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Huang LY, Ge YJ, Fu Y, Zhao YL, Ou YN, Zhang Y, Ma LZ, Chen SD, Guo ZX, Feng JF, Cheng W, Tan L, Yu JT. Identifying modifiable factors and their joint effect on brain health: an exposome-wide association study. GeroScience 2024; 46:6257-6268. [PMID: 38822946 PMCID: PMC11493923 DOI: 10.1007/s11357-024-01224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
Considerable uncertainty remains regarding the associations of multiple factors with brain health. We aimed to conduct an exposome-wide association study on neurodegenerative disease and neuropsychiatry disorders using data of participants from the UK Biobank. Multivariable Cox regression models with the least absolute shrinkage and selection operator technique as well as principal component analyses were used to evaluate the exposures in relation to common disorders of central nervous system (CNS). Restricted cubic splines were conducted to explore potential nonlinear correlations. Then, weighted standardized scores were generated based on the coefficients to calculate the joint effects of risk factors. We also estimated the potential impact of eliminating the unfavorable profiles of risk domains on CNS disorders using population attributable fraction (PAF). Finally, sensitivity analyses were performed to reduce the risk of reverse causality. The current study discovered the significantly associated exposures fell into six primary exposome categories. The joint effects of identified risk factors demonstrated higher risks for common disorders of CNS (HR = 1.278 ~ 3.743, p < 2e-16). The PAF varied by exposome categories, with lifestyle and medical history contributing to majority of disease cases. In total, we estimated that up to 3.7 ~ 64.1% of disease cases could be prevented.This study yielded modifiable variables of different categories and assessed their joint effects on common disorders of CNS. Targeting the identified exposures might help formulate effective strategies for maintaining brain health.
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Affiliation(s)
- Liang-Yu Huang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yi-Jun Ge
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Fu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yong-Li Zhao
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yi Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ling-Zhi Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shi-Dong Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ze-Xin Guo
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Wei Cheng
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Fudan ISTBI-ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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March M, Bar O, Chadehumbe M, Catterall K, Mintz M. The Clinical Utility of Finding Unexpected Subclinical Spikes Detected by High-Density EEG During Neurodiagnostic Investigations. Clin EEG Neurosci 2024:15500594241284090. [PMID: 39289916 DOI: 10.1177/15500594241284090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
This study aimed to analyze the frequency of unexpected subclinical spikes (USCS) in pediatric patients who underwent high-density electroencephalogram (HD-EEG). Of the 4481 successful HD-EEG studies, 18.5% (829) were abnormal, and 49.7% of these abnormal studies showed SCS, of which 64.1% were USCS. USCS were found to be correlated with attention/concentration deficits and executive dysfunction, often accompanied by the dual psychiatric diagnosis of ADHD. MRI revealed abnormal findings in 32.6% of the subjects with USCS, such as abnormal signal or signal hyperintensity in brain parenchyma, temporal or arachnoid cysts, and vascular malformations. Moreover, the USCS group who received neuropsychiatric testing scored lower than the population mean on Full-Scale Intelligence Quotient, Working Memory Index, and Processing Speed Index. This study highlights the potential of USCS as biomarkers that can lead to changes in clinical management and outcomes, provide valuable information about pathophysiological mechanisms, and suggest potential treatment pathways.
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Affiliation(s)
| | - Omri Bar
- NeurAbilities Healthcare, Voorhees, New Jersey, USA
| | | | | | - Mark Mintz
- NeurAbilities Healthcare, Voorhees, New Jersey, USA
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Kovács Z, Rauch E, D’Agostino DP, Ari C. Putative Role of Adenosine A1 Receptors in Exogenous Ketone Supplements-Evoked Anti-Epileptic Effect. Int J Mol Sci 2024; 25:9869. [PMID: 39337356 PMCID: PMC11432942 DOI: 10.3390/ijms25189869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Approximately 30% of patients with epilepsy are drug-refractory. There is an urgent need to elucidate the exact pathophysiology of different types of epilepsies and the mechanisms of action of both antiseizure medication and metabolic therapies to treat patients more effectively and safely. For example, it has been demonstrated that exogenous ketone supplement (EKS)-generated therapeutic ketosis, as a metabolic therapy, may decrease epileptic activity in both animal models and humans, but its exact mechanism of action is unknown. However, it was demonstrated that therapeutic ketosis, among others, can increase adenosine level, which may enhance activity of A1 adenosine receptors (A1Rs) in the brain. It has also been demonstrated previously that adenosine has anti-epileptic effect through A1Rs in different models of epilepsies. Thus, it is possible that (i) therapeutic ketosis generated by the administration of EKSs may exert its anti-epileptic effect through, among other mechanisms, increased adenosine level and A1R activity and that (ii) the enhanced activity of A1Rs may be a necessary anti-epileptic mechanism evoked by EKS administration-generated ketosis. Moreover, EKSs can evoke and maintain ketosis without severe side effects. These results also suggest that the therapeutic application of EKS-generated ketosis may be a promising opportunity to treat different types of epilepsies. In this literature review, we specifically focus on the putative role of A1Rs in the anti-epileptic effect of EKS-induced ketosis.
