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Mitchell JW, Sossi F, Miller I, Jaber PB, Das-Gupta Z, Fialho LS, Amos A, Austin JK, Badzik S, Baker G, Ben Zeev B, Bolton J, Chaplin JE, Cross JH, Chan D, Gericke CA, Husain AM, Lally L, Mbugua S, Megan C, Mesa T, Nuñez L, von Oertzen TJ, Perucca E, Pullen A, Ronen GM, Sajatovic M, Singh MB, Wilmshurst JM, Wollscheid L, Berg AT. Development of an International Standard Set of Outcomes and Measurement Methods for Routine Practice for Infants, Children, and Adolescents with Epilepsy: The International Consortium for Health Outcomes Measurement Consensus Recommendations. Epilepsia 2024; 65:1938-1961. [PMID: 38758635 DOI: 10.1111/epi.17976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
At present, there is no internationally accepted set of core outcomes or measurement methods for epilepsy clinical practice. The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group of experts in epilepsy, people with epilepsy, and their representatives to develop minimum sets of standardized outcomes and outcome measurement methods for clinical practice. Using modified Delphi consensus methods with consecutive rounds of online voting over 12 months, a core set of outcomes and corresponding measurement tool packages to capture the outcomes were identified for infants, children, and adolescents with epilepsy. Consensus methods identified 20 core outcomes. In addition to the outcomes identified for the ICHOM Epilepsy adult standard set, behavioral, motor, and cognitive/language development outcomes were voted as essential for all infants and children with epilepsy. The proposed set of outcomes and measurement methods will facilitate the implementation of the use of patient-centered outcomes in daily practice.
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Affiliation(s)
- James W Mitchell
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Frieda Sossi
- International Consortium for Health Outcomes Measurement, London, UK
| | - Isabel Miller
- International Consortium for Health Outcomes Measurement, London, UK
| | | | - Zofia Das-Gupta
- International Consortium for Health Outcomes Measurement, London, UK
| | - Luz Sousa Fialho
- International Consortium for Health Outcomes Measurement, London, UK
| | - Action Amos
- International Bureau for Epilepsy, Africa Region, University of Edinburgh, Edinburgh, UK
| | - Joan K Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Scott Badzik
- Lived experience representative, Cincinnati, Ohio, USA
| | - Gus Baker
- University of Liverpool, Liverpool, UK
| | - Bruria Ben Zeev
- Sheba Medical Center, Edmond and Lilly Safra Children's Hospital, Tel Hashomer, Israel
| | | | | | - J Helen Cross
- Developmental Neurosciences Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Derrick Chan
- KK Women's and Children's Hospital, Duke-NUS, Singapore, Singapore
| | | | - Aatif M Husain
- Duke University Medical Center and Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Lorraine Lally
- LLM (International Human Rights Law), LLM (Financial Services Law), Galway, Ireland
| | | | | | - Tomás Mesa
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lilia Nuñez
- Centro Medico Nacional 20 de Noviembre, Médica Sur, Mexico City, Mexico
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emilio Perucca
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia
| | | | - Gabriel M Ronen
- Department of Pediatrics, CanChild Centre for Childhood Disability Research, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Martha Sajatovic
- Departments of Psychiatry and Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mamta B Singh
- All Indian Institute of Medicine Sciences, New Delhi, India
| | - Jo M Wilmshurst
- Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | | | - Anne T Berg
- Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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2
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Proost R, Macea J, Lagae L, Van Paesschen W, Jansen K. Wearable detection of tonic seizures in childhood epilepsy: An exploratory cohort study. Epilepsia 2023; 64:3013-3024. [PMID: 37602476 DOI: 10.1111/epi.17756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To investigate the performance of a multimodal wearable device for the offline detection of tonic seizures (TS) in a pediatric childhood epilepsy cohort, with a focus on patients with Lennox-Gastaut syndrome. METHODS Parallel with prolonged video-electroencephalography (EEG), the Plug 'n Patch system, a multimodal wearable device using the Sensor Dot and replaceable electrode adhesives, was used to detect TS. Multiple biosignals were recorded: behind-the-ear EEG, surface electromyography, electrocardiography, and accelerometer/gyroscope. Biosignals were annotated blindly by a neurologist. Seizure characteristics were described, and performance was assessed by sensitivity, positive predictive value (PPV), F1 score, and false alarm rate (FAR) per hour. Performance was compared to seizure diaries kept by the caretaker. RESULTS Ninety-nine TS were detected in 13 patients. Seven patients (54%) had Lennox-Gastaut syndrome and six patients (46%) had other forms of (developmental) epileptic encephalopathies or drug-resistant epilepsy. All but one patient had intellectual disability. Overall sensitivity was 41%, with a PPV of 9%, an F1 score of 14%, and a median FAR per hour of 0.75. Performance increased to an F1 score of 66% for nightly seizures lasting at least 10 s (sensitivity 66%, PPV 66%) and 71% for nightly seizures lasting at least 20 s (sensitivity 62%, PPV 82%). For these seizures there were no false alarms in 10 of 13 patients. Sensitivity of seizure diaries reached a maximum of 52% for prolonged (≥20 s) nightly seizures, even though caretakers slept in the same room. SIGNIFICANCE We showed that it is feasible to use a multimodal wearable device with multiple adhesive sites in children with epilepsy and intellectual disability. For prolonged nightly seizures, offline manual detection of TS outperformed seizure diaries. The recognition of seizure-specific signatures using multiple modalities can help in the development of automated TS detection algorithms.
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Affiliation(s)
- Renee Proost
- Paediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jaiver Macea
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Lieven Lagae
- Paediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Katrien Jansen
- Paediatric Neurology Department, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Bosco F, Guarnieri L, Leo A, Tallarico M, Gallelli L, Rania V, Citraro R, De Sarro G. Audiogenic epileptic DBA/2 mice strain as a model of genetic reflex seizures and SUDEP. Front Neurol 2023; 14:1223074. [PMID: 37681009 PMCID: PMC10481168 DOI: 10.3389/fneur.2023.1223074] [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: 05/15/2023] [Accepted: 07/14/2023] [Indexed: 09/09/2023] Open
Abstract
Epilepsy is a chronic neurological disease characterized by abnormal brain activity, which results in repeated spontaneous seizures. Sudden unexpected death in epilepsy (SUDEP) is the leading cause of seizure-related premature death, particularly in drug-resistant epilepsy patients. The etiology of SUDEP is a structural injury to the brain that is not fully understood, but it is frequently associated with poorly controlled and repeated generalized tonic-clonic seizures (GTCSs) that cause cardiorespiratory and autonomic dysfunctions, indicating the involvement of the brainstem. Both respiratory and cardiac abnormalities have been observed in SUDEP, but not much progress has been made in their prevention. Owing to the complexity of SUDEP, experimental animal models have been used to investigate cardiac and/or respiratory dysregulation due to or associated with epileptic seizures that may contribute to death in humans. Numerous rodent models, especially mouse models, have been developed to better understand epilepsy and SUDEP physiopathology. This review synthesizes the current knowledge about dilute brown agouti coat color (DBA/2) mice as a possible SUDEP model because respiratory arrest (RA) and sudden death induced by audiogenic generalized seizures (AGSs) have been observed in these animals. Respiratory/cardiac dysfunction, brainstem arousal system dysfunction, and alteration of the neurotransmitter systems, which are observed in human SUDEP, have also been observed in these mice. In particular, serotonin (5-HT) alteration and adenosine neurotransmission appear to contribute to not only the pathophysiological mechanisms of medication but also seizure-related respiratory dysfunctions in this animal model. These neurotransmitter systems could be the relevant targets for medication development for chronic epilepsy and SUDEP prevention. We reviewed data on AGSs in DBA/2 mice and the relevance of this model of generalized tonic-clonic epilepsy to human SUDEP. Furthermore, the advantages of using this strain prone to AGSs for the identification of possible new therapeutic targets and treatment options have also been assessed.
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Affiliation(s)
- Francesca Bosco
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Lorenza Guarnieri
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Martina Tallarico
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Vincenzo Rania
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Section of Pharmacology, Science of Health Department, School of Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Research Center FAS@UMG, Department of Health Science, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
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Suresh H, Ibrahim GM. Medicate or operate: epilepsy surgery could save lives. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:442-443. [PMID: 37276876 DOI: 10.1016/s2352-4642(23)00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Hrishikesh Suresh
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON M5G 1X8, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON M5G 1X8, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5G 1X8, Canada; Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada.
