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Zhang Y, Li Y, Ni Y, Gong X, Lu Z, Zhou Y, Wang Y, Yu L, Zhou S. Long-term effectiveness and seizure recurrence risk factors of ketogenic diet for pediatric refractory epilepsy: Experience from a tertiary care center in China. Epileptic Disord 2023; 25:856-866. [PMID: 37712490 DOI: 10.1002/epd2.20160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE This study aimed to assess the long-term effectiveness and seizure recurrence risk in children with drug-resistant epilepsy who achieved seizure freedom on a ketogenic diet (KD). Predictors associated with seizure recurrence were also evaluated. METHODS Patients with drug-resistant epilepsy who received KD therapy for at least 3 months between May 2011 and April 2020 were included. The clinical efficacy of the KD was evaluated. Patients who achieved seizure freedom for at least 3 months on the KD were focused. Multivariate Cox regression models were used to explore the risk factors of seizure relapse in patients who achieved seizure freedom. RESULTS This study included 288 patients (163 males, 125 females). The seizure-free rates of the KD at 3, 6, 12, and 24 months were 9.7%, 16.7%, 14.2%, and 9.0%, respectively. Additionally, the seizure reduction rates between 50% and 99% were 46.5%, 39.9%, 30.2%, and 20.5%, respectively. Patients with Angelman syndrome (AS) showed the highest efficacy rate, followed by those with Dravet syndrome (DS). 51 patients achieved at least 3 months of seizure freedom on the KD. Seizures recurred in 24 (47.1%) patients. None of the patients with AS relapsed, while those with DS had the highest recurrence rate. The etiology of epilepsy, KD maintenance treatment period, and electroencephalography (EEG) abnormalities during follow-up differed significantly between patients with and without recurrence. However, multivariate Cox regression analysis indicated that a KD maintenance treatment period of less than 12 months and the presence of EEG abnormalities during follow-up were significantly correlated with a higher risk of relapse. Epilepsy control was restored in 3 of the 24 (12.5%) patients who experienced relapse. SIGNIFICANCE KD appears to be effective in children with various types of drug-resistant epilepsy. A short KD maintenance treatment period and EEG abnormalities during follow-up were associated with an increased risk of seizure recurrence.
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Affiliation(s)
- Yunjian Zhang
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yijie Li
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yan Ni
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoyan Gong
- Department of Clinical Nutrition, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Zhongying Lu
- Department of Clinical Nutrition, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Lifei Yu
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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Odero N, Oyieke K, Gwer S, Samia P. Risk factors for seizure recurrence after initial withdrawal of anti-seizure medications in children with epilepsy at Aga Khan University Hospital, Nairobi, Kenya. Epilepsy Behav Rep 2023; 22:100596. [PMID: 37013158 PMCID: PMC10066516 DOI: 10.1016/j.ebr.2023.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 04/05/2023] Open
Abstract
Objectives We sought to determine risk factors associated with seizure recurrence following initial withdrawal of anti-seizure medications (ASM) among children with epilepsy. Methods This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of anti-seizure medication following remission of seizures. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electroencephalography data of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests. Results A total of 49 records of children who underwent withdrawal of ASM out of a total of 613 patients on follow up during the same period were included. The median age at ASM withdrawal was 70 months (IQR 52-112 months) and 14 (28.6%) were female. Thirteen patients (26.5%) had seizure recurrence within 24 months following withdrawal of ASM. Focal onset seizure type was associated with significant risk of seizure recurrence (OR 13.7; 95% CI 0.97, 193.54; P value = 0.011). Age at epilepsy diagnosis, abnormal EEG at initiation of treatment and at the time of de-escalation, abnormal MRI findings, first or second degree relative with epilepsy, history of developmental delay, seizure burden, use of 2 or more ASMs and duration of seizure-freedom before de-escalation of ASM were not associated with increased risk of relapse. Conclusion Focal onset seizure type is associated with increased with risk of seizure recurrence in this cohort.