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Affiliation(s)
- Zsolt Kovács
- Department of Biology, BDTTC, ELTE Eötvös Loránd University, Károlyi Gáspár tér 4., 9700 Szombathely, Hungary or (Z.K.); (E.R.)
| | - Enikő Rauch
- Department of Biology, BDTTC, ELTE Eötvös Loránd University, Károlyi Gáspár tér 4., 9700 Szombathely, Hungary or (Z.K.); (E.R.)
- Institute of Biology, University of Pécs, Ifjúság Str. 6, 7624 Pécs, Hungary
| | - Dominic P. D’Agostino
- Ketone Technologies LLC., Tampa, FL 33612, USA;
- Department of Molecular Pharmacology and Physiology, Laboratory of Metabolic Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- Institute for Human and Machine Cognition, Ocala, FL 34471, USA
| | - Csilla Ari
- Ketone Technologies LLC., Tampa, FL 33612, USA;
- Department of Psychology, Behavioral Neuroscience Research Laboratory, University of South Florida, Tampa, FL 33620, USA
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Watanabe RGS, Thais MERDO, Marmentini EL, Freitas TG, Wolf P, Lin K. Theory of mind in epilepsy. Epilepsy Behav 2024; 158:109910. [PMID: 38959746 DOI: 10.1016/j.yebeh.2024.109910] [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: 01/15/2024] [Revised: 04/28/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024]
Abstract
Epilepsy is characterized by recurrent, chronic, and unprovoked seizures. Epilepsy has a significant negative impact on a patient's quality of life even if seizures are well controlled. In addition to the distress caused by seizures, patients with epilepsy (PwE) may suffer from cognitive impairment with serious social consequences such as poor interpersonal relationships, loss of employment, and reduced social networks. Pathological changes and functional connectivity abnormalities observed in PwE can disrupt the neural network responsible for the theory of mind. Theory of mind is the ability to attribute mental states to other people (intentions, beliefs, and emotions). It is a complex aspect of social cognition and includes cognitive and affective constructs. In recent years, numerous studies have assessed the relationship between social cognition, including the theory of mind, in PwE, and suggested impairment in this domain. Interventions targeting the theory of mind can be potentially helpful in improving the quality of life of PwE.
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Affiliation(s)
- Rafael Gustavo Sato Watanabe
- Medical Sciences Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, UFSC, Florianópolis, SC, Brazil.
| | | | | | - Tatiana Goes Freitas
- Medical Sciences Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Medical Sciences Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, UFSC, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Katia Lin
- Medical Sciences Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, UFSC, Florianópolis, SC, Brazil; Centre for Applied Neurosciences, UFSC, SC, Brazil
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Xiao L, Xiang S, Chen C, Zhu H, Zhou M, Tang Y, Feng L, Hu S. Association of synaptic density and cognitive performance in temporal lobe epilepsy: Humans and animals PET imaging study with [ 18F]SynVesT-1. Psychiatry Clin Neurosci 2024; 78:456-467. [PMID: 38804583 DOI: 10.1111/pcn.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 05/29/2024]
Abstract
AIM Cognitive impairment is a common comorbidity in individuals with temporal lobe epilepsy (TLE), yet the underlying mechanisms remain unknown. This study explored the putative association between in vivo synaptic loss and cognitive outcomes in TLE patients by PET imaging of synaptic vesicle glycoprotein 2A (SV2A). METHODS We enrolled 16 TLE patients and 10 cognitively normal controls. All participants underwent SV2A PET imaging using [18F]SynVesT-1 and cognitive assessment. Lithium chloride-pilocarpine-induced rats with status epilepticus (n = 20) and controls (n = 6) rats received levetiracetam (LEV, specifically binds to SV2A), valproic acid (VPA), or saline for 14 days. Then, synaptic density was quantified by [18F]SynVesT-1 micro-PET/CT. The novel object recognition and Morris water maze tests evaluated TLE-related cognitive function. SV2A expression was examined and confirmed by immunohistochemistry. RESULTS Temporal lobe epilepsy patients showed significantly reduced synaptic density in hippocampus, which was associated with cognitive performance. In the rat model of TLE, the expression of SV2A and synaptic density decreased consistently in a wider range of brain regions, including the entorhinal cortex, insula, hippocampus, amygdala, thalamus, and cortex. We treated TLE animal models with LEV or VPA to explore whether synaptic loss contributes to cognitive deficits. It was found that LEV significantly exerted protective effects against brain synaptic deficits and cognitive impairment. CONCLUSION This is the first study to link synaptic loss to cognitive deficits in TLE, suggesting [18F]SynVesT-1 PET could be a promising biomarker for monitoring synaptic loss and cognitive dysfunction. LEV might help reverse synaptic deficits and ameliorate learning and memory impairments in TLE patients.