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Donnan AM, Schneider AL, Russ-Hall S, Churilov L, Scheffer IE. Rates of Status Epilepticus and Sudden Unexplained Death in Epilepsy in People With Genetic Developmental and Epileptic Encephalopathies. Neurology 2023; 100:e1712-e1722. [PMID: 36750385 PMCID: PMC10115508 DOI: 10.1212/wnl.0000000000207080] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The genetic developmental and epileptic encephalopathies (DEEs) comprise a large group of severe epilepsy syndromes, with a wide phenotypic spectrum. Currently, the rates of convulsive status epilepticus (CSE), nonconvulsive status epilepticus (NCSE), and sudden unexplained death in epilepsy (SUDEP) in these diseases are not well understood. We aimed to describe the proportions of patients with frequently observed genetic DEEs who developed CSE, NCSE, mortality, and SUDEP. Understanding the risks of these serious presentations in each genetic DEE will enable earlier diagnosis and appropriate management. METHODS In this retrospective analysis of patients with a genetic DEE, we estimated the proportions with CSE, NCSE, and SUDEP and the overall and SUDEP-specific mortality rates for each genetic diagnosis. We included patients with a pathogenic variant in the genes SCN1A, SCN2A, SCN8A, SYNGAP1, NEXMIF, CHD2, PCDH19, STXBP1, GRIN2A, KCNT1, and KCNQ2 and with Angelman syndrome (AS). RESULTS The cohort comprised 510 individuals with a genetic DEE, in whom we observed CSE in 47% and NCSE in 19%. The highest proportion of CSE occurred in patients with SCN1A-associated DEEs, including 181/203 (89%; 95% CI 84-93) patients with Dravet syndrome and 8/15 (53%; 95% CI 27-79) non-Dravet SCN1A-DEEs. CSE was also notable in patients with pathogenic variants in KCNT1 (6/10; 60%; 95% CI 26-88) and SCN2A (8/15; 53%; 95% CI 27-79). NCSE was common in patients with non-Dravet SCN1A-DEEs (8/15; 53%; 95% CI 27-79) and was notable in patients with CHD2-DEEs (6/14; 43%; 95% CI 18-71) and AS (6/19; 32%; 95% CI 13-57). There were 42/510 (8%) deaths among the cohort, producing a mortality rate of 6.1 per 1,000 person-years (95% CI 4.4-8.3). Cases of SUDEP accounted for 19/42 (48%) deaths. Four genes were associated with SUDEP: SCN1A, SCN2A, SCN8A, and STXBP1. The estimated SUDEP rate was 2.8 per 1,000 person-years (95% CI 1.6-4.3). DISCUSSION We showed that proportions of patients with CSE, NCSE, and SUDEP differ for commonly encountered genetic DEEs. The estimates for each genetic DEE studied will inform early diagnosis and management of status epilepticus and SUDEP and inform disease-specific counseling for patients and families in this high-risk group of conditions.
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Affiliation(s)
- Alice M Donnan
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Amy L Schneider
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Sophie Russ-Hall
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Leonid Churilov
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia
| | - Ingrid E Scheffer
- From the Epilepsy Research Centre (A.M.D., A.L.S., S.R.-H., I.E.S.), Department of Medicine, The University of Melbourne, Austin Health; Melbourne Medical School (L.C.), Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville; The Florey Institute of Neurosciences and Mental Health (L.C., I.E.S.), Melbourne; and Department of Paediatrics (I.E.S.), The University of Melbourne, Royal Children's Hospital, and Murdoch Children's Research Institute, Victoria, Australia.
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Slingerland AL, Chua MMJ, Bolton J, Staffa SJ, Tsuboyama M, Prabhu SP, Pearl PL, Madsen JR, Stone SSD. Stereoelectroencephalography followed by combined electrode removal and MRI-guided laser interstitial thermal therapy or open resection: a single-center series in pediatric patients with medically refractory epilepsy. J Neurosurg Pediatr 2023; 31:206-211. [PMID: 36681974 DOI: 10.3171/2022.11.peds22262] [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: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT) have emerged as safe, effective, and less invasive alternatives to subdural grid placement and open resection, respectively, for the localization and treatment of medically refractory epilepsy (MRE) in children. Reported pediatric experience combining these complementary techniques is limited, with traditional workflows separating electrode removal and ablation/resection. The authors describe the largest reported series of pediatric epilepsy patients who underwent MRgLITT following SEEG contrasted with a cohort that underwent craniotomy following SEEG, combining ablation/resection with electrode explantation as standard practice. METHODS The medical records of all patients with MRE who had undergone SEEG followed by MRgLITT or open resection/disconnection at Boston Children's Hospital between November 2015 and December 2020 were retrospectively reviewed. Primary outcome variables included surgical complication rates, length of hospital stay following treatment, and Engel classification at the last follow-up. RESULTS Of 74 SEEG patients, 27 (median age 12.1 years, 63% female) underwent MRgLITT and 47 (median age 12.1 years, 49% female) underwent craniotomy. Seventy patients (95%) underwent SEEG followed by combined electrode removal and treatment. Eight MRgLITT cases (30%) and no open cases targeted the insula (p < 0.001). Complication rates did not differ, although trends toward more subdural/epidural hematomas, infarcts, and permanent unanticipated neurological deficits were evident following craniotomy, whereas a trend toward more temporary unanticipated neurological deficits was seen following MRgLITT. The median duration of hospitalization after treatment was 3 and 5 days for MRgLITT and open cases, respectively (p = 0.078). Seizure outcomes were similar between the cohorts, with 74% of MRgLITT and craniotomy patients attaining Engel class I or II outcomes (p = 0.386) at the last follow-up (median 1.1 and 1.9 years, respectively). CONCLUSIONS MRgLITT and open resection following SEEG can both effectively treat MRE in pediatric patients and generally can be performed in a two-surgery workflow during a single hospitalization. In appropriately selected patients, MRgLITT tended to be associated with shorter hospitalizations and fewer complications following treatment and may be best suited for focal deep-seated targets associated with relatively challenging open surgical approaches.
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Affiliation(s)
| | | | | | - Steven J Staffa
- 3Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital
| | | | - Sanjay P Prabhu
- 4Department of Radiology, Division of Neuroradiology, Boston Children's Hospital, Boston, Massachusetts
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Whitney R, Sharma S, Ramachandrannair R. Sudden unexpected death in epilepsy in children. Dev Med Child Neurol 2023. [PMID: 36802063 DOI: 10.1111/dmcn.15553] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/20/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality in children and adults living with epilepsy. The incidence of SUDEP is comparable in both children and adults; it is approximately 1.2 per 1000 person years. The pathophysiology of SUDEP is not well understood but may involve mechanisms such as cerebral shutdown, autonomic dysfunction, altered brainstem function, and cardiorespiratory demise. Risk factors for SUDEP include the presence of generalized tonic-clonic seizures, nocturnal seizures, possible genetic predisposition, and non-adherence to antiseizure medications. Pediatric-specific risk factors are not fully elucidated. Despite recommendations from consensus guidelines, many clinicians still do not follow the practice of counseling their patients about SUDEP. SUDEP prevention has been an area of important research focus and includes several strategies, such as obtaining seizure control, optimizing treatment regimens, nocturnal supervision, and seizure detection devices. This review discusses what is currently known about SUDEP risk factors and reviews current and future preventive strategies for SUDEP.
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Affiliation(s)
- Robyn Whitney
- Division of Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Suvasini Sharma
- Neurology Division, Department of Pediatrics, Lady Harding Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - Rajesh Ramachandrannair
- Division of Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Direk MÇ, Epcacan S, Özdemir AA, Uysal F, Okuyaz Ç. Effects of levetiracetam treatment on autonomic nervous system functions in pediatric epilepsy patients. Pediatr Int 2023; 65:e15636. [PMID: 37795856 DOI: 10.1111/ped.15636] [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: 10/17/2022] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND This study investigated the effects of levetiracetam (LEV) treatment on cardiac rhythm and heart rate variability. METHODS The study included two groups of patients diagnosed with non-lesional epilepsy who had not yet been treated and who presented to the outpatient pediatric neurology clinic at Van Training and Research Hospital, Van, Turkey, between 2019 and 2020. The heart rate variability (HRV) of 47 patients in the first group, before and at the 3rd month of treatment, and intravenous (IV) LEV loading in 13 patients in the second group was evaluated by Holter electrocardiography (ECG). RESULTS It was determined that the values of triangular index, standard deviation of the RR intervals over a 24-hour period (SDNN), standard deviation of all 5-minute mean RR intervals (SDANN), mean of standard deviations of all normal RR intervals (SDNNI), the percentage of RR intervals with >50-millisecond variation (PNN50), and the square root of mean squared differences of successive RR intervals (RMSSD). HRV of 47 patients under LEV treatment significantly increased in the 3rd month of treatment compared to baseline (p < 0.05). No difference was found in HRV between the intravenous loading and the control group (p > 0.05). CONCLUSIONS Our study suggests that the sympathovagal balance before treatment in the patient group is in favor of the sympathetic nervous system and that the sympathovagal imbalance improves after treatment. Our results show that LEV monotherapy and loading have no negative effect on HRV and potential cardiac arrhythmia risk in children with epilepsy.
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Affiliation(s)
| | - Serdar Epcacan
- Department of Pediatric Cardiology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Asena Ayca Özdemir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Fahrettin Uysal
- Department of Turkey Pediatric Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Çetin Okuyaz
- Department of Pediatric Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Nono D, Gumisiriza N, Tumwine C, Amaral LJ, Elvis Ainamani H, Musisi S, Colebunders R. Impact of COVID-19 on the well-being of children with epilepsy including nodding syndrome in Uganda: A qualitative study. Epilepsy Behav 2023; 138:108992. [PMID: 36423386 PMCID: PMC9647031 DOI: 10.1016/j.yebeh.2022.108992] [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: 07/14/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the impact of the COVID-19 pandemic and related restrictions on the access and use of health services by children with epilepsy including nodding syndrome in Uganda. METHODS Four focus group discussions (FGD) with parents/caregivers of children with epilepsy and five in-depth interviews with key informants were conducted between April and May 2021 at Butabika National Mental Referral Hospital and Kitgum General Hospital. RESULTS COVID-19-related restrictions, including the halting of non-essential services and activities, and suspension of public transport, created several challenges not only for children with epilepsy and their parents/caregivers but also for their healthcare providers. Study participants described extreme transport restrictions that reduced their access to healthcare care services, increased food insecurity and shortage or inability to afford essential medicines as consequences of COVID-19-related restrictions. However, parents/caregivers and healthcare workers adopted several coping strategies for these challenges. Parents/caregivers mentioned taking on casual work to earn an income to buy food, medicines, and other necessities. Healthcare workers intensified outreach services to affected communities. A positive impact of lockdown measures described by some FGD participants was that most family members stayed at home and were able to care for children with epilepsy in turn. CONCLUSIONS Our study highlights the significant negative impact of the COVID-19 pandemic and related restrictions on access to health services and the general well-being of children with epilepsy. Decentralized epilepsy treatment services and nutritional support could reduce the suffering of children with epilepsy and their families during the ongoing COVID-19 pandemic and similar future emergencies.