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Affiliation(s)
- Nicholas Odero
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
- Corresponding author at: Aga Khan University Hospital, Department of Paediatrics, 3rd Parklands Avenue, Off Limuru Road, P.O Box 30270, GPO, 00100 Nairobi, Kenya.
| | - Katherine Oyieke
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Samson Gwer
- School of Medicine, Kenyatta University, Nairobi, Kenya
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
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Wang S, Yang J, Wei N, Lv W, Jiang Z, Huang H, Zhang J, Xu P, Yu CY, Xu Z. Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic. ACTA EPILEPTOLOGICA 2022. [PMCID: PMC9084936 DOI: 10.1186/s42494-022-00092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.
Methods
The survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.
Results
There were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.
Conclusions
During the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.
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Li W, Lai W, Peng A, Chen L. Two cases of anesthetics-induced epileptic seizures: a case report and literature review. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-021-00074-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Anesthetics like propofol have been reported to be capable of controlling status epilepticus. However, we have observed during daily clinical work that some anesthetics can induce epileptic seizures. Therefore, this study aims to explore the relationships between anesthetics and epilepsy.
Case presentation
We collect and report two cases of anesthetics-induced epileptic seizures, in order to arouse attention towards this critical phenomenon. We also summarize the current research progress on this topic, analyze associations between anesthetics and epilepsy, and discuss the mechanisms underlying the associations. Two females, seizure-free for more than 3 years, presented with anesthetics-induced epileptic seizures and controlled by administration of Midazolam and Diazepam. By literature review, we included six studies which found that the occurrence of epileptic seizures has no relationship with the age/sex of patients, the surgery procedure, nor the type of anesthesia. It is closely related to the decreased blood concentration of antiepileptic drugs (AEDs) and the inadequate preoperative preparation.
Conclusions
Unnecessary surgery should be avoided for patients with epilepsy, and anesthetists should make careful selections on anesthetics and prepare adequately for surgery.
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Liang X, Yu N, Zhang YF, Gu L, Di Q. Prognostic implications of persistent interictal epileptiform discharges on antiseizure medication withdrawal in patients with epilepsy in five-year remission. Seizure 2021; 94:100-106. [PMID: 34883461 DOI: 10.1016/j.seizure.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Whether patients with epilepsy in long-term remission and interictal epileptiform discharges (IEDs) can stop antiseizure medication (ASM) remains a challenging topic even though multiple studies have investigated ASM withdrawal. This study aimed to estimate seizure relapse and its risk factors in patients with epilepsy in five-year remission and persistent IEDs. METHODS Patients with epilepsy and persistent IEDs were prospectively recruited from the Affiliated Nanjing Brain Hospital of Nanjing Medical University from Dec.1, 2010 to Dec.30, 2019. All enrolled patients achieved seizure remission for over five years and were divided into the ASM withdrawal and continuous treatment groups according to their personal preference. Seizure outcomes and 24 h video electroencephalogram findings were obtained through clinical visits or telephone interviews every three months until March 31, 2021. The cumulative recurrence rate and its diversity between the ASM withdrawal and continuous treatment groups were tested using Kaplan-Meier analysis. Multivariate Cox regression analysis was performed to explore the independent predictors for seizure recurrence. Relapsed patients were further monitored for their seizure control and prognosis. RESULTS A total of 83 patients with epilepsy in five-year remission and persistent IEDs were enrolled in this study, including 41 (49.4%) in the ASM withdrawal group and 42 (50.6%) in the continuous ASM treatment group. During the follow-up with a median time of 36.8 months (range from 18.7 to 104.6 months), the seizure relapse in off-medication patients (43.9%, 18/41) was higher than that in on-medication patients (21.4%, 9/42; P = 0.031). In the multivariate analysis model, independent predictors for seizure recurrence were structural-metabolic epilepsy or unknown cause (HR = 6.185, 95% CI 1.166-32.805) and multiple seizure types (HR = 2.807, 95% CI 1.051-7.502). ASM withdrawal was not found to be an independent risk factor for seizure recurrence. Of 27 patients with seizure recurrence, 25 were given reinstitution or continuous ASM therapy, whereas two chose sustained observation without medication. At the end of the follow-up, 70.4% (19/27) of recurrence patients were completely free from seizures for at least one year again, and only one patient developed refractory epilepsy. CONCLUSION For patients with epilepsy in five-year remission and persistent IEDs, drug withdrawal may be a rational choice after the individualized assessment of benefits and risks. Furthermore, the independent risk factors for the seizure relapse were structural-metabolic epilepsy or an unknown cause, and multiple seizure types. Finally, patients with epilepsy relapsing after ASM withdrawal could achieve seizure remission again after ASM retreatment.
