeed prompt the clinician to suspect specific etiologies, expediting the diagnosis.
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15
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Gulcebi MI, Bartolini E, Lee O, Lisgaras CP, Onat F, Mifsud J, Striano P, Vezzani A, Hildebrand MS, Jimenez-Jimenez D, Junck L, Lewis-Smith D, Scheffer IE, Thijs RD, Zuberi SM, Blenkinsop S, Fowler HJ, Foley A, Sisodiya SM, Berkovic S, Cavalleri G, Correa DJ, Martins Custodio H, Galovic M, Guerrini R, Henshall D, Howard O, Hughes K, Katsarou A, Koeleman BP, Krause R, Lowenstein D, Mandelenaki D, Marini C, O'Brien TJ, Pace A, De Palma L, Perucca P, Pitkänen A, Quinn F, Selmer KK, Steward CA, Swanborough N, Thijs R, Tittensor P, Trivisano M, Weckhuysen S, Zara F. Climate change and epilepsy: Insights from clinical and basic science studies. Epilepsy Behav 2021; 116:107791. [PMID: 33578223 PMCID: PMC9386889 DOI: 10.1016/j.yebeh.2021.107791] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 12/23/2022]
Abstract
Climate change is with us. As professionals who place value on evidence-based practice, climate change is something we cannot ignore. The current pandemic of the novel coronavirus, SARS-CoV-2, has demonstrated how global crises can arise suddenly and have a significant impact on public health. Global warming, a chronic process punctuated by acute episodes of extreme weather events, is an insidious global health crisis needing at least as much attention. Many neurological diseases are complex chronic conditions influenced at many levels by changes in the environment. This review aimed to collate and evaluate reports from clinical and basic science about the relationship between climate change and epilepsy. The keywords climate change, seasonal variation, temperature, humidity, thermoregulation, biorhythm, gene, circadian rhythm, heat, and weather were used to search the published evidence. A number of climatic variables are associated with increased seizure frequency in people with epilepsy. Climate change-induced increase in seizure precipitants such as fevers, stress, and sleep deprivation (e.g. as a result of more frequent extreme weather events) or vector-borne infections may trigger or exacerbate seizures, lead to deterioration of seizure control, and affect neurological, cerebrovascular, or cardiovascular comorbidities and risk of sudden unexpected death in epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. According to the results of the limited number of experimental studies with animal models of seizures or epilepsy, different seizure types appear to have distinct susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, has a critical role in seizure threshold and seizure-related brain damage. Links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, which makes predictions difficult. We need more data on possible climate-driven altered risks for seizures, epilepsy, and epileptogenesis, to identify underlying mechanisms at systems, cellular, and molecular levels for better understanding of the impact of climate change on epilepsy. Further focussed data would help us to develop evidence for mitigation methods to do more to protect people with epilepsy from the effects of climate change.
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Affiliation(s)
- Medine I. Gulcebi
- Department of Medical Pharmacology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Omay Lee
- Department of Neurology and Clinical Neurophysiology, St. George's University Hospitals NHS Foundation Trust, London, UK.
| | - Christos Panagiotis Lisgaras
- New York University Langone Health, 100 First Ave., New York, NY 10016, USA; The Nathan S. Kline Institute for Psychiatric Research, Center for Dementia Research, 140 Old Orangeburg Rd., Orangeburg, NY 10962, USA.
| | - Filiz Onat
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey,Department of Medical Pharmacology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, University of Malta, Msida MSD2040, Malta.
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, IRCCS “Giannina Gaslini” Institute, Genova, Italy
| | - Annamaria Vezzani
- Laboratory of Experimental Neurology, Department of Neuroscience, IRCCS 'Mario Negri' Institute for Pharmacological Research, Milan, Italy.
| | - Michael S. Hildebrand
- Department of Medicine (Austin Health), University of Melbourne, and Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Diego Jimenez-Jimenez
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK.