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Affiliation(s)
- Denis Nono
- AfriChild Centre for the Study of the African Child, Makerere University, Kampala, Uganda
| | - Nolbert Gumisiriza
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Christopher Tumwine
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | | | | | - Seggane Musisi
- Department of Psychiatry, Makerere University, Kampala, Uganda
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Yu X, Zha J, Yi Z, Li X, Chen H, Xu Y, Zhong J. Case report of antiseizure medicine-induced long QT syndrome and a literature review. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
To realize the clinical characteristics of long QT syndrome (LQTS) caused by antiseizure medicines (ASMs), and to improve the prevention and management of ASM-acquired QT syndrome.
Case presentation
A case of ASM-acquired QT syndrome was diagnosed and relevant literature was reviewed. The case was a 7-year-old boy who presented with a sudden onset of panic followed by changes in consciousness, with or without convulsions, lasting from tens of seconds to 3 min. The patient then received antiepileptic treatment with valproic acid, levetiracetam and oxcarbazepine and was seizure free for about a year. However, on August 12, 2021, his illness flared up again. Electroencephalogram (EEG) showed the background activity was slow, and no obvious epileptic discharge was detected. But electrocardiogram (ECG) showed a surprisingly prolonged QT interval (770 ms). Torsades de Pointes was found during Holter monitoring, while electrolyte levels were normal. The ECG recordings gradually returned to normal after stopping ASMs. For literature search, only 21 related papers were obtained after reading titles and full-texts of 105 English-language papers retrieved using keywords "acquired QT interstitial syndrome/acquired Long QT Syndrome (aLQTS)" and "anti-epileptic seizure drugs/ASMs", in the databases of Wanfang, CNKI, Pubmed, and other databases, from publication year 1965 to October 26, 2021. There are 12 types of drug-acquired LQTS caused by ASMs, most of which are Na+ blockers, but LQTS caused by oxcarbazepine had not been reported previously.
Conclusions
ASMs such as oxcarbazepine can cause acquired LQTS. When Na+ or K+ channel blockers are used clinically, ECG should be reviewed regularly and abnormal ECG should be intervened in time to reduce iatrogenic accidents in patients with epilepsy.
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Li W, Wang G, Lei X, Sheng D, Yu T, Wang G. Seizure detection based on wearable devices: A review of device, mechanism, and algorithm. Acta Neurol Scand 2022; 146:723-731. [PMID: 36255131 DOI: 10.1111/ane.13716] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022]
Abstract
With sudden and unpredictable nature, seizures lead to great risk of the secondary damage, status epilepticus, and sudden unexpected death in epilepsy. Thus, it is essential to use a wearable device to detect seizure and inform patients' caregivers for assistant to prevent or relieve adverse consequence. In this review, we gave an account of the current state of the field of seizure detection based on wearable devices from three parts: devices, physiological activities, and algorithms. Firstly, seizure monitoring devices available in the market primarily involve wristband-type devices, patch-type devices, and armband-type devices, which are able to detect motor seizures, focal autonomic seizures, or absence seizures. Secondly, seizure-related physiological activities involve the discharge of brain neurons presented, autonomous nervous activities, and motor. Plenty of studies focus on features from one signal, while it is a lack of evidences about the change of signal coupling along with seizures. Thirdly, the seizure detection algorithms developed from simple threshold method to complicated machine learning and deep learning, aiming at distinguish seizures from normal events. After understanding of some preliminary studies, we will propose our own thought for future development in this field.
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Affiliation(s)
- Wen Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Guangming Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Xiyuan Lei
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Duozheng Sheng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Tao Yu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
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12
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Haridas B, Chuang DT, Nei M, Kang JY. Sudden Unexpected Death in Epilepsy: Pathogenesis, Risk Factors, and Prevention. Semin Neurol 2022; 42:658-664. [PMID: 36223819 DOI: 10.1055/a-1960-1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a tragic and unexpected cause of death in patients with a known diagnosis of epilepsy. It occurs in up to 6.3 to 9.3/1,000 patients with drug-resistant epilepsy. The main three risk factors associated with SUDEP are the presence of generalized tonic-clonic seizures, the presence of a seizure in the past year, and an intellectual disability. There are several mechanisms that can result in SUDEP. The most likely sequence of events appears to be a convulsive seizure, overactivation of the autonomic nervous system, cardiorespiratory dysfunction, and death. While the risk of SUDEP is relatively high in patients with drug-resistant epilepsy, studies indicate that more than 50% of patients and caregivers are unaware of the diagnosis. Counseling about the diagnosis and preventative measures at the time of diagnosis is important. There are numerous interventions that may reduce the risk of SUDEP, including conservative measures such as nocturnal surveillance with a bed partner (where applicable) and automated devices. Optimizing seizure control with antiseizure medications and surgical interventions can result in a reduced risk of SUDEP.
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Affiliation(s)
- Babitha Haridas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David T Chuang
- Department of Neurology, Weill Cornell School of Medicine, New York, New York
| | - Maromi Nei
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Joon Y Kang
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland
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13
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PAEDIATRIC SUDDEN UNEXPECTED DEATH IN EPILEPSY: FROM PATHOPHYSIOLOGY TO PREVENTION. Seizure 2022; 101:83-95. [DOI: 10.1016/j.seizure.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/22/2022] Open
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14
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Trivisano M, Muccioli L, Ferretti A, Lee HF, Chi CS, Bisulli F. Risk of SUDEP during infancy. Epilepsy Behav 2022; 131:107896. [PMID: 33741238 DOI: 10.1016/j.yebeh.2021.107896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 11/03/2022]
Abstract
Risk of sudden unexpected death in epilepsy (SUDEP) in children is influenced by different factors such as etiology, seizure type and frequency, treatment, and environment. A greater severity of epilepsy, in terms of seizure frequency, seizures type, especially with nocturnal generalized tonic-clonic seizures (GTCS), and resistance to anti-seizure medication are predisposing factors to SUDEP. Potential mechanisms of SUDEP might involve respiratory, cardiovascular, and central autonomic dysfunctions, either combined or in isolation. Patients with epilepsy carrying mutations in cardiac channelopathy genes might be disposed to seizure-induced arrhythmias. Other than in channelopathies, SUDEP has been reported in further patients with genetic epilepsies due to mutations of genes such as DEPDC5, TBC1D24, FHF1, or 5q14.3 deletion. Age-related electro-clinical differences in GTCS may therefore be relevant in explaining differences in SUDEP between adults and children. Typical GTCS represent a rare seizure type in infants and toddlers, they are characterized by a shorter tonic phase and, in direct proportion, by shorter postictal generalized EEG suppression (PGES). The presence of night-time supervision has been found to reduce SUDEP risk, likely reducing SUDEP incidence in children. Reconsideration of safety protocols in epilepsy monitoring units with the aim of reducing the risk of SUDEP, and the use of devices for seizure detection, might contribute to reduce the risk of death in patients affected by epilepsy. This article is part of the Special Issue "Severe Infantile Epilepsies".
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Affiliation(s)
- Marina Trivisano
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
| | - Lorenzo Muccioli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Alessandro Ferretti
- Rare and Epilepsies Unit, Department of Neurological Science, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Hsiu-Fen Lee
- Division of Pediatric Neurology, Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Shiang Chi
- Division of Pediatric Neurology, Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Francesca Bisulli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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15
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Gogou M, Cross JH. Seizures and Epilepsy in Childhood. Continuum (Minneap Minn) 2022; 28:428-456. [PMID: 35393965 DOI: 10.1212/con.0000000000001087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article highlights basic concepts of seizures and epilepsy in pediatric patients, as well as basic treatment principles for this age group. RECENT FINDINGS Epilepsy is the most common neurologic disorder in childhood. Accurate diagnosis is key; in older children, epileptic seizures need to be differentiated from various paroxysmal nonepileptic events, whereas in neonates, the majority of seizures are subclinical (electroencephalographic). Antiseizure medications remain the first-line treatment, but ketogenic diet and epilepsy surgery have also shown positive outcomes and can decrease drug burden. Genetic causes account for approximately 30% of cases, and the recognition of electroclinical syndromes is being replaced by the concept of genetic spectrums. Precision medicine therapies are promising, but wide application in daily practice still has a long way to go. Early access to specialist centers and optimal treatments positively affects prognosis and future neurodevelopment. SUMMARY Although novel findings from all fields of research are being incorporated into everyday clinical practice, a better quality of life for children with seizures and epilepsy and their families is the ultimate priority.