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Affiliation(s)
- Ling Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shijun Xiang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, China
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Mukaino T. [Memory impairments in temporal lobe epilepsy]. Rinsho Shinkeigaku 2024; 64:453-459. [PMID: 38910118 DOI: 10.5692/clinicalneurol.cn-001886] [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: 06/25/2024]
Abstract
Temporal lobe epilepsy is known to present with various cognitive impairments, among which memory deficits are frequently reported by patients. Memory deficits can be classified into two types: classical hippocampal amnesia, which is characterized by abnormalities detected in neuropsychological assessments, and atypical memory deficits, such as accelerated long-term amnesia and autobiographical memory impairment, which cannot be identified using standard testing methods. These deficits are believed to arise from a complex interplay among structural brain abnormalities, interictal epileptic discharges, pharmacological factors, and psychological states. While fundamental treatments are limited, there are opportunities for interventions such as environmental adjustments and rehabilitation. This review article aims to provide a comprehensive overview of the types, underlying pathophysiology, and intervention methods for memory disorders observed in patients with temporal lobe epilepsy.
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Duma GM, Cuozzo S, Wilson L, Danieli A, Bonanni P, Pellegrino G. Excitation/Inhibition balance relates to cognitive function and gene expression in temporal lobe epilepsy: a high density EEG assessment with aperiodic exponent. Brain Commun 2024; 6:fcae231. [PMID: 39056027 PMCID: PMC11272395 DOI: 10.1093/braincomms/fcae231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Patients with epilepsy are characterized by a dysregulation of excitation/inhibition balance (E/I). The assessment of E/I may inform clinicians during the diagnosis and therapy management, even though it is rarely performed. An accessible measure of the E/I of the brain represents a clinically relevant feature. Here, we exploited the exponent of the aperiodic component of the power spectrum of the electroencephalography (EEG) signal, as a non-invasive and cost-effective proxy of the E/I balance. We recorded resting-state activity with high-density EEG from 67 patients with temporal lobe epilepsy and 35 controls. We extracted the exponent of the aperiodic fit of the power spectrum from source-reconstructed EEG and tested differences between patients with epilepsy and controls. Spearman's correlation was performed between the exponent and clinical variables (age of onset, epilepsy duration and neuropsychology) and cortical expression of epilepsy-related genes derived from the Allen Human Brain Atlas. Patients with temporal lobe epilepsy showed a significantly larger exponent, corresponding to inhibition-directed E/I balance, in bilateral frontal and temporal regions. Lower E/I in the left entorhinal and bilateral dorsolateral prefrontal cortices corresponded to a lower performance of short-term verbal memory. Limited to patients with temporal lobe epilepsy, we detected a significant correlation between the exponent and the cortical expression of GABRA1, GRIN2A, GABRD, GABRG2, KCNA2 and PDYN genes. EEG aperiodic exponent maps the E/I balance non-invasively in patients with epilepsy and reveals a close relationship between altered E/I patterns, cognition and genetics.
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Affiliation(s)
- Gian Marco Duma
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Simone Cuozzo
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Luc Wilson
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
| | - Alberto Danieli
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Paolo Bonanni
- Scientific Institute IRCCS E.Medea, Epilepsy and Clinical Neurophysiology Unit, 31015, Conegliano, Italy
| | - Giovanni Pellegrino
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London N6A5C1, Canada
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Cano-López I, Catalán-Aguilar J, Lozano-García A, Hidalgo V, Hampel KG, Tormos-Pons P, Salvador A, Villanueva V, González-Bono E. Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity. Clin Neuropsychol 2024:1-24. [PMID: 38965831 DOI: 10.1080/13854046.2024.2375605] [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: 04/28/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion. RESULTS Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47). CONCLUSIONS Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.
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Affiliation(s)
- Irene Cano-López
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Judit Catalán-Aguilar
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alejandro Lozano-García
- Faculty of Health Sciences, Valencian International University, Valencia, Spain
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
| | - Vanesa Hidalgo
- Department of Psychology and Sociology, Area of Psychobiology, Social and Human Sciences Center, University of Zaragoza, Teruel, Spain
| | - Kevin G Hampel
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paula Tormos-Pons
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Alicia Salvador
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Neurology Service, Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Esperanza González-Bono
- Institut d'Investigació en Psicologia dels Recursos Humans, del Desenvolupament Organitzacional i de la Qualitat de Vida Laboral (IDOCAL)/Department of Psychobiology, Psychology Center, Universitat de València, Valencia, Spain
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Liu S, Cao Z, He Z, Shi W, Li J. Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study. Epilepsy Behav 2024; 155:109775. [PMID: 38640724 DOI: 10.1016/j.yebeh.2024.109775] [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: 01/06/2024] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities. METHODS A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms. RESULTS A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01). DISCUSSION Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.