| | - Larry Junck
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Ingrid E. Scheffer
- University of Melbourne, Austin Health and Royal Children’s Hospital, Florey Institute and Murdoch Children’s Research Institute, Melbourne, Australia
| | - Roland D. Thijs
- Department of Neurology, Leiden University Medical Centre (LUMC), PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Sameer M. Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Fraser of Allander Neurosciences Unit, Royal Hospital for Children, UK
| | | | - Hayley J. Fowler
- Centre for Earth Systems Engineering Research, School of Engineering, Newcastle University, UK
| | - Aideen Foley
- Department of Geography, Birkbeck College University of London, London, UK.
| | - Epilepsy Climate Change ConsortiumBalestriniSimonaaaBerkovicSamuelabCavalleriGianpieroacCorreaDaniel JoséadMartins CustodioHelenaaeGalovicMarianafGuerriniRenzoagHenshallDavidahHowardOlgaaiHughesKelvinajKatsarouAnnaakKoelemanBobby P.C.alKrauseRolandamLowensteinDanielanMandelenakiDespoinaaoMariniCarlaapO’BrienTerence J.aqPaceAdrianarDe PalmaLucaasPeruccaPieroatPitkänenAslaauQuinnFinolaavSelmerKaja KristineawStewardCharles A.axSwanboroughNicolaayThijsRolandazTittensorPhilbaTrivisanoMarinabbWeckhuysenSarahbcZaraFedericobdDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK and Chalfont Centre for Epilepsy, Bucks, UKEpilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin 2, Ireland; The FutureNeuro Research Centre, Dublin 2, IrelandSaul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, 1410 Pelham Parkway South, K-312, Bronx, NY 10461, USADepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Bucks, UKUniversity Hospital Zurich, SwitzerlandDepartment of Child Neurology and Psychiatry, University of Pisa and IRCCS Fondazione Stella Maris, 56018 Calambrone, Pisa, ItalyFutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin D02 YN77, IrelandUCB Pharma Ltd, Slough, UKDravet Syndrome UK, UKLaboratory of Developmental Epilepsy, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USAUniversity Medical Center, Utrecht, The NetherlandsLuxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, LuxembourgDepartment of Neurology, University of California, San Francisco, CA, USADepartment of Pediatric Neurology, Queen Fabiola Children’s University Hospital, Brussels, Brussels Capital Region, BelgiumNeuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, ItalyMelbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, AustraliaGozo General Hospital, MaltaNeurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, ItalyDepartment of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, AustraliaA.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FIN-70211 Kuopio, FinlandILAE-IBE Congress Secretariat, Dublin, IrelandNational Centre for Rare Epilepsy-related Disorders, Oslo University Hospital, Oslo, Norway; Department of Medical Genetics, Oslo University Hospital, University of Oslo, Oslo, NorwayCongenica Ltd, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1DR, UK; Wellcome Sanger InstituteWellcome Genome Campus, Hinxton, Cambridge CB10 1SA, UKEpilepsy Society, Bucks, UKStichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UKRoyal Wolverhampton NHS Trust, Wolverhampton, UKRare and Complex Epilepsy Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children’s Hospital, IRCCS, Rome, ItalyNeurogenetics Group, Center for Molecular Neurology, VIB, University of Antwerp, Antwerp 2610, BelgiumUnit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK and Chalfont Centre for Epilepsy, Bucks, UK,Corresponding author at: Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
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16
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Sahai N, Bard AM, Devinsky O, Kalume F. Disordered autonomic function during exposure to moderate heat or exercise in a mouse model of Dravet syndrome. Neurobiol Dis 2020; 147:105154. [PMID: 33144172 DOI: 10.1016/j.nbd.2020.105154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/18/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine autonomic regulation of core body temperature, heart rate (HR), and breathing rate (BR) in response to moderately elevated ambient temperature or moderate physical exercise in a mouse model of Dravet syndrome (DS). METHODS We studied video-EEG, ECG, respiration, and temperature in mice with global heterozygous Scn1a knockout (KO) (DS mice), interneuron specific Scn1a KO, and wildtype (WT) mice during exposure to increased environmental temperature and moderate treadmill exercise. RESULTS Core body temperatures of WT and DS mice were similar during baseline. After 15 mins of heat exposure, the peak value was lower in DS than WT mice. In the following mins of heat exposure, the temperature slowly returned close to baseline level in WT, whereas it remained elevated in DS mice. KO of Scn1a in GABAergic neurons caused similar thermoregulatory deficits in mice. During exercise, the HR increase was less prominent in DS than WT mice. After exercise, the HR was significantly more suppressed in DS. The heart rate variability (HRV) was lower in DS than WT mice during baseline and higher in DS during exercise-recovery periods. SIGNIFICANCE We found novel abnormalities that expand the spectrum of interictal, ictal, and postictal autonomic dysregulation in DS mice. During mild heat stress, there was a significantly blunted correction of body temperature, and a less suppression of both HR and respiration rate in DS than WT mice. These effects were seen in mice with selective KO of Scn1A in GABAergic neurons. During exercise stress, there was diminished increase in HR, followed by an exaggerated HR suppression and HRV elevation during recovery in DS mice compared to controls. These findings suggest that different environmental stressors can uncover distinct autonomic disturbances in DS mice. Interneurons play an important role in thermoregulation. Understanding the spectrum and mechanisms of autonomic disorders in DS may help develop more effective strategies to prevent seizures and SUDEP.