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Mudigoudar B, Wheless JW. Sudden Unexpected Death in Epilepsy (SUDEP): How Do We Prevent This Childhood Tragedy? J Pediatr Pharmacol Ther 2022; 27:99-101. [DOI: 10.5863/1551-6776-27.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Basanagoud Mudigoudar
- Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute (BM, JWW), Le Bonheur Children's Hospital, Memphis, TN; Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
- Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - James W. Wheless
- Le Bonheur Comprehensive Epilepsy Program and Neuroscience Institute (BM, JWW), Le Bonheur Children's Hospital, Memphis, TN; Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
- Division of Pediatric Neurology (BM, JWW), Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
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Scorza FA, de Almeida ACG, Scorza CA, Finsterer J. Omega-3 Fatty Acids May Prevent Sudden Unexpected Death in Epilepsy in Children. J Pediatr Pharmacol Ther 2022; 27:198-199. [DOI: 10.5863/1551-6776-27.2.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Fulvio Alexandre Scorza
- Disciplina de Neurociência (FAS, CAS), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
- Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima” (FAS, CAS, A-CGA), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Antônio-Carlos Guimarães de Almeida
- Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima” (FAS, CAS, A-CGA), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas (A-CGA), Universidade Federal de São João del-Rei (UFSJ), Brasil
| | - Carla Alessanra Scorza
- Disciplina de Neurociência (FAS, CAS), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
- Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima” (FAS, CAS, A-CGA), Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
| | - Josef Finsterer
- Klinikum Landstrasse (JF), Messerli Institute, Vienna, Austria
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Li Z, Wang Y, Li L, He H, Lin L, Pan M, Yang T, Liu Q. A bibliometric analysis of the cause of sudden unexplained death in forensic medicine: Research trends, hot spots and prospects. Comput Biol Med 2022; 144:105330. [DOI: 10.1016/j.compbiomed.2022.105330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 01/03/2023]
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Neubauer J, Forst AL, Warth R, Both CP, Haas C, Thomas J. Genetic variants in eleven central and peripheral chemoreceptor genes in sudden infant death syndrome. Pediatr Res 2022; 92:1026-1033. [PMID: 35102300 PMCID: PMC9586864 DOI: 10.1038/s41390-021-01899-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/14/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) is still one of the leading causes of postnatal infant death in developed countries. The occurrence of SIDS is described by a multifactorial etiology that involves the respiratory control system including chemoreception. It is still unclear whether genetic variants in genes involved in respiratory chemoreception might play a role in SIDS. METHODS The exome data of 155 SIDS cases were screened for variants within 11 genes described in chemoreception. Pathogenicity of variants was assigned based on the assessment of variant types and in silico protein predictions according to the current recommendations of the American College of Medical Genetics and Genomics. RESULTS Potential pathogenic variants in genes encoding proteins involved in respiratory chemoreception could be identified in 5 (3%) SIDS cases. Two of the variants (R137S/A188S) were found in the KNCJ16 gene, which encodes for the potassium channel Kir5.1, presumably involved in central chemoreception. Electrophysiologic analysis of these KCNJ16 variants revealed a loss-of-function for the R137S variant but no obvious impairment for the A188S variant. CONCLUSIONS Genetic variants in genes involved in respiratory chemoreception may be a risk factor in a fraction of SIDS cases and may thereby contribute to the multifactorial etiology of SIDS. IMPACT What is the key message of your article? Gene variants encoding proteins involved in respiratory chemoreception may play a role in a minority of SIDS cases. What does it add to the existing literature? Although impaired respiratory chemoreception has been suggested as an important risk factor for SIDS, genetic variants in single genes seem to play a minor role. What is the impact? This study supports previous findings, which indicate that genetic variants in single genes involved in respiratory control do not have a dominant role in SIDS.
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Affiliation(s)
- Jacqueline Neubauer
- grid.7400.30000 0004 1937 0650Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Anna-Lena Forst
- grid.7727.50000 0001 2190 5763Medical Cell Biology, Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Richard Warth
- grid.7727.50000 0001 2190 5763Medical Cell Biology, Institute of Physiology, University of Regensburg, Regensburg, Germany
| | - Christian Peter Both
- grid.412341.10000 0001 0726 4330Department of Anesthesiology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Cordula Haas
- grid.7400.30000 0004 1937 0650Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Jörg Thomas
- Department of Anesthesiology, University Children's Hospital Zurich, Zurich, Switzerland.
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Sahly AN, Shevell M, Sadleir LG, Myers KA. SUDEP risk and autonomic dysfunction in genetic epilepsies. Auton Neurosci 2021; 237:102907. [PMID: 34773737 DOI: 10.1016/j.autneu.2021.102907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/11/2021] [Accepted: 11/06/2021] [Indexed: 01/02/2023]
Abstract
The underlying pathophysiology of sudden unexpected death in epilepsy (SUDEP) remains unclear. This phenomenon is likely multifactorial, and there is considerable evidence that genetic factors play a role. There are certain genetic causes of epilepsy in which the risk of SUDEP appears to be increased relative to epilepsy overall. For individuals with pathogenic variants in genes including SCN1A, SCN1B, SCN8A, SCN2A, GNB5, KCNA1 and DEPDC5, there are varying degrees of evidence to suggest an increased risk for sudden death. Why the risk for sudden death is higher is not completely clear; however, in many cases pathogenic variants in these genes are also associated with autonomic dysfunction, which is hypothesized as a contributing factor to SUDEP. We review the evidence for increased SUDEP risk for patients with epilepsy due to pathogenic variants in these genes, and also discuss what is known about autonomic dysfunction in these contexts.
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Affiliation(s)
- Ahmed N Sahly
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Michael Shevell
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of the McGill University Medical Centre, Montreal, Quebec, Canada
| | - Lynette G Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Kenneth A Myers
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Research Institute of the McGill University Medical Centre, Montreal, Quebec, Canada.
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21
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Shlobin NA, Sander JW. Reducing Sudden Unexpected Death in Epilepsy: Considering Risk Factors, Pathophysiology and Strategies. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00691-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose of Review
Sudden Unexpected Death in Epilepsy (SUDEP) is the commonest cause of epilepsy-related premature mortality in people with chronic epilepsy. It is the most devastating epilepsy outcome. We describe and discuss risk factors and possible pathophysiological mechanisms to elucidate possible preventative strategies to avert SUDEP.
Recent Findings
Sudden death accounts for a significant proportion of premature mortality in people with epilepsy compared to the general population. Unmodifiable risk factors include a history of neurologic insult, younger age of seizure-onset, longer epilepsy duration, a history of convulsions, symptomatic epilepsy, intellectual disability, and non-ambulatory status. Modifiable risk factors include the presence of convulsive seizures, increased seizure frequency, timely and appropriate use of antiseizure medications, polytherapy, alcoholism, and supervision while sleeping. Pathophysiology is unclear, but several possible mechanisms such as direct alteration of cardiorespiratory function, pulmonary impairment, electrocerebral shutdown, adenosine dysfunction, and genetic susceptibility suggested.
Summary
Methods to prevent SUDEP include increasing awareness of SUDEP, augmenting knowledge of unmodifiable risk factors, obtaining full seizure remission, addressing lifestyle factors such as supervision and prone positioning, and enacting protocols to increase the detection of and intervention for SUDEP. Further studies are required to characterize precisely and comprehensively SUDEP risk factors and pathophysiological drivers and develop evidence-based algorithms to minimize SUDEP in people with epilepsy.
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22
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Scorza FA, de Almeida ACG, Scorza CA, Finsterer J. Epilepsy due to Congenital Zika Virus Infection: The Ongoing Threat. J Child Neurol 2021; 36:1136-1137. [PMID: 34293941 DOI: 10.1177/08830738211019614] [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: 11/15/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência. Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.,Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima," Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Antonio-Carlos G de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.,Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Carla A Scorza
- Disciplina de Neurociência. Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.,Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima," Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brasil
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Greenlaw C, Elhefnawy Y, Jonas R, Douglass LM. Using an animated video to promote an informed discussion on SUDEP with adolescents. Epilepsy Behav 2021; 122:108182. [PMID: 34256339 DOI: 10.1016/j.yebeh.2021.108182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to create and test an animated video to teach adolescent patients about Sudden Unexpected Death in Epilepsy (SUDEP). METHOD Thirty-nine patients and thirteen parents watched the SUDEP video and completed at least one survey. Patients with epilepsy aged 14+ and their parents were recruited to watch the video during neurology clinic visits. Parents of minors provided verbal permission for their child to view the video. Participants were asked to complete pre- and post-video surveys. Data analysis included Fischer's exact tests for comparative data and percentages for categorical variables. RESULTS After watching the SUDEP video, 100% of parents and patients agreed that the video provided helpful knowledge, and 100% of parents and 96% of patients agreed that patients with epilepsy should know about SUDEP. Half of the parents surveyed, and 20% of patients, felt increased concerns after watching the video. Patients rated their understanding of SUDEP significantly higher after watching the video (p < 0.001). CONCLUSION Participants in this study thought that it was important for patients with epilepsy to know about SUDEP, and all agreed that the animated SUDEP video provided helpful knowledge. While some parents endorsed increased concerns after watching the video, the majority of parents still agreed to allow their child to watch the video. Adolescent education on SUDEP using a family-centered approach may be an important method of encouraging harm-reducing behaviors that can be lifesaving for patients with epilepsy. The standard of practice for SUDEP disclosure should continue to be face-to-face discussion with providers, and we propose this video as a tool to elevate and inform those discussions.
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Affiliation(s)
- Celia Greenlaw
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
| | - Yasmine Elhefnawy
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Rinat Jonas
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Laurie M Douglass
- Departments of Pediatrics and Neurology, Division of Pediatric Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Wicker E, Cole JW. Sudden Unexpected Death in Epilepsy (SUDEP): A Review of Risk Factors and Possible Interventions in Children. J Pediatr Pharmacol Ther 2021; 26:556-564. [PMID: 34421404 DOI: 10.5863/1551-6776-26.6.556] [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: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a serious and devastating, yet poorly understood outcome in epilepsy. This review discusses the current knowledge and understanding of SUDEP in children and adolescents. Established risk factors for SUDEP include history of generalized tonic-clonic seizures and nocturnal seizures. Other proposed risk factors include the use of multiple antiseizure medications and poor medication adherence. Possible prevention strategies for SUDEP include improved medication adherence, surgical interventions, nighttime safety, seizure detection devices, and diet. Pediatric providers have a great opportunity to educate families about SUDEP, assess medication adherence, and provide families with tools to improve medication adherence and learn about SUDEP in children and adolescents with epilepsy. Future research in SUDEP aims to further understand the etiology and risk factors of SUDEP, while developing more intervention strategies to prevent SUDEP.