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Affiliation(s)
- Shengyi Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhen Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Geriatrics, The Second People's Hospital of Yibin, Yibin, China.
| | - Zihua He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China.
| | - Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Xie K, Royer J, Larivière S, Rodriguez-Cruces R, Frässle S, Cabalo DG, Ngo A, DeKraker J, Auer H, Tavakol S, Weng Y, Abdallah C, Arafat T, Horwood L, Frauscher B, Caciagli L, Bernasconi A, Bernasconi N, Zhang Z, Concha L, Bernhardt BC. Atypical connectome topography and signal flow in temporal lobe epilepsy. Prog Neurobiol 2024; 236:102604. [PMID: 38604584 DOI: 10.1016/j.pneurobio.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/18/2023] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
Temporal lobe epilepsy (TLE) is the most common pharmaco-resistant epilepsy in adults. While primarily associated with mesiotemporal pathology, recent evidence suggests that brain alterations in TLE extend beyond the paralimbic epicenter and impact macroscale function and cognitive functions, particularly memory. Using connectome-wide manifold learning and generative models of effective connectivity, we examined functional topography and directional signal flow patterns between large-scale neural circuits in TLE at rest. Studying a multisite cohort of 95 patients with TLE and 95 healthy controls, we observed atypical functional topographies in the former group, characterized by reduced differentiation between sensory and transmodal association cortices, with most marked effects in bilateral temporo-limbic and ventromedial prefrontal cortices. These findings were consistent across all study sites, present in left and right lateralized patients, and validated in a subgroup of patients with histopathological validation of mesiotemporal sclerosis and post-surgical seizure freedom. Moreover, they were replicated in an independent cohort of 30 TLE patients and 40 healthy controls. Further analyses demonstrated that reduced differentiation related to decreased functional signal flow into and out of temporolimbic cortical systems and other brain networks. Parallel analyses of structural and diffusion-weighted MRI data revealed that topographic alterations were independent of TLE-related cortical thinning but partially mediated by white matter microstructural changes that radiated away from paralimbic circuits. Finally, we found a strong association between the degree of functional alterations and behavioral markers of memory dysfunction. Our work illustrates the complex landscape of macroscale functional imbalances in TLE, which can serve as intermediate markers bridging microstructural changes and cognitive impairment.
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Affiliation(s)
- Ke Xie
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada; Analytical Neurophysiology Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Raul Rodriguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Stefan Frässle
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Donna Gift Cabalo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Jordan DeKraker
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Hans Auer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Shahin Tavakol
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chifaou Abdallah
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Thaera Arafat
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Linda Horwood
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada; Analytical Neurophysiology Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada; Department of Neurology, Duke University School of Medicine and Department of Biomedical Engineering, Duke University Pratt School of Engineering, Durham, NC 27705, USA
| | - Lorenzo Caciagli
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, Inselspital, Sleep-Wake-Epilepsy-Center, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3 BG, United Kingdom
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de Mexico (UNAM), Queretaro, Mexico
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC H3A 2B4, Canada.
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11
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Ceasar Kimera J, Mpungu Nakimuli E, Kampikaho Turiho A, Levin J, Kaddumukasa M, Sajatovic M, Katabira E, Kaddumukasa M. Prevalence and factors associated with psychosis among adults with epilepsy at a tertiary hospital in Uganda, cross-sectional study. Epilepsy Behav 2024; 153:109691. [PMID: 38368789 PMCID: PMC11019152 DOI: 10.1016/j.yebeh.2024.109691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/10/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Psychotic disorders are prevalent among people with epilepsy compared to the general population. However, there is limited information regarding psychosis among people with epilepsy in Uganda. This study therefore determined the prevalence and associated factors of psychosis among adults with epilepsy attending Butabika National Referral Mental Hospital in Uganda. METHODS This was a cross-sectional study involving adults with epilepsy. The diagnosis of psychosis was assessed using the Mini-International Neuropsychiatric Interview, module for Psychotic disorders. Logistic regression analysis identified factors associated with psychosis. RESULTS Out of 250 participants, 6.8% had psychosis and 13.6% had depression. Psychosis was significantly associated with older age, greater perceived stigma and substance use. CONCLUSION Psychosis affects nearly 7% of adults with epilepsy in Uganda especially among those who are older, with perceived stigma and substance use. Routine screening and early intervention to management of psychosis in PWE is highly recommended.