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Affiliation(s)
- Nikhil Sahai
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Angela M Bard
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA
| | - Orrin Devinsky
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA
| | - Franck Kalume
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA.
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17
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Arida RM. Physical exercise and seizure activity. Biochim Biophys Acta Mol Basis Dis 2020; 1867:165979. [PMID: 32980461 DOI: 10.1016/j.bbadis.2020.165979] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
Neuroprotective and antiepileptogenic therapies have been extensively investigated for epilepsy prevention and treatment. This review gives an overview of the promising contribution of the ketogenic diet, a complementary treatment, on the intestinal microbiota to reduce seizure susceptibility. Next, the relevance of physical exercise is extensively addressed as a complementary therapy to reduce seizure susceptibility, and thereby impact beneficially on the epilepsy condition. In this context, particular attention is given to the potential risks and benefits of physical exercise, possible precipitant factors related to exercise and proposed mechanisms by which exercise can reduce seizures, and its antiepileptogenic effects. Finally, this review points to emerging evidence of exercise reducing comorbidities from epilepsy and improving the quality of life of people with epilepsy. Based on evidence from current literature, physical or sport activities represent a potential non-pharmacological intervention that can be integrated with conventional therapy for epilepsy.
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Affiliation(s)
- Ricardo Mario Arida
- Department of Physiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
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18
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Zhang CQ, Catron MA, Ding L, Hanna CM, Gallagher MJ, Macdonald RL, Zhou C. Impaired State-Dependent Potentiation of GABAergic Synaptic Currents Triggers Seizures in a Genetic Generalized Epilepsy Model. Cereb Cortex 2020; 31:768-784. [PMID: 32930324 DOI: 10.1093/cercor/bhaa256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/14/2022] Open
Abstract
Epileptic activity in genetic generalized epilepsy (GGE) patients preferentially appears during sleep and its mechanism remains unknown. Here, we found that sleep-like slow-wave oscillations (0.5 Hz SWOs) potentiated excitatory and inhibitory synaptic currents in layer V cortical pyramidal neurons from wild-type (wt) mouse brain slices. In contrast, SWOs potentiated excitatory, but not inhibitory, currents in cortical neurons from a heterozygous (het) knock-in (KI) Gabrg2+Q/390X model of Dravet epilepsy syndrome. This created an imbalance between evoked excitatory and inhibitory currents to effectively prompt neuronal action potential firings. Similarly, physiologically similar up-/down-state induction (present during slow-wave sleep) in cortical neurons also potentiated excitatory synaptic currents within brain slices from wt and het KI mice. Moreover, this state-dependent potentiation of excitatory synaptic currents entailed some signaling pathways of homeostatic synaptic plasticity. Consequently, in het KI mice, in vivo SWO induction (using optogenetic methods) triggered generalized epileptic spike-wave discharges (SWDs), being accompanied by sudden immobility, facial myoclonus, and vibrissa twitching. In contrast, in wt littermates, SWO induction did not cause epileptic SWDs and motor behaviors. To our knowledge, this is the first mechanism to explain why epileptic SWDs preferentially happen during non rapid eye-movement sleep and quiet-wakefulness in human GGE patients.