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Calcaterra V, Verduci E, Pascuzzi MC, Magenes VC, Fiore G, Di Profio E, Tenuta E, Bosetti A, Todisco CF, D'Auria E, Zuccotti G. Metabolic Derangement in Pediatric Patient with Obesity: The Role of Ketogenic Diet as Therapeutic Tool. Nutrients 2021; 13:2805. [PMID: 34444964 PMCID: PMC8400548 DOI: 10.3390/nu13082805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
Obesity is defined as a condition characterized by an excessive fat accumulation that has negative health consequences. Pediatric obesity is associated with an increased risk for many diseases, including impaired glycemic and lipidic control that may lead to the development of chronic, and potentially disabling, pathologies, such as type 2 diabetes mellitus (T2DM) and cardiovascular events, in adult life. The therapeutic strategy initially starts with interventions that are aimed at changing lifestyle and eating behavior, to prevent, manage, and potentially reverse metabolic disorders. Recently, the ketogenic diet (KD) has been proposed as a promising dietary intervention for the treatment of metabolic and cardiovascular risk factors related to obesity in adults, and a possible beneficial role has also been proposed in children. KD is very low in carbohydrate, high in fat, and moderate to high in protein that may have the potential to promote weight loss and improve lipidic derangement, glycemic control, and insulin sensitivity. In this review, we present metabolic disorders on glycemic and lipidic control in children and adolescents with obesity and indication of KD in pediatrics, discussing the role of KD as a therapeutic tool for metabolic derangement. The results of this review may suggest the validity of KD and the need to further research its potential to address metabolic risk factors in pediatric obesity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Martina Chiara Pascuzzi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Vittoria Carlotta Magenes
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Giulia Fiore
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Elisabetta Di Profio
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Elisavietta Tenuta
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Bosetti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Carolina Federica Todisco
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
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Scorza FA, Moret MA, de Almeida ACG, Scorza CA, Finsterer J. Is there a seasonal influence on SUDEP? Epilepsy Behav 2021; 118:107913. [PMID: 33810990 DOI: 10.1016/j.yebeh.2021.107913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
| | - Marcelo A Moret
- UNEB- Rua Silveira Martins, 2555, Cabula 41150-000 Salvador, Bahia, Brazil
| | - Antonio-Carlos G de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima." Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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27
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Craig DP, Choi YY, Hughes E, Osland K, Hanna J, Kerr MP, Thomas RH. Paediatric sudden unexpected death in epilepsy: A parental report cohort. Acta Neurol Scand 2021; 143:509-513. [PMID: 33210735 DOI: 10.1111/ane.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) accounts for a large percentage of deaths in children with epilepsy. Contributing factors to paediatric SUDEP are incompletely understood. AIMS OF STUDY The Epilepsy Deaths Register (EDR) is an anonymized register that compiles information on deaths related to epilepsy, across all ages and epilepsy classifications. Using the EDR, we sought to identify key risk factors for SUDEP in children to assist the development of preventive measures. METHODS All registrations between the ages of 1 and 16 years were reviewed to identify definite or probable SUDEP. These cases were analysed to identify common demographics, comorbidities, monitoring, treatments and circumstances near to the deaths. RESULTS We identified forty-six cases (27 males) of definite or probable SUDEP. Paediatric SUDEP is more common in a 12- to 16-year age group and in those with neuro-disability. Most paediatric SUDEP occurs during apparent sleep. There were four cases with a vagus nerve stimulator. SUDEP can occur early after the onset of seizures. CONCLUSIONS This is the largest single cohort of SUDEP reported in children. Reports from caregivers can augment population data. Surveillance in sleep is a priority area of development.
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Affiliation(s)
| | - Yun Young Choi
- Wonju College of Medicine Yonsei University Wonju South Korea
| | - Elaine Hughes
- Paediatric Neurosciences Evelina London Children’s Hospital London UK
| | | | | | - Mike P. Kerr
- Psychological Medicine and Clinical Neurosciences Cardiff University Cardiff UK
| | - Rhys H. Thomas
- Royal Victoria Infirmary Newcastle‐upon‐Tyne UK
- Translational and Clinical Research Institute Newcastle University Newcastle UK
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28
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Singh J, Lanzarini E, Santosh P. Autonomic Characteristics of Sudden Unexpected Death in Epilepsy in Children-A Systematic Review of Studies and Their Relevance to the Management of Epilepsy in Rett Syndrome. Front Neurol 2021; 11:632510. [PMID: 33613425 PMCID: PMC7892970 DOI: 10.3389/fneur.2020.632510] [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: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023] Open
Abstract
Aim: To systematically identify and critically appraise studies that investigate the autonomic characteristics of Sudden Unexpected Death in Epilepsy (SUDEP) in the pediatric population. We also wanted to explore how this information would be relevant to the management of epilepsy in patients with Rett Syndrome. Method: Using PRISMA guidelines, a systematic review of PubMed, Scopus, Cochrane, PsycINFO, Embase, and Web of Science databases was performed to identify eligible studies. After extracting data from the included studies, a thematic analysis was undertaken to identify emerging themes. A quality appraisal was also done to assess the quality of the included studies. Results: The systematic search revealed 41 records, and 15 full-text articles on the autonomic characteristics of SUDEP in children were included in the final analysis. Following thematic analysis, three themes were identified (I) modulation in sympathovagal tone, (II) pre- and post-ictal autonomic changes, and (III) other markers of autonomic dysregulation in children with epilepsy. Modulation in sympathovagal tone emerged as the theme with the highest frequency followed by pre- and post-ictal autonomic changes. While the themes provide additional insight into the management of epilepsy in the Rett Syndrome population, the quality of evidence concerning the autonomic characteristics of SUDEP in the pediatric population was low and underscores the importance of much needed research in this area. Conclusion: The mechanism of SUDEP in the pediatric population is complex and involves an interplay between several components of the autonomic nervous system. While direct clinical inferences regarding pediatric SUDEP could not be made, the thematic analysis does suggest that in vulnerable populations such as Rett Syndrome, where there is already a pervasive autonomic dysregulation, pro-active surveillance of the autonomic profile in this patient group would be useful to better manage epilepsy and reduce the SUDEP risk.
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Affiliation(s)
- Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Evamaria Lanzarini
- Child and Adolescent Neuropsychiatry Unit, Infermi Hospital, Rimini, Italy
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Personalised Medicine in Rett Syndrome, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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29
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Strzelczyk A, Schubert-Bast S, Simon A, Wyatt G, Holland R, Rosenow F. Epidemiology, healthcare resource use, and mortality in patients with probable Lennox-Gastaut syndrome: A population-based study on German health insurance data. Epilepsy Behav 2021; 115:107647. [PMID: 33358132 DOI: 10.1016/j.yebeh.2020.107647] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This retrospective study examined patients with probable Lennox-Gastaut syndrome (LGS) identified from German healthcare data. METHODS This 10-year study (2007-2016) assessed healthcare insurance claims information from the Vilua Healthcare research database. A selection algorithm considering diagnoses and drug prescriptions identified patients with probable LGS. To increase the sensitivity of the identification algorithm, two populations were defined: all patients with probable LGS (broadly defined) and only those with a documented epilepsy diagnosis before 6 years of age (narrowly defined). This specific criterion was used as LGS typically has a peak seizure onset between age 3 and 5 years. Primary analyses were prevalence and demographics; secondary analyses included healthcare costs, hospitalization rate and length of stay (LOS), medication use, and mortality. RESULTS In the final year of the study, 545 patients with broadly defined probable LGS (mean [range] age: 31.4 [2-89] years; male: 53%) were identified. Using the narrowly defined probable LGS definition, the number of patients was reduced to 102 (mean [range] age: 7.4 [2-14] years; male: 52%). Prevalence of broadly defined and narrowly defined probable LGS was 39.2 and 6.5 per 100,000 people. During the 10-year study, 208 patients with narrowly defined probable LGS were identified and followed up for 1379 patient-years. The mean annual cost of healthcare was €22,787 per patient-year (PPY); greatest costs were attributable to inpatient care (33%), home nursing care (13%), and medication (10%). Mean annual healthcare costs were significantly greater for those with prescribed rescue medication (45% of patient-years) versus those without (€33,872 vs. €13,785 PPY, p < 0.001). Mean (standard deviation [SD]) annual hospitalization rate was 1.6 (2.0) PPY with mean (SD) annual LOS of 22.7 (46.0) days. Annual hospitalization rate was significantly greater in those who were prescribed rescue medication versus those who were not (2.2 [2.3] vs. 1.1 [1.6] PPY, p < 0.001). The mean (SD) number of different medications prescribed was 11.3 (7.3) PPY and 33.8 (17.0) over the entire observable time per patient (OET); antiepileptic drugs only accounted for 2.1 (1.1) of the medications prescribed PPY and 3.8 (2.0) OET. Over the 10-year study period, mortality in patients with narrowly defined probable LGS was significantly higher than the matched control population (six events [2.88%] vs. oneevent [0.01%], p < 0.001). CONCLUSION Annual healthcare costs incurred by patients with probable LGS in Germany were substantial, and mostly attributable to inpatient care, home nursing care, and medication. Patients prescribed with rescue medication incurred significantly greater costs than those who were not. Patients with narrowly defined probable LGS had a higher mortality rate versus control populations.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | | | - Geoffrey Wyatt
- Market Access and Health Economics and Outcomes Research, GW Pharma Ltd, London, UK.
| | - Rowena Holland
- Market Access and Health Economics and Outcomes Research, GW Pharma Ltd, London, UK.