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Affiliation(s)
- Xue Liang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Nian Yu
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Yan-Fang Zhang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Li Gu
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Qing Di
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China.
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Wang Y, Xia L, Li R, Li Y, Li J, Zhou Q, Pan S. Comparison of Long-Term Outcomes of Monotherapy and Polytherapy in Seizure-Free Patients With Epilepsy Following Antiseizure Medication Withdrawal. Front Neurol 2021; 12:669703. [PMID: 34108931 PMCID: PMC8182048 DOI: 10.3389/fneur.2021.669703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/07/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The objectives of this study were to compare the risk and timing of seizure relapse in seizure-free patients with epilepsy following the withdrawal of monotherapy or polytherapy and to identify relevant influencing factors. Methods: Patients who had achieved at least a 2-year seizure remission and started the withdrawal of antiseizure medication (ASM) were enrolled in this study. All patients were followed for at least 3 years or until seizure relapse. According to the number of ASMs at the time of withdrawalwas about twice than that, patients were divided into two groups: monotherapy group and polytherapy group. The Cox proportional hazards model was used to compare the recurrence risk of the two groups. Univariate analysis and multiple logistic regression analysis were used to analyze potential confounding variables between patients treated with monotherapy and polytherapy. Results: A total of 188 patients (119 males and 69 females) were included. The average prescribed daily dose of most ASMs at the time of withdrawal was moderate or low (30–50% defined daily dose). The recurrence of most patients (89.2%) occurred within the first 3 years after withdrawal. The recurrence risk in patients treated with polytherapy at the time of withdrawal was about twice than that of the monotherapy group [p = 0.001, hazard ratio (HR) = 2.152, 95% confidence interval (CI) = 1.350–3.428]. Multivariate analysis showed that patients treated with polytherapy were significantly older at seizure onset [p = 0.024, odd ratio (OR) = 1.027, 95% CI = 1.004–1.052] and had a significantly longer duration of epilepsy before treatment (p = 0.004, OR = 1.009, 95% CI = 1.003–1.015) compared to patients in the monotherapy group. In addition, a history of perinatal injury was found to be an independent risk factor of seizure relapse in patients with ASM withdrawal. Conclusion: The average prescribed daily dose of most ASMs at the time of withdrawal was moderate or low. Patients who received polytherapy at the time of withdrawal, particularly those with later seizure onset age and longer epilepsy duration before treatment, had a higher recurrence risk after ASMs withdrawal compared to patients treated with monotherapy.
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Affiliation(s)
- Yuxuan Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Xia
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yudan Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Zhou
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songqing Pan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Kim KT, Kim DW, Yang KI, Lee ST, Byun JI, Seo JG, No YJ, Kang KW, Kim D, Cho YW. Refining General Principles of Antiepileptic Drug Treatments for Epilepsy. J Clin Neurol 2020; 16:383-389. [PMID: 32657058 PMCID: PMC7354982 DOI: 10.3988/jcn.2020.16.3.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022] Open
Abstract
Antiepileptic drugs (AEDs) are the primary treatment strategy for epilepsy. As the use of AEDs has become more widespread and diverse over the past century, it has become necessary to refine the associated prescription strategies. This prompted the Drug Committee of the Korean Epilepsy Society to perform a systemic review of both international and domestic guidelines as well as literature related to medical treatment of epilepsy, and prepared a series of reviews to provide practical guidelines for clinicians to follow. This article is the first in a series on AED treatments for epilepsy in South Korea.
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Affiliation(s)
- Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyunghee University Hospital at Gangdong, Seoul, Korea
| | - Jong Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Joo No
- Department of Neurology, Samsung Noble County, Yongin, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
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