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Affiliation(s)
- Chun-Qing Zhang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Mackenzie A Catron
- Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Li Ding
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Caitlyn M Hanna
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Martin J Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Robert L Macdonald
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Chengwen Zhou
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Neuroscience Graduate Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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19
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Adverse Events Following Immunization Among Children With Epilepsy: A Self-Controlled Case Series. Pediatr Infect Dis J 2020; 39:454-459. [PMID: 32301921 DOI: 10.1097/inf.0000000000002553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In children with epilepsy, fever and illness are known triggers for seizure; therefore, clinicians and parents could be concerned that immunization-induced inflammation and fever could also trigger seizures. We sought to estimate the risk of emergency department (ED) visit or hospitalization for epilepsy/seizure and all causes after immunization in children younger than 7 years of age with epilepsy. METHODS We conducted a self-controlled case series of children diagnosed with epilepsy before their 7th birthday and immunized from 2005 to 2015 in Ontario (population 14.2 million) and Manitoba (population 1.3 million), Canada, using administrative healthcare data. We estimated the age- and season-adjusted relative incidence (aRI) of epilepsy/seizure-related and all-cause ED visits/hospitalizations during various risk periods 0-28 days after inactivated and live immunizations versus a control period 35-83 days postimmunization. Estimates from each province were analyzed separately and then combined in a random-effects meta-analysis. RESULTS The combined risk of epilepsy/seizure-related hospitalization/ED visit was increased 0-2 days after inactivated vaccines (aRI = 1.5, 95% confidence interval: 1.1-1.9) and 7-10 days after live vaccines (aRI = 1.9, 1.4-2.7). For all-cause ED visit/hospitalization, the combined aRI estimate was 0.9 (0.8-1.2) 0-2 days after inactivated vaccines and 1.3 (1.1-1.5) 7-10 days after live vaccines. CONCLUSIONS The risk of epilepsy/seizure-related ED visit/hospitalization was modestly increased among children with epilepsy during peak periods of fever and inflammation following inactivated and live vaccines. These risks must be balanced against the risk of complications from vaccine-preventable diseases.
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20
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Bartolini E, Campostrini R, Kiferle L, Pradella S, Rosati E, Chinthapalli K, Palumbo P. Epilepsy and brain channelopathies from infancy to adulthood. Neurol Sci 2019; 41:749-761. [PMID: 31838630 DOI: 10.1007/s10072-019-04190-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/06/2019] [Indexed: 01/04/2023]
Abstract
Genetic brain channelopathies result from inherited or de novo mutations of genes encoding ion channel subunits within the central nervous system. Most neurological channelopathies arise in childhood with paroxysmal or episodic symptoms, likely because of a transient impairment of homeostatic mechanisms regulating membrane excitability, and the prototypical expression of this impairment is epilepsy. Migraine, episodic ataxia and alternating hemiplegia can also occur, as well as chronic phenotypes, such as spinocerebellar ataxias, intellectual disability and autism spectrum disorder. Voltage-gated and ligand-gated channels may be involved. In most cases, a single gene may be associated with a phenotypical spectrum that shows variable expressivity. Different clinical features may arise at different ages and the adult phenotype may be remarkably modified from the syndrome onset in childhood or adolescence. Recognizing the prominent phenotypical traits of brain channelopathies is essential to perform appropriate diagnostic investigations and to provide the better care not only in the paediatric setting but also for adult patients and their caregivers. Herein, we provide an overview of genetic brain channelopathies associated with epilepsy, highlight the different molecular mechanisms and describe the different clinical characteristics which may prompt the clinician to suspect specific syndromes and to possibly establish tailored treatments.