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt and Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
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30
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Wirrell EC, Grinspan ZM, Knupp KG, Jiang Y, Hammeed B, Mytinger JR, Patel AD, Nabbout R, Specchio N, Cross JH, Shellhaas RA. Care Delivery for Children With Epilepsy During the COVID-19 Pandemic: An International Survey of Clinicians. J Child Neurol 2020; 35:924-933. [PMID: 32666891 PMCID: PMC7364331 DOI: 10.1177/0883073820940189] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the effect of the COVID-19 pandemic on global access to care and practice patterns for children with epilepsy. METHODS We conducted a cross-sectional, online survey of pediatric neurologists across the world affiliated with the International Child Neurology Association, the Chinese Child Neurology Society, the Child Neurology Society, and the Pediatric Epilepsy Research Consortium. Results were analyzed in relation to regional burden of COVID-19 disease. RESULTS From April 10 to 24, 2020, a sample of 212 respondents from 49 countries indicated that the COVID-19 pandemic has dramatically changed many aspects of pediatric epilepsy care, with 91.5% reporting changes to outpatient care, 90.6% with reduced access to electroencephalography (EEG), 37.4% with altered management of infantile spasms, 92.3% with restrictions in ketogenic diet initiation, 93.4% with closed or severely limited epilepsy monitoring units, and 91.3% with canceled or limited epilepsy surgery. Telehealth use had increased, with 24.7% seeing patients exclusively via telehealth. Changes in practice were related both to COVID-19 burden and location. CONCLUSIONS In response to COVID-19, pediatric epilepsy programs have implemented crisis standards of care that include increased telemedicine, decreased EEG use, changes in treatments of infantile spasms, and cessation of epilepsy surgery. The long-term impact of these abrupt changes merit careful study.
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Affiliation(s)
- Elaine C. Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department
of Neurology, Mayo Clinic, Rochester, MN, USA,These are co-first authors of this article
| | - Zachary M. Grinspan
- Departments of Population Sciences and Pediatrics, Weill Cornell
Medicine, New York, NY, USA,These are co-first authors of this article
| | - Kelly G. Knupp
- Department of Pediatrics and Neurology, University of Colorado
Anschutz Medical Campus, Aurora, CO, USA
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First
Hospital, Beijing, China
| | - Biju Hammeed
- Paediatric Neurosciences, Great Ormond Street Children’s Hospital, London, United Kingdom
| | - John R. Mytinger
- Department of Pediatrics, Division of Pediatric Neurology,
Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
| | - Anup D. Patel
- Department of Pediatrics, Division of Pediatric Neurology,
Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
| | - Rima Nabbout
- Centre de Reference Epilepsies Rares, Department of Pediatric
Neurology, Necker Enfants Malades Hospital, Imagine Institute, Paris Descartes University, Paris,
France
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino
Gesu’ Children’s Hospital, IRCCS, Rome, Italy and Member of European Reference
Network EpiCARE
| | - J. Helen Cross
- Developmental Neurosciences, UCL NIHR BRC Great Ormond Street
Institute of Child Health, London, WC1 N 1EH, & and Member of European Reference
Network EpiCARE
| | - Renée A. Shellhaas
- Department of Pediatrics (Pediatric Neurology), Michigan Medicine,
University of Michigan, Ann Arbor, MI, USA,Renée A. Shellhaas, MD, MS, CS Mott
Children’s Hospital, Room 12-733, 1540 E. Hospital Dr, Ann Arbor, MI 48109, USA.
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31
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McGuone D, Crandall LG, Devinsky O. Sudden Unexplained Death in Childhood: A Neuropathology Review. Front Neurol 2020; 11:582051. [PMID: 33178125 PMCID: PMC7596260 DOI: 10.3389/fneur.2020.582051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Sudden Unexplained Death in Childhood (SUDC) is the unexpected death of a child over age 12 months that remains unexplained after a thorough case investigation, including review of the child's medical history, circumstances of death, a complete autopsy and ancillary testing (1). First defined in 2005, SUDC cases are more often male, with death occurring during a sleep period, being found prone, peak winter incidence, associated with febrile seizure history in ~28% of cases and mild pathologic changes insufficient to explain the death (1, 2). There has been little progress in understanding the causes of SUDC and no progress in prevention. Despite reductions in sudden unexpected infant death (SUID) and other causes of mortality in childhood, the rate of SUDC has increased during the past two decades (3-5). In Ireland, SUID deaths were cut in half from 1994 to 2008 while SUDC deaths more than doubled (4). Surveillance issues, including lack of standardized certification practices, affect our understanding of the true magnitude of unexplained child deaths. Mechanisms underlying SUDC, like SUID, remain largely speculative. Limited and inconsistent evidence implicates abnormalities in brainstem autonomic and serotonergic nuclei, critical for arousal, cardiorespiratory control, and reflex responses to life-threatening hypoxia or hypercarbia in sleep (6). Abnormalities in medullary serotonergic neurons and receptors, as well as cardiorespiratory brainstem nuclei occur in some SUID cases, but have never been studied in SUDC. Retrospective, small SUDC studies with non-standardized methodologies most often demonstrate minor hippocampal abnormalities, as well as focal cortical dysplasia and dysgenesis of the brainstem and cerebellum. The significance of these findings to SUDC pathogenesis remains unclear with some investigators and forensic pathologists labeling these findings as normal variants, or potential causes of SUDC. The development of preventive strategies will require a greater understanding of underlying mechanisms.
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Affiliation(s)
- Declan McGuone
- Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Laura G Crandall
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, United States.,SUDC Foundation, Herndon, VA, United States
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, United States
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32
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Mesraoua B, Deleu D, Hassan AH, Gayane M, Lubna A, Ali MA, Tomson T, Khalil BA, Cross JH, Asadi-Pooya AA. Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality. Curr Med Res Opin 2020; 36:1473-1480. [PMID: 32476500 DOI: 10.1080/03007995.2020.1776234] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Dirk Deleu
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Al Hail Hassan
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Melykian Gayane
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Alsheikh Lubna
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Torbjorn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bassel Abou Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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33
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Scher MS. Neurologic outcome after fetal inflammatory response syndrome: Trimester-specific considerations. Semin Fetal Neonatal Med 2020; 25:101137. [PMID: 33158496 DOI: 10.1016/j.siny.2020.101137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Clinical signs and neuroimaging patterns associated with the fetal inflammatory response syndrome (FIRS) worsen or mimic the clinical repertoire after intrapartum hypoxic-ischemic encephalopathy (HIE) during labor and/or parturition. Diagnostic considerations expressed as neonatal encephalopathy (NE) must consider chronic as well as acute factors associated with FIRS. Trimester-specific factors adversely alter the interactions of the maternal/placental/fetal (MPF) triad and influence the postnatal phenotype of FIRS. Anticipatory guidance for families by clinicians caring for survivors with FIRS, as well as researchers, must consider acute and chronic effects that influence neurologic outcome. Novel neurotherapeutic interventions must include prenatal preventive as well as peripartum/postnatal rescue and repair strategies to effectively reduce the presence and severity of sequelae from FIRS.
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Affiliation(s)
- Mark S Scher
- Emeritus Full Professor of Pediatrics and Neurology, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, University Hospitals Cleveland Medical Center, Case Western Reserve University, School of Medicine, 11100 Euclid Avenue Cleveland, Ohio, 44106, USA.
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34
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Kon FC, Vázquez RZ, Lang A, Cohen MC. Hippocampal abnormalities and seizures: a 16-year single center review of sudden unexpected death in childhood, sudden unexpected death in epilepsy and SIDS. Forensic Sci Med Pathol 2020; 16:423-434. [PMID: 32712908 DOI: 10.1007/s12024-020-00268-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/27/2022]
Abstract
Sudden Unexpected Death in Childhood (SUDC) is the unexplained death of children aged between 1 and 18 years old. Hippocampal abnormalities have previously been described in Sudden Unexpected Death in Epilepsy (SUDEP) and it is possible that SUDC shares similar pathogenic mechanisms with SUDEP. Our aim was to determine the prevalence of hippocampal abnormalities, history of seizures and demographic features in our caseload of SUDC, SUDEP and SIDS cases. A review of post-mortem reports from 2003 to 2018 was carried out to identify cases of SUDC, SUDEP and SIDS. Histological evidence of hippocampal abnormalities, patient demographics (age, gender), sleeping position, and past medical history (history of seizures and illness 72 hours prior to death) were recorded. Statistical analysis was performed to compare the three groups. 48 SUDC, 18 SUDEP and 358 SIDS cases were identified. Hippocampal abnormalities associated with temporal lobe epilepsy were found in 44.4% of SUDC cases. 5/15 SUDC cases with a history of seizures demonstrated hippocampal abnormalities. SUDC cases were also more likely to be found prone compared to SIDS cases. In comparison with SIDS, both SUDC and SUDEP cases were more likely to demonstrate hippocampal abnormalities (SUDC: (OR = 9.4, 95% CI: 3.1-29.1, p < 0.001; SUDEP: OR = 35.4, 95% CI: 8.3-151.5, p < 0.001). We found a potential link between hippocampal abnormalities and epileptic seizures in SUDC. A concerted effort should be directed towards consistent sampling and standardized description of the hippocampus and clinical correlation with a history of seizures/epilepsy in postmortem reports.
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Affiliation(s)
- Fu Chuen Kon
- Histopathology Department, Sheffield Children's Hospital NHS FT, Sheffield, UK.,Medical School, University of Sheffield, Sheffield, UK
| | | | - Andrew Lang
- Histopathology Department, Sheffield Children's Hospital NHS FT, Sheffield, UK
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's Hospital NHS FT, Sheffield, UK. .,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.