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Affiliation(s)
- Julius Ceasar Kimera
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Etheldreda Mpungu Nakimuli
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Andrew Kampikaho Turiho
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Jennifer Levin
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Martin Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Gandelman-Marton R, Theitler J. Trends in enzyme-inducing antiseizure medication use: A retrospective analysis among adults with epilepsy. Epilepsy Behav 2024; 152:109662. [PMID: 38277853 DOI: 10.1016/j.yebeh.2024.109662] [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: 10/26/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Enzyme-inducing antiseizure medications (EIASMs) were associated with drug interactions and long-term adverse effects. Therefore, it was suggested that epilepsy treatment should be started with non-EIASMs, and in patients treated with EIASMs, replacement with non-EIASMs should be evaluated OBJECTIVE: To assess potent EIASM use among patients with epilepsy at their first visit in our epilepsy outpatient clinic. METHODS We retrospectively reviewed the computerized database and the medical records of all the patients who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021). Of 730 patients with ASM treated epilepsy, 243 (33%) were receiving potent EIASMs. RESULTS The annual potent EIASM use decreased from 35.1 % in 2012 to 11.8 % in 2021. Most of the patients who received potent EIASM had their first visit during 2012-2015 compared to the following years (56.8 % vs 43.2 %) (p = 0.0001). Patients with epilepsy receiving potent EIASMs were older (44.3 vs 34.7) (p = 0.0001), more likely men (60.9 % vs 47.2 %) (p = 0.001), with longer disease duration (13 vs 9.3 y) (p = 0.0001), higher rate of neuropsychiatric comorbidity (37 % vs 27.9 %) (p = 0.014), and were treated with more ASMs (1.6 vs 1.3) (p = 0.0001) compared to patients receiving non-EIASMs. CONCLUSIONS Potent EIASM use has been declining over the past decade. Additional efforts to further decrease EIASM use should be exerted among all patients with ASM-treated epilepsy, with emphasis on men with focal epilepsy and epilepsy duration > 10 years.
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Affiliation(s)
- Revital Gandelman-Marton
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Israel.
| | - Jacques Theitler
- Neurology Department, Shamir-Assaf Harofeh Medical Center, Zerifin, Israel; Faculty of Medicine, Tel Aviv University, Israel
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Ibañez-Micó S, López-Pina JA, Gómez-Conesa A. Cross-cultural validation and psychometric properties of the Spanish version of the quality of life in Childhood epilepsy Questionnaire (QOLCE-55). Epilepsy Behav 2024; 151:109619. [PMID: 38194772 DOI: 10.1016/j.yebeh.2023.109619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE The aims of the present study were to translate and validate the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) into Spanish. METHODS A backtranslation procedure was used to translate the English version of QOLCE-55 to Spanish, and subsequently, parents of 88 children (aged four to 12 years), completed the Spanish version of three self-reported questionnaires: the QOLCE-55, the Pediatric Quality-of-Life Inventory (PedsQLTM 4.0), and the Pediatric Sleep Questionnaire (PSQ). Seven to 10 days later, parents completed the questionnaires again under the same conditions. RESULTS Internal consistency was between 0.669 and 0.968 for the four subscales: cognitive (CF), emotional (EF), social (SF) and physical functioning (PF); and 0.954 for the total score. The test-retest reliability assessed with the intraclass correlation coefficient obtained values from 0.683 for SF to 0.962 for CF. The standard error of measurement for the total score was 5.776, and the minimal detectable change was 16.01. Spearman correlations between the total score of the Spanish version of the QOLCE-55 with the subscales was 0.760 for the CF, 0.776 for the EF, 0.799 for the SF, and 0.682 for the PF (p < 0.001). Convergent validity of QOLCE-55 with the PedsQLTM 4.0 scale was -0.962 (p < 0.001), and the discriminant validity of the QOLCE-55 with PSQ was 0.154 (p = 0.272). This version presented a correlation with maximum lifetime consumption of anti-epileptic drugs (0.500; p < 0.001), and current consumption (0.448; p < 0.001). CONCLUSIONS The Spanish version of the QOLCE-55 has demonstrated adequate psychometric properties, indicating that it can be confidently used to measure the health-related quality-of-life (HRQoL) in children with epilepsy in a Spanish-speaking population. These results corroborate the instrument's cross-cultural validity.
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Affiliation(s)
- Salvador Ibañez-Micó
- Pediatric Neurology Unit, Virgen de la Arrixaca University Clinic Hospital, Murcia, Spain.
| | - José A López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, 30100 Murcia, Spain; Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain.
| | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain.