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Affiliation(s)
- Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy.
| | - Roberto Campostrini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | - Lorenzo Kiferle
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | - Eleonora Rosati
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy
| | | | - Pasquale Palumbo
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy
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21
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Sisodiya SM, Fowler HJ, Lake I, Nanji RO, Gawel K, Esguerra CV, Newton C, Foley A. Climate change and epilepsy: Time to take action. Epilepsia Open 2019; 4:524-536. [PMID: 31819908 PMCID: PMC6885657 DOI: 10.1002/epi4.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/18/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022] Open
Abstract
Climate change is the biggest challenge facing humanity today. The associated global warming and humidification, increases in the severity and frequency of extreme climate events, extension of the ranges of vector-borne diseases, and the consequent social and economic stresses and disruption will have major negative consequences on many aspects of health care. People whose resilience to change is already impaired may suffer disproportionately from these environmental changes, which are of unprecedented reach and magnitude. There has been little connection made so far between climate change and epilepsy. We briefly review the history of climate change science and the subsequent response of the global scientific community. We consider how climate change effects might in general affect health and disease. We consider some of the underlying complex interactions that, for example, favor the spread of vector-borne diseases and how climate models operate and may help plan for global and local changes. We then speculate specifically on how these generic ideas may apply specifically to epilepsy. We consider these impacts at levels from molecular to the epidemiological. Data are sparse, and there is undoubtedly a need for more information to enable better estimation of possible effects of climate change on care in epilepsy. We also consider how the professional activities of those involved in epilepsy health care might contribute to global carbon emissions, for example, through flying for conference attendance. Healthcare organizations across the world are already considering, and responding to, many of these issues. We argue for more research in this area, but also for action today. Actions today are likely to generate cobenefits for health care, including care in epilepsy, resulting from efforts to decarbonize, mitigate effects of climate change that has already happened, and plan for adaptation to climate change.
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Affiliation(s)
- Sanjay M. Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St. PeterUK
| | - Hayley J. Fowler
- School of Civil Engineering and GeosciencesNewcastle UniversityNewcastle upon TyneUK
| | - Iain Lake
- School of Environmental SciencesUniversity of East AngliaNorwichUK
| | - Rosemary O. Nanji
- Centre for Molecular Medicine NorwayFaculty of Medicine and Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
| | - Kinga Gawel
- Centre for Molecular Medicine NorwayFaculty of Medicine and Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
- Department of Experimental and Clinical PharmacologyMedical University of LublinLublinPoland
| | - Camila V. Esguerra
- Centre for Molecular Medicine NorwayFaculty of Medicine and Department of PharmacyFaculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
| | | | - Aideen Foley
- Department of GeographyBirkbeck CollegeUniversity of LondonLondonUK
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22
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Bartolini E, Sander JW. Dealing with the storm: An overview of seizure precipitants and spontaneous seizure worsening in drug-resistant epilepsy. Epilepsy Behav 2019; 97:212-218. [PMID: 31254841 DOI: 10.1016/j.yebeh.2019.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
In drug-resistant epilepsy, periods of seizure stability may alternate with abrupt worsening, with frequent seizures limiting the individual's independence and physical, social, and psychological well-being. Here, we review the literature focusing on different clinical scenarios related to seizure aggravation in people with drug-resistant epilepsy. The role of antiseizure medication (ASM) changes is examined, especially focusing on paradoxical seizure aggravation after increased treatment. The external provocative factors that unbalance the brittle equilibrium of seizure control are reviewed, distinguishing between unspecific triggering factors, specific precipitants, and 'reflex' mechanisms. The chance of intervening surgical or medical conditions, including somatic comorbidities and epilepsy surgery failure, causing increased seizures is discussed. Spontaneous exacerbation is also explored, emphasizing recent findings on subject-specific circadian and ultradian rhythms. Awareness of external precipitants and understanding the subject-specific spontaneous epilepsy course may allow individuals to modify their lifestyles. It also allows clinicians to counsel appropriately and to institute suitable medical treatment to avoid sudden loss of seizure control.
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Affiliation(s)
- Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, via suor Niccolina Infermiera 20, 59100 Prato, Italy.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Achterweg 5, Heemstede 2103 SW, the Netherlands.