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35
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Cooper K, Kirkpatrick P, Brand C, Rolfe A, Florida-James S. Discussing sudden unexpected death in epilepsy with children and young people with epilepsy and their parents/carers: A mixed methods systematic review. Seizure 2020; 78:159-167. [DOI: 10.1016/j.seizure.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/23/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022] Open
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36
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Pensel MC, Nass RD, Taubøll E, Aurlien D, Surges R. Prevention of sudden unexpected death in epilepsy: current status and future perspectives. Expert Rev Neurother 2020; 20:497-508. [PMID: 32270723 DOI: 10.1080/14737175.2020.1754195] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Sudden unexpected death in epilepsy (SUDEP) affects about 1 in 1000 people with epilepsy, and even more in medically refractory epilepsy. As most people are between 20 and 40 years when dying suddenly, SUDEP leads to a considerable loss of potential life years. The most important risk factors are nocturnal and tonic-clonic seizures, underscoring that supervision and effective seizure control are key elements for SUDEP prevention. The question of whether specific antiepileptic drugs are linked to SUDEP is still controversially discussed. Knowledge and education about SUDEP among health-care professionals, patients, and relatives are of outstanding importance for preventive measures to be taken, but still poor and widely neglected.Areas covered: This article reviews epidemiology, pathophysiology, risk factors, assessment of individual SUDEP risk and available measures for SUDEP prevention. Literature search was done using Medline and Pubmed in October 2019.Expert opinion: Significant advances in the understanding of SUDEP were made in the last decade which allow testing of novel strategies to prevent SUDEP. Promising current strategies target neuronal mechanisms of brain stem dysfunction, cardiac susceptibility for fatal arrhythmias, and reliable detection of tonic-clonic seizures using mobile health technologies.Abbreviations: AED, antiepileptic drug; CBZ, carbamazepine; cLQTS, congenital long QT syndrome; EMU, epilepsy monitoring unit; FBTCS, focal to bilateral tonic-clonic seizures; GTCS, generalized tonic-clonic seizures; ICA, ictal central apnea; LTG, lamotrigine; PCCA, postconvulsive central apnea; PGES, postictal generalized EEG suppression; SRI, serotonin reuptake inhibitor; SUDEP, sudden unexpected death in epilepsy; TCS, tonic-clonic seizures.
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Affiliation(s)
| | | | - Erik Taubøll
- Department of Neurology, Oslo University Hospital, Nydalen, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Aurlien
- Neuroscience Research Group and Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Tseng WC, Wu MH, Chiu SN, Chen HC, Kao FY, Huang SK. Cumulative postnatal risk of pediatric sudden death and all-cause mortality in nationwide birth cohorts of Taiwan and the United States. J Formos Med Assoc 2020; 119:1842-1853. [PMID: 32173231 DOI: 10.1016/j.jfma.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/13/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate the cumulative postnatal risk of pediatric sudden death (SD) for each neonate and the temporal/regional differences which are still unclear. METHODS We established a birth cohort (2000-2014) from our national database and obtained reference data about the United States (US) from the national website. RESULTS Among 3,097,277 live births, we identified 1661 children with SD (56.8% male). The postnatal cumulative risk of SD was 0.35, 0.49, 0.56 and 0.59/1000 by age 0, 5, 11 and 14 years. Coexisting cardiac diagnosis was noted in 347 (20.9%) and non-cardiac diagnosis in 300 (18.1%) patients. Cumulative all-cause mortality was 5.3, 6.78, 7.63 and 8.06/1000 by age 0, 5, 11 and 14 years. Risks of SD and all-cause death decreased over birthyear. SD risk decreased particularly after the 2008 birthyear. Risks of SD and all-cause death were the highest in Eastern Taiwan, but SD/all-cause death ratio was high in Taipei metropolitan and Northern Taiwan. Cumulative risk of SD (0.54/1000 by age 14) and all-cause mortality (9.06/1000 by age 14) in the US decreased over time. African-Americans were at the highest risks of SD and all-cause mortality. However, American-Indians/Alaska-natives exhibited the highest SD/all-cause death ratio. CONCLUSION This study provides the cumulative risk of SD (1 in 1694 newborns) by age 14 years. The time trend underlines the effect of medical advance and education on SD prevention. Distinct regional/ethnic differences in risks of SD and all-cause death in Taiwan and the US indicate the necessity of different strategies to diminish the disparity.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Mei-Hwan Wu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan.
| | - Sheunn-Nan Chiu
- Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Hui-Chi Chen
- Obstetrics and Gynecology, National Taiwan University Hospital and Medical College, National Taiwan University, Taiwan
| | - Feng-Yu Kao
- Administration of National Health Insurance, Taipei, Taiwan
| | - San-Kuei Huang
- Administration of National Health Insurance, Taipei, Taiwan
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Abdel-Mannan O, Hughes E, Dunkley C. Epilepsy deaths in children: Improvements driven by data and surveillance in pediatrics. Epilepsy Behav 2020; 103:106493. [PMID: 31526647 DOI: 10.1016/j.yebeh.2019.106493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
Epilepsy-related death in children and young people deserves understanding and intervention along with epilepsy-related deaths in adults. Risk of death from epilepsy varies at different ages, and the specific calculations of risk remains complex and varies between studies. There have been several UK studies examining factors associated with epilepsy-related deaths. A UK national audit with other national initiatives has evidenced improving quality of care and more recently allowed service provision factors associated with reduced epilepsy-related death to be evidenced. A national program of health education, formalized epilepsy networks, commissioned surgical pathways, and patient information resources around risk and participation are examples of quality improvement initiatives. Epilepsy-related death is a key outcome, and there remains many difficulties and opportunities at local, regional, and national level to better understand and improve this outcome for children and young people and the adults that they should become. This paper is for the Special Issue: Prevent 21: SUDEP Summit - Time to Listen.
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Affiliation(s)
| | - Elaine Hughes
- Paediatric Neurosciences, Evelina London Children's Hospital and King's College Hospital NHS Foundation Trust, United Kingdom
| | - Colin Dunkley
- Dept. of Paediatrics, Sherwood Forest Hospital NHS Foundation Trust, United Kingdom.
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Zelleke T, Pasupuleti A, Depositario-Cabacar D, Kao A. Antiepileptic Drugs in Pediatrics. Handb Exp Pharmacol 2020; 261:1-24. [PMID: 31342278 DOI: 10.1007/164_2019_248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Epilepsy affects approximately 1% of the population. First-line treatment for epilepsy is the administration of anti-seizure medication, also referred to as antiepileptic drugs (AEDs), although this nomenclature is erroneous as these medications typically do not impact underlying epileptogenic processes; the goal of these medications is to control symptoms. Over 30% of patients are classified as having "medically refractory" epilepsy, i.e., lack of adequate seizure control despite trials of two or three AEDs (Kwan and Brodie, N Engl J Med 342:314-9, 2000). Epilepsy is associated with worse quality of life in children, adolescents, and their families (Cianchetti et al., Seizure 24:93-101, 2015). Patients with epilepsy have a two to three times greater risk of death than the general population, by various causes including sudden unexplained death in epilepsy patients (SUDEP) (Abdel-Mannan et al., Epilepsy Behav 90:99-106, 2019). It is these factors, among others, that have motivated the continued development of AEDs. This chapter will review the history and evolution of AED development, features of specific AEDs with a focus on the newest generation, and examples of AEDs in development.
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Affiliation(s)
- Tesfaye Zelleke
- Division of Epilepsy and Neurophysiology, Children's National Health System, Washington, DC, USA
| | - Archana Pasupuleti
- Division of Epilepsy and Neurophysiology, Children's National Health System, Washington, DC, USA
| | - Dewi Depositario-Cabacar
- Division of Epilepsy and Neurophysiology, Children's National Health System, Washington, DC, USA
| | - Amy Kao
- Division of Epilepsy and Neurophysiology, Children's National Health System, Washington, DC, USA.
- Center for Behavioral Neurosciences, Children's National Health System, Washington, DC, USA.
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Neininger MP, Woltermann S, Jeschke S, Herziger B, Müller RM, Kiess W, Bertsche T, Bertsche A. How do pediatric patients perceive adverse drug events of anticonvulsant drugs? A survey. Eur J Pediatr 2020; 179:1413-1420. [PMID: 32162065 PMCID: PMC7413904 DOI: 10.1007/s00431-020-03571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/20/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
Abstract
Anticonvulsant drugs have a high risk of adverse drug events. Little is known about the perception of those events by pediatric patients. We performed a survey in the neuropediatric departments of two university hospitals. Using a questionnaire, we interviewed patients aged 6-18 years with current anticonvulsant treatment regarding (i) their fears about potential adverse drug events, (ii) experienced adverse drug events, and (iii) perceived burden of experienced adverse drug events. One hundred patients took part in the interview. (i) 40 (40%) expressed fears that the medication could harm them. Eighteen of 40 (45%) named fears concerning specific adverse drug events. Of those, 12/18 (67%) feared neurologic or psychiatric symptoms. (ii) 37 (37%) of children described altogether 60 experienced adverse drug events. Of those, 38 (63%) concerned neurologic or psychiatric symptoms. (iii) 32/37 (82%) children who experienced adverse drug events felt bothered by the experienced event. Among others, they described an emotional burden (11/37, 30%), and restrictions in school performance (8/37, 22%) and favorite leisure activities (4/37, 11%).Conclusion: School-aged children are well able to describe adverse drug events of their anticonvulsant medication. Almost two thirds of the described events concern neurologic or psychiatric symptoms that cause an emotional burden and restrictions according to the patients. What is Known: • Anticonvulsants have a high potential of adverse drug events. • In an earlier survey, parents expressed fears of severe adverse drug events such as liver failure, which seldom occur, and reported a high number of neurological and psychological adverse drug events. What is New: • Many children fear that their anticonvulsants could harm them, and they fear and experience neurological and psychological adverse drug events. • According to the children, adverse drug events cause an emotional burden and restrictions in school performance and favorite leisure activities.