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14
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Krauss GL, Chung SS, Ferrari L, Stern S, Rosenfeld WE. Cognitive and psychiatric adverse events during adjunctive cenobamate treatment in phase 2 and phase 3 clinical studies. Epilepsy Behav 2024; 151:109605. [PMID: 38184949 DOI: 10.1016/j.yebeh.2023.109605] [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: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Cognitive and psychiatric adverse events in patients with epilepsy are important determinants of therapeutic outcomes and patient quality of life. We assessed the relationship between adjunctive cenobamate treatment and selected cognitive and psychiatric treatment-emergent adverse events (TEAEs) in adults with uncontrolled focal epilepsy. METHODS This was a retrospective analysis of pooled populations of patients with focal epilepsy from two phase 2, randomized, double-blind clinical trials; two open-label extensions (OLEs) of those trials; and a long-term, open-label, phase 3 safety study. Occurrence of cognitive and psychiatric TEAEs in patients treated with adjunctive cenobamate or placebo during double-blind treatment were evaluated. Exposure-adjusted incidence rates of the cognitive and psychiatric TEAEs, defined as the number of TEAEs per patient-year of treatment, during up to 7 years of long-term adjunctive cenobamate treatment, were determined in the pooled OLE and phase 3 patient populations. RESULTS The pooled randomized trials resulted in a population of 442 patients treated with cenobamate (100 mg/day: n = 108; 200 mg/day: n = 223; 400 mg/day: n = 111) and 216 placebo-treated patients. The combined open-label studies resulted in pooled populations of cenobamate-treated patients ranging from n = 1690 during Year 1 to n = 103 during Year 7. Among cenobamate-treated (all doses) and placebo-treated patients during double-blind treatment, cognitive TEAEs were reported by ≤ 1.9 % (range, 0 %-1.9 %) and ≤ 0.5 % (range, 0 %-0.5 %), respectively, and psychiatric TEAEs by ≤ 3.6 % (range, 0 %-3.6 %) and ≤ 3.2 % (range, 0 %-3.2 %), respectively. During up to 7 years of open-label adjunctive cenobamate treatment, exposure-adjusted incidence rates of cognitive and psychiatric TEAEs were < 0.018 and < 0.038 events per patient-year, respectively. Discontinuation of adjunctive cenobamate due to cognitive or psychiatric TEAEs assessed in this study during double-blind or open-label treatment occurred in ≤ 0.3 % and ≤ 1.7 % of patients, respectively. CONCLUSIONS Cognitive and psychiatric TEAEs were reported by similar numbers of cenobamate- and placebo-treated patients during double-blind adjunctive cenobamate treatment (< 4 % of patients), and exposure-adjusted incidence rates of these TEAEs remained low during open-label cenobamate treatment for up to 7 years. Treatment discontinuations due to these TEAEs were rare. The results of this post-hoc analysis indicate that adjunctive cenobamate treatment exhibits a low incidence of cognitive or psychiatric TEAEs in patients with uncontrolled focal seizures.
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Affiliation(s)
- Gregory L Krauss
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Steve S Chung
- Neuroscience Institute, Banner-University Medical Center, 755 East McDowell Road, Phoenix, AZ 85006.
| | - Louis Ferrari
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - Sean Stern
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA.
| | - William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, 11134 Conway Road, St. Louis, MO 63131, USA.
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Hohmann L, Bien CG, Holtkamp M, Grewe P. German questionnaires assessing quality of life and psycho-social status in people with epilepsy: Reliable change and intercorrelations. Epilepsy Behav 2024; 150:109554. [PMID: 38041998 DOI: 10.1016/j.yebeh.2023.109554] [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: 08/21/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES People with epilepsy (PWE) not only suffer from seizures but also from various psycho-social issues containing facets such as social functioning, anxiety, depression or stigmatization, and consequently quality of life. (1) Assessing reliable change of these issues is crucial to evaluate their course and potential treatment effects. As most psycho-social self-report questionnaires have been validated in separate samples, their clinical-socio-demographic differences may limit the comparability and generalizability of the scales' internal consistency, which is important for the reliable change index (RCI). Using a co-normalized approach, we provide the internal consistency and RCIs for a large set of questionnaires targeting quality of life (QOLIE-31-P), depressive symptoms (NDDI-E), anxiety (GAD-7), seizure severity (LSSS), subjective antiseizure medication adverse events (LAEP), stigma, epilepsy-related fear, and restrictions in daily life (PESOS), and subjective cognition (FLei). As for some German versions of these measures, psychometric data is still missing, we also add important information for the German language area. (2) In addition, knowledge about intercorrelations of these constructs is needed to shape questionnaire usage and treatment approaches. We thus investigate associations of these scales and compare weighted and unweighted subscales of the QOLIE-31-P. METHODS In our prospective study, 202 adult in-patients of the Epilepsy-Center Berlin-Brandenburg with a reliable diagnosis of epilepsy filled out a set of self-report questionnaires between 03/2018 and 03/2021. We calculated Cronbach's α, RCIs, and bivariate intercorrelations and compared the respective correlations of weighted and unweighted scales of the QOLIE-31-P. RESULTS For most of the scales, good to excellent internal consistency was identified. Furthermore, we found intercorrelations in the expected directions with strong links between scales assessing similar constructs (e.g., QOLIE-31-P Cognition and FLei), but weak relationships between measures for different constructs (e.g., QOLIE-31-P Seizure worry and FLei). The QOLIE-31-P Total score was highly correlated with most of the other scales. Some differences regarding their correlational patterns for weighted and unweighted QOLIE-31-P scales were identified. CONCLUSIONS Psycho-social constructs share a large amount of common variance, but still can be separated from each other. The QOLIE-31-P Total score represents an adequate measure of general psycho-social burden.