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23
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Schoonjans AS, De Keersmaecker S, Van Bouwel M, Ceulemans B. More daytime sleepiness and worse quality of sleep in patients with Dravet Syndrome compared to other epilepsy patients. Eur J Paediatr Neurol 2019; 23:61-69. [PMID: 30340858 DOI: 10.1016/j.ejpn.2018.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 09/13/2018] [Accepted: 09/23/2018] [Indexed: 01/15/2023]
Abstract
AIM Sleep problems are often reported in patients with a Dravet Syndrome (DS). In this study we explored the sleep behavior in DS and compared the prevalence of sleep problems with other epilepsy patients. METHODS An online questionnaire based on the 'Sleep Behavior Questionnaire by Simonds & Parraga (SQ-SP)' was distributed amongst DS parents and a control group (parents from children with epilepsy). Completed questionnaires were evaluated by factor scores and Composite Sleep Index (CSI). RESULTS Fifty-six responses were recorded in the DS group (42 were ≤18 year). Caregivers reported an overall frequency of sleep problems in 42.3% (22/52). Severe sleep problems, measured by CSI, were found in 28.3% (13/46) mainly related to night waking or daytime sleepiness. In the control group (n = 66, 62 were ≤18 year), sleep problems were reported by 21.2% (14/52) of the parents. Comparison analysis between pediatric DS and epilepsy patients revealed no significant differences between the prevalence of different types of sleep disorders, except for daytime sleepiness (p = 0.042). However, the parent (or caregiver)-reported quality of sleep was significantly lower in the DS group (p = 0.011). INTERPRETATION Sleep problems are frequent in DS patients and are mainly related to daytime sleepiness and night waking. Compared with other epilepsy patients, severe sleep problems are not more common in patients with a DS. However DS patients tend to have more mild night waking problems, which may explain the worse parental-reported sleep quality in DS patients.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Belgium.
| | | | - Maxime Van Bouwel
- Faculty of Medicine and Health Sciences, Antwerp University Hospital, Antwerp, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Belgium
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Perineal stimulation triggering seizures in a child with Dravet syndrome. Seizure 2018; 62:106-107. [DOI: 10.1016/j.seizure.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022] Open
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Abstract
PURPOSE OF REVIEW Dravet syndrome is a rare but severe genetic epilepsy that has unique treatment challenges. This is a review of current and future potential treatment options. RECENT FINDINGS Treatment for Dravet syndrome should encompass many aspects of the syndrome such as gait, behavior, and nutrition, as well as focus on seizure control. Many sodium channel blockers should be avoided as they are likely to exacerbate seizures. Current options for treatment include valproic acid, clobazam, stiripentol, and ketogenic diet. Testing is underway for several new treatment options with unique mechanisms of action and therapeutic targets, including the serotonin system and genetic modulation. Accurate and early diagnosis of Dravet syndrome will lead to avoidance of medications that may exacerbate seizures. Additionally, a multi-disciplinary approach and careful planning for management of episodes of status epilepticus may lead to improved outcomes. Ongoing research for novel approaches to treatment creates optimism for future improvement in outcomes.
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Knupp KG, Scarbro S, Wilkening G, Juarez-Colunga E, Kempe A, Dempsey A. Parental Perception of Comorbidities in Children With Dravet Syndrome. Pediatr Neurol 2017; 76:60-65. [PMID: 28982531 DOI: 10.1016/j.pediatrneurol.2017.06.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/08/2017] [Accepted: 06/17/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND We hypothesized that children with Dravet syndrome may have additional common features beyond seizures and cognitive impairment. To address this gap in knowledge, we conducted a survey of caregivers of children with Dravet syndrome to identify and quantify their perception of associated symptoms in this population. METHODS An electronic survey was developed in REDcap (Research Electronic Data Capture) and sent via e-mail to the participants on the Dravet Syndrome Foundation e-mail list. Questions focused on eating, sleep, behavior, and other symptoms that might be related to Dravet syndrome. The questions were assessed using a four-point Likert scale (e.g., strongly agree to strongly disagree). Results were later dichotomized for analysis. Logistic regression was used to calculate odds ratios of various demographic factors potentially associated with symptoms. Multivariable models were constructed using backward elimination to assess the relationship among a variety of symptoms. RESULTS There were 202 respondents, 96% were parents of a child with Dravet syndrome (the remainder were grandparents or guardians); 90.5% were female. The median age of the affected child was eight years (interquartile range five to 14), 50% were male, and 90.5% were reported to have a known SCN1A mutation. At least one symptom associated with appetite was reported in 99% of respondents, 82% reported a disturbance of sleep, one third reported autonomic symptoms, and 75% reported problems with gait. Inattention and perseveration were reported more commonly than other behavioral disturbances. SIGNIFICANCE Caregivers have the perception of many symptoms in children with Dravet syndrome in addition to those that have been previously reported, including appetite, sleep, gait, and behavior. Many of these can significantly affect quality of life for both the child and the caregiver.