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Affiliation(s)
- Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Sarah Woltermann
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Sarah Jeschke
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Birthe Herziger
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Ruth Melinda Müller
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
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Evaluation of potential auras in generalized epilepsy from EEG signals using deep convolutional neural networks and time-frequency representation. ACTA ACUST UNITED AC 2019; 65:379-391. [DOI: 10.1515/bmt-2019-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/07/2019] [Indexed: 01/02/2023]
Abstract
Abstract
The general uncertainty of epilepsy and its unpredictable seizures often affect badly the quality of life of people exposed to this disease. There are patients who can be considered fortunate in terms of prediction of any seizures. These are patients with epileptic auras. In this study, it was aimed to evaluate pre-seizure warning symptoms of the electroencephalography (EEG) signals by a convolutional neural network (CNN) inspired by the epileptic auras defined in the medical field. In this context, one-dimensional EEG signals were transformed into a spectrogram display form in the frequency-time domain by applying a short-time Fourier transform (STFT). Systemic changes in pre-epileptic seizure have been described by applying the CNN approach to the EEG signals represented in the image form, and the subjective EEG-Aura process has been tried to be determined for each patient. Considering all patients included in the evaluation, it was determined that the 1-min interval covering the time from the second minute to the third minute before the seizure had the highest mean and the lowest variance to determine the systematic changes before the seizure. Thus, the highest performing process is described as EEG-Aura. The average success for the EEG-Aura process was 90.38 ± 6.28%, 89.78 ± 8.34% and 90.47 ± 5.95% for accuracy, specificity and sensitivity, respectively. Through the proposed model, epilepsy patients who do not respond to medical treatment methods are expected to maintain their lives in a more comfortable and integrated way.
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42
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Abdel‐Mannan O, Sutcliffe AG. A national surveillance study of childhood epilepsy mortality in the UK and Ireland. Eur J Neurol 2019; 27:327-333. [DOI: 10.1111/ene.14081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/03/2019] [Indexed: 11/27/2022]
Affiliation(s)
- O. Abdel‐Mannan
- Department of Neurology Great Ormond Street Hospital for Children NHS Trust London UK
| | - A. G. Sutcliffe
- Population, Policy and Practice Unit UCL Great Ormond Street Institute of Child Health London UK
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Mbizvo GK, Bennett K, Simpson CR, Duncan SE, Chin RFM. Epilepsy-related and other causes of mortality in people with epilepsy: A systematic review of systematic reviews. Epilepsy Res 2019; 157:106192. [PMID: 31526975 DOI: 10.1016/j.eplepsyres.2019.106192] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND This systematic review of epilepsy mortality systematic reviews evaluates comparative risks, causes, and risk factors for all-cause mortality in people with epilepsy (PWE) to specifically establish the burden of epilepsy-related deaths. METHODS MEDLINE and Embase were searched from conception to 26/12/2018 for systematic reviews evaluating all-cause mortality in PWE of any age. Independent study selection, data extraction and quality assessment were performed. Deaths were separated into epilepsy-related and unrelated using a recently published classification system. Outcomes included standardized mortality ratio (SMR) and mortality rate (MR) in a primary analysis of comparative risks, causes, and risk factors for all-cause and epilepsy-related mortality. A narrative synthesis of review findings was used to present results, including from a secondary analysis of individual epilepsy-related death risk factors. RESULTS Six moderate or high-quality systematic reviews were included in the primary analysis, evaluating 103 observational studies. All-cause mortality remained similarly high between 1950 and present (median SMR range 2.2-3.4). Africa had the highest SMR (median 5.4, range 2.6-7.2). SMRs were also higher for children <18 years (median 7.5, range 3.1-22.4) than adults (median 2.6, range 1.3-8.7), and for epilepsy-related (median 3.8, range 0.0-82.4,) than unrelated causes (median 1.7, range 0.7-17.6). Structural brain disease conferred the greatest risk for all-cause mortality (SMR range 24.0-41.5). Common epilepsy-related causes included alcohol, drowning, pneumonia, and suicide. In secondary analysis of nine additional systematic reviews, epilepsy-related death risk factors were reported for sudden unexpected death in epilepsy (SUDEP), drowning and suicide. CONCLUSIONS Premature all-cause mortality remains a major problem in PWE globally, particularly in children and young adults, with most being epilepsy-related and potentially preventable. SUDEP is only one of several other common and important epilepsy-related causes of death.
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Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
| | - Kyle Bennett
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK.
| | - Colin R Simpson
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand; Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Susan E Duncan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK; Royal Hospital for Sick Children, Edinburgh, UK.
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44
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Bolea I, Gella A, Sanz E, Prada-Dacasa P, Menardy F, Bard AM, Machuca-Márquez P, Eraso-Pichot A, Mòdol-Caballero G, Navarro X, Kalume F, Quintana A. Defined neuronal populations drive fatal phenotype in a mouse model of Leigh syndrome. eLife 2019; 8:e47163. [PMID: 31403401 PMCID: PMC6731060 DOI: 10.7554/elife.47163] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/11/2019] [Indexed: 12/12/2022] Open
Abstract
Mitochondrial deficits in energy production cause untreatable and fatal pathologies known as mitochondrial disease (MD). Central nervous system affectation is critical in Leigh Syndrome (LS), a common MD presentation, leading to motor and respiratory deficits, seizures and premature death. However, only specific neuronal populations are affected. Furthermore, their molecular identity and their contribution to the disease remains unknown. Here, using a mouse model of LS lacking the mitochondrial complex I subunit Ndufs4, we dissect the critical role of genetically-defined neuronal populations in LS progression. Ndufs4 inactivation in Vglut2-expressing glutamatergic neurons leads to decreased neuronal firing, brainstem inflammation, motor and respiratory deficits, and early death. In contrast, Ndufs4 deletion in GABAergic neurons causes basal ganglia inflammation without motor or respiratory involvement, but accompanied by hypothermia and severe epileptic seizures preceding death. These results provide novel insight in the cell type-specific contribution to the pathology, dissecting the underlying cellular mechanisms of MD.
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Affiliation(s)
- Irene Bolea
- Center for Developmental Therapeutics, Seattle Children’s Research InstituteSeattleUnited States
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Alejandro Gella
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Biochemistry and Molecular BiologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Elisenda Sanz
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Patricia Prada-Dacasa
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Fabien Menardy
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Angela M Bard
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | | | - Abel Eraso-Pichot
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
| | - Guillem Mòdol-Caballero
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)BellaterraSpain
| | - Xavier Navarro
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)BellaterraSpain
| | - Franck Kalume
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological SurgeryUniversity of WashingtonSeattleUnited States
- Department of PharmacologyUniversity of WashingtonSeattleUnited States
| | - Albert Quintana
- Center for Developmental Therapeutics, Seattle Children’s Research InstituteSeattleUnited States
- Institut de Neurociències, Universitat Autònoma de BarcelonaBellaterraSpain
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Cell Biology, Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterraSpain
- Department of PediatricsUniversity of WashingtonSeattleUnited States
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45
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Lee KH, Lee YJ, Seo JH, Baumgartner JE, Westerveld M. Epilepsy Surgery in Children versus Adults. J Korean Neurosurg Soc 2019; 62:328-335. [PMID: 31085959 PMCID: PMC6514317 DOI: 10.3340/jkns.2019.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/24/2019] [Indexed: 11/29/2022] Open
Abstract
Epilepsy is one of the most common chronic neurological disorder affecting 6–7 per 1000 worldwide. Nearly one-third of patients with newly diagnosed epilepsy continue to have recurrent seizures despite adequate trial of more than two anti-seizure drugs : drug-resistant epilepsy (DRE). Children with DRE often experience cognitive and psychosocial co-morbidities requiring more urgent and aggressive treatment than adults. Epilepsy surgery can result in seizure-freedom in approximately two-third of children with improvement in cognitive development and quality of life. Understanding fundamental differences in etiology, co-morbidity, and neural plasticity between children and adults is critical for appropriate selection of surgical candidates, appropriate presurgical evaluation and surgical approach, and improved overall outcome.
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Affiliation(s)
- Ki Hyeong Lee
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
| | - Yun-Jin Lee
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA.,Department of Pediatrics, Pusan University College of Medicine, Yangsan, Korea
| | - Joo Hee Seo
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
| | | | - Michael Westerveld
- Comprehensive Epilepsy Center, Advent Health for Children, Orlando, FL, USA
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Goswami JN, Sharma S. Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatr Dis Treat 2019; 15:3273-3285. [PMID: 31819454 PMCID: PMC6883945 DOI: 10.2147/ndt.s201862] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/18/2019] [Indexed: 12/31/2022] Open
Abstract
Drug-refractory epilepsy is a commonly prevalent pediatric neurological illness of global significance. Ketogenic diet (KD) is a time-tested therapeutic modality for refractory epilepsy, which has reemerged as a robust alternative to anti-epileptic pharmacotherapy. There is a growing body of evidence which supports the anti-seizure efficacy, safety profile and feasibility of KD use in childhood epilepsy. In addition, this modality has been recognized to reduce anti-epileptic exposure, improve cognition and behavioral profile of patients as well as improve the quality-of-life of care-givers. Current indications of KD include refractory epilepsy syndromes, selected metabolic disorders (such as pyruvate dehydrogenase deficiency) and a host of varied neurological entities. KD research has broadened the knowledge-base about its mechanisms of action. Four types of KD are in vogue currently with varying nutritional constitution, palatability, administration protocols and comparable efficacy. KD initiation and maintenance are the result of concerted effort of a team of pediatric neurologist/epileptologist, nutritionist and patient's primary care-giver. Consensus is being formulated about various practical aspects of KD such as patient-selection, parental counseling, baseline work-up, dietary prescription, nutritional supplementation, concurrent anti-epileptic drug administration, follow-up and treatment-duration. Novel applications of KD include its use in neonatal epilepsy and super-refractory status epilepticus and tailor-made formulations such as cooking oil-based KD in predominantly rice-fed populations. Increasing body of clinical experience, improved nutritional designs and translational research are promoting KD as a major therapeutic modality. Currently, KD forms a core essence in the armamentarium against refractory epilepsy. In this review, we summarize the recent advances and current perspectives in the use of KD in refractory epilepsy.
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Affiliation(s)
| | - Suvasini Sharma
- Neurology Division, Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi 110001, India
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