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Affiliation(s)
- Louisa Hohmann
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany.
| | - Christian G Bien
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Martin Holtkamp
- Department of Neurology, Berlin-Brandenburg Epilepsy Center, Charité-Universitätsmedizin Berlin, corporate member of Free University and Humboldt University of Berlin, Berlin, Germany; Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Queen Elisabeth Herzberge Protestant Hospital, Berlin, Germany
| | - Philip Grewe
- Department of Epileptology, Mara Hospital (Bethel Epilepsy Center), Medical School OWL, Bielefeld University, Bielefeld, Germany; Neuropsychology and Epilepsy Research, Medical School OWL, Bielefeld University, Bielefeld, Germany
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16
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Bender AC, Jaleel A, Pellerin KR, Moguilner S, Sarkis RA, Cash SS, Lam AD. Altered Sleep Microarchitecture and Cognitive Impairment in Patients With Temporal Lobe Epilepsy. Neurology 2023; 101:e2376-e2387. [PMID: 37848332 PMCID: PMC10752648 DOI: 10.1212/wnl.0000000000207942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the spatiotemporal characteristics of sleep waveforms in temporal lobe epilepsy (TLE) and examine their association with cognition. METHODS In this retrospective, cross-sectional study, we examined overnight EEG data from adult patients with TLE and nonepilepsy comparisons (NECs) admitted to the epilepsy monitoring unit at Mass General Brigham hospitals. Automated algorithms were used to characterize sleep macroarchitecture (sleep stages) and microarchitecture (spindles, slow oscillations [SOs]) on scalp EEG and to detect hippocampal interictal epileptiform discharges (hIEDs) from foramen ovale electrodes simultaneously recorded in a subset of patients with TLE. We examined the association of sleep features and hIEDs with memory and executive function from clinical neuropsychological evaluations. RESULTS A total of 81 adult patients with TLE and 28 NEC adult patients were included with similar mean ages. There were no significant differences in sleep macroarchitecture between groups, including relative time spent in each sleep stage, sleep efficiency, and sleep fragmentation. By contrast, the spatiotemporal characteristics of sleep microarchitecture were altered in TLE compared with NEC and were associated with cognitive impairments. Specifically, we observed a ∼30% reduction in spindle density in patients with TLE compared with NEC, which was significantly associated with worse memory performance. Spindle-SO coupling strength was also reduced in TLE and, in contrast to spindles, was associated with diminished executive function. We found no significant association between sleep macroarchitectural and microarchitectural parameters and hIEDs. DISCUSSION There is a fundamental alteration of sleep microarchitecture in TLE, characterized by a reduction in spindle density and spindle-SO coupling, and these changes may contribute to neurocognitive comorbidity in this disorder.
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Affiliation(s)
- Alex C Bender
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA.
| | - Afareen Jaleel
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Kyle R Pellerin
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Sebastian Moguilner
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Rani A Sarkis
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Sydney S Cash
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
| | - Alice D Lam
- From the Epilepsy Service (A.C.B., A.J., K.R.P., S.M., S.S.C., A.D.L.), Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston; and Epilepsy Service (R.A.S.), Department of Neurology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA
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Liao P, Trollor J, Reppermund S, Cvejic RC, Srasuebkul P, Vajdic CM. Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1317-1335. [PMID: 36330725 PMCID: PMC10952954 DOI: 10.1111/jir.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). METHODS This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5-64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. RESULTS Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41-3.29). CONCLUSIONS Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors.
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Affiliation(s)
- P. Liao
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - J. Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - S. Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - R. C. Cvejic
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - P. Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
| | - C. M. Vajdic
- Centre for Big Data Research in Health, Faculty of Medicine and HealthUniversity of New South WalesSydneyNSWAustralia
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
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Chung KM, Hack J, Andrews J, Galindo-Kelly M, Schreiber J, Watkins J, Hammer MF. Clinical severity is correlated with age at seizure onset and biophysical properties of recurrent gain of function variants associated with SCN8A-related epilepsy. Epilepsia 2023; 64:3365-3376. [PMID: 37585367 DOI: 10.1111/epi.17747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Genetic variants in the SCN8A gene underlie a wide spectrum of neurodevelopmental phenotypes including several distinct seizure types and a host of comorbidities. One of the major challenges facing clinicians and researchers alike is to identify genotype-phenotype (G-P) correlations that may improve prognosis, guide treatment decisions, and lead to precision medicine approaches. METHODS We investigated G-P correlations among 270 participants harboring gain-of-function (GOF) variants enrolled in the International SCN8A Registry, a patient-driven online database. We performed correlation analyses stratifying the cohort by clinical phenotypes to identify diagnostic features that differ among patients with varying levels of clinical severity, and that differ among patients with distinct GOF variants. RESULTS Our analyses confirm positive correlations between age at seizure onset and developmental skills acquisition (developmental quotient), rate of seizure freedom, and percentage of cohort with developmental delays, and identify negative correlations with number of current and weaned antiseizure medications. This set of features is more detrimentally affected in individuals with a priori expectations of more severe clinical phenotypes. Our analyses also reveal a significant correlation between a severity index combining clinical features of individuals with a particular highly recurrent variant and an independent electrophysiological score assigned to each variant based on in vitro testing. SIGNIFICANCE This is one of the first studies to identify statistically significant G-P correlations for individual SCN8A variants with GOF properties. The results suggest that individual GOF variants (1) are predictive of clinical severity for individuals carrying those variants and (2) may underlie distinct clinical phenotypes of SCN8A disease, thus helping to explain the wide SCN8A-related epilepsy disease spectrum. These results also suggest that certain features present at initial diagnosis are predictive of clinical severity, and with more informed treatment plans, may serve to improve prognosis for patients with SCN8A GOF variants.