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Affiliation(s)
- Kelly G Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado.
| | - Sharon Scarbro
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Greta Wilkening
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Elizabeth Juarez-Colunga
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Kempe
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Amanda Dempsey
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Villas N, Meskis MA, Goodliffe S. Dravet syndrome: Characteristics, comorbidities, and caregiver concerns. Epilepsy Behav 2017; 74:81-86. [PMID: 28732259 DOI: 10.1016/j.yebeh.2017.06.031] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/24/2022]
Abstract
The Dravet Syndrome Foundation (DSF) conducted the largest in-depth survey of parents and caregivers of patients with Dravet syndrome (DS) to date, in order to (1) identify top concerns among caregivers, (2) establish an approximate frequency of characteristics and comorbidities of DS beyond seizures, and (3) provide direction for clinicians and researchers looking to study the effects of DS on the patient and family unit. Two hundred fifty-six responses were received representing a patient age range of 9months to 32years with a median age group of 7-10years (IQR=8). In an open response, caregivers ranked speech/communication, impacts on siblings, and cognitive impairment as their top concerns after seizure control, and nearly two-thirds of caregivers reported having suffered from depression. Some characteristics of DS such as gait issues increased with patient age, while others, including photosensitivity, hypotonia, and ataxia, were present from a young age. Comorbidities such as sleep disturbances and cardiac abnormalities were more frequently reported than in previous studies and some (including bradycardia) were correlated with SCN1A mutation status. This survey supports the concept of Dravet syndrome as a disease of the central nervous system with far-reaching effects and highlights the importance of the patient voice in determining appropriate research objectives. While seizure frequency is a relatively well-understood objective, seizures represent only a portion of parent and caregiver concerns. Studying the characteristics of DS described herein may identify additional outcomes significant for research.
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Affiliation(s)
- Nicole Villas
- Dravet Syndrome Foundation, PO Box 3026, Cherry Hill, NJ 08034, USA.
| | - Mary Anne Meskis
- Dravet Syndrome Foundation, PO Box 3026, Cherry Hill, NJ 08034, USA.
| | - Sue Goodliffe
- Dravet Syndrome Foundation, PO Box 3026, Cherry Hill, NJ 08034, USA.
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Hessel EVS, van Lith HA, Wolterink-Donselaar IG, de Wit M, Groot Koerkamp MJA, Holstege FCP, Kas MJH, Fernandes C, de Graan PNE. Mapping of aFEB3homologous febrile seizure locus on mouse chromosome 2 containing candidate genesScn1aandScn3a. Eur J Neurosci 2016; 44:2950-2957. [DOI: 10.1111/ejn.13420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/10/2016] [Accepted: 08/09/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Ellen V. S. Hessel
- Brain Center Rudolf Magnus; Department of Translational Neuroscience; University Medical Center Utrecht; Universiteitsweg 100 3584 CG Utrecht The Netherlands
| | - Hein A. van Lith
- Division of Animal Welfare & Laboratory Animal Science; Department of Animals in Science & Society; Faculty of Veterinary Medicine and Brain Center Rudolf Magnus; Utrecht University; Utrecht The Netherlands
| | - Inge G. Wolterink-Donselaar
- Brain Center Rudolf Magnus; Department of Translational Neuroscience; University Medical Center Utrecht; Universiteitsweg 100 3584 CG Utrecht The Netherlands
| | - Marina de Wit
- Brain Center Rudolf Magnus; Department of Translational Neuroscience; University Medical Center Utrecht; Universiteitsweg 100 3584 CG Utrecht The Netherlands
| | | | - Frank C. P. Holstege
- Department of Molecular Cancer Research; University Medical Center Utrecht; Utrecht The Netherlands
| | - Martien J. H. Kas
- Brain Center Rudolf Magnus; Department of Translational Neuroscience; University Medical Center Utrecht; Universiteitsweg 100 3584 CG Utrecht The Netherlands
- Groningen Institute for Evolutionary Life Sciences; University of Groningen; Groningen The Netherlands
| | - Cathy Fernandes
- Social, Genetic & Developmental Psychiatry Centre; Institute of Psychiatry; Psychology and Neuroscience; King's College London; London UK
| | - Pierre N. E. de Graan
- Brain Center Rudolf Magnus; Department of Translational Neuroscience; University Medical Center Utrecht; Universiteitsweg 100 3584 CG Utrecht The Netherlands
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Abstract
AbstractA child with Dravet syndrome shakes family life to the core. Dravet syndrome usually has three phases: (1) up to 1-1½ years: with episodes of febrile status epilepticus but normal development; (2) age 1½ to ~6-10 years: with frequent seizures of varying types, developmental stagnation, behavioural and sleep problems; (3) after ~10 years: improvement in seizures, deteriorating gait, intellectual disability but some developmental gains. Complete seizure control is rare—simply prescribing medication is inadequate to help families. Based on structured interviews with 24 families and confirmed by more informal discussions with other families, we suggest strategies for coping with this catastrophe. A child with Dravet syndrome usually means that one parent cannot work—financial pressures should be anticipated. In Stage 1, the approach to status should include a written protocol. An indwelling catheter for rapid venous access may be helpful. In Stage 2, assistance finding qualified babysitters is required, and the extended family needs encouragement to help. Appropriate equipment, rescue medication and protocols should travel with the child. Siblings may benefit from a system of one parent “on call.” An internet support group provides an invaluable lifeline. In Stage 3, family isolation may be extreme—respite care and personal time for parents are important. Death from status, accidents and SUDEP (sudden unexplained death in epilepsy) occurs in 15%. Fear of SUDEP needs to be addressed. Moving from paediatric to adult care is frightening; an epilepsy transition clinic is useful. Attention to these realities may improve the quality of life for both child and family.
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Schoonjans AS, Lagae L, Ceulemans B. Low-dose fenfluramine in the treatment of neurologic disorders: experience in Dravet syndrome. Ther Adv Neurol Disord 2015; 8:328-38. [PMID: 26600876 DOI: 10.1177/1756285615607726] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this paper, we review the experience with fenfluramine in epileptic and other paroxysmal disorders. Since the best available data are from the treatment of Dravet syndrome, we will focus primarily on this condition. Originally fenfluramine was launched as an anorectic agent. As early as 1985, seizure reduction in children could be demonstrated in a few cases with photosensitive, self-induced epilepsy. Hereafter, a small study was launched in patients with self-induced epilepsy. Results showed a significant seizure reduction, and review of the patient data showed that 5 of the 12 patients had Dravet syndrome. During that observation period, fenfluramine was withdrawn from the market because of cardiovascular side effects associated with prescribing higher doses in combination with phentermine for weight loss. In March 2002, a Belgian Royal Decree was issued permitting further study of fenfluramine in pediatric patients with intractable epilepsy. In 2011 under the Royal Decree, a prospective study of patients with Dravet syndrome treated with low-dose fenfluramine was initiated and is currently ongoing. The initial results are promising in terms of reduction of seizure frequency and overall tolerability.
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Affiliation(s)
- An-Sofie Schoonjans
- Department of Neurology-Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Lieven Lagae
- Department of Pediatric Neurology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Berten Ceulemans
- Department of Neurology-Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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Hallucinations and delusions are frequently reported in individuals with Dravet syndrome. Epilepsy Behav 2015; 52:222-4. [PMID: 26469797 DOI: 10.1016/j.yebeh.2015.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/13/2015] [Indexed: 12/17/2022]
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