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Affiliation(s)
- Kyung Mi Chung
- BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Joshua Hack
- BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Jennifer Andrews
- Department of Pediatrics, University of Arizona, Tucson, Arizona, USA
| | | | - John Schreiber
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Joseph Watkins
- Department of Mathematics, University of Arizona, Tucson, Arizona, USA
| | - Michael F Hammer
- BIO5 Institute, University of Arizona, Tucson, Arizona, USA
- Neurology Department, University of Arizona, Tucson, Arizona, USA
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19
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Jhaveri DJ, McGonigal A, Becker C, Benoliel JJ, Nandam LS, Soncin L, Kotwas I, Bernard C, Bartolomei F. Stress and Epilepsy: Towards Understanding of Neurobiological Mechanisms for Better Management. eNeuro 2023; 10:ENEURO.0200-23.2023. [PMID: 37923391 PMCID: PMC10626502 DOI: 10.1523/eneuro.0200-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/03/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Stress has been identified as a major contributor to human disease and is postulated to play a substantial role in epileptogenesis. In a significant proportion of individuals with epilepsy, sensitivity to stressful events contributes to dynamic symptomatic burden, notably seizure occurrence and frequency, and presence and severity of psychiatric comorbidities [anxiety, depression, posttraumatic stress disorder (PTSD)]. Here, we review this complex relationship between stress and epilepsy using clinical data and highlight key neurobiological mechanisms including the hypothalamic-pituitary-adrenal (HPA) axis dysfunction, altered neuroplasticity within limbic system structures, and alterations in neurochemical pathways such as brain-derived neurotrophic factor (BNDF) linking epilepsy and stress. We discuss current clinical management approaches of stress that help optimize seizure control and prevention, as well as psychiatric comorbidities associated with epilepsy. We propose that various shared mechanisms of stress and epilepsy present multiple avenues for the development of new symptomatic and preventative treatments, including disease modifying therapies aimed at reducing epileptogenesis. This would require close collaborations between clinicians and basic scientists to integrate data across multiple scales, from genetics to systems biology, from clinical observations to fundamental mechanistic insights. In future, advances in machine learning approaches and neuromodulation strategies will enable personalized and targeted interventions to manage and ultimately treat stress-related epileptogenesis.
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Affiliation(s)
- Dhanisha J Jhaveri
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Aileen McGonigal
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Epilepsy Unit, Department of Neurosciences, Mater Hospital, Brisbane, QLD 4101, Australia
| | - Christel Becker
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
| | - Jean-Jacques Benoliel
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
- Site Pitié-Salpêtrière, Service de Biochimie Endocrinienne et Oncologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, 75651, France
| | - L Sanjay Nandam
- Turner Inst for Brain & Mental Health, Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Melbourne, 3800, Australia
| | - Lisa Soncin
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Côte d'Azur University, Nice, 06300, France
| | - Iliana Kotwas
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
| | - Christophe Bernard
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
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20
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Ballarà Petitbò M, González Alguacil E, Gutiérrez Delicado E, Ortiz Cabrera NV, Duat Rodríguez A, García Peñas JJ, Soto Insuga V. Neuropsychiatric comorbidities and cognition in epilepsy with eyelid myoclonia: A retrospective pediatric case series. Epileptic Disord 2023; 25:758-768. [PMID: 37584565 DOI: 10.1002/epd2.20148] [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: 02/16/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Epilepsy with eyelid myoclonia (EEM) is a rare epileptic syndrome classified within the Genetic Generalized Epilepsies of childhood. It is characterized by a high drug resistance, and little is known about prognostic factors and neurodevelopmental comorbidities. The aim of this study was to describe the clinical features, cognitive profile, and prognostic factors in a series of children with EEM. METHODS This is a retrospective observational study of patients diagnosed with EEM from 2012 to 2022 in a tertiary pediatric hospital. RESULTS Seventeen patients were analyzed (mean age at symptom onset 5.8 years). Neuropsychiatric comorbidities were present in 76.4% (attention deficit hyperactivity disorder 58.8%, behavioral disorder 11.8%, autism spectrum disorder 11.8%, and psychotic outbreaks 11.8%). Neurocognitive assessment was performed in 75%, revealing cognitive impairment in 66.6% (62.5% with borderline intellectual function and 37.5% with -IQ <70-), with predominant difficulties in executive functions, comprehensive language, and motor skills. Cognitive deterioration was observed in one patient in parallel onset with psychotic symptoms. High refractoriness to antiseizure medication (ASM) was observed, with only 23.5% of the patients being seizure-free after a mean follow-up of 7 years. The most effective ASM was valproic acid, and two of them received ketogenic diet with good response. Regarding prognostic factors, psychotic symptoms were associated with a greater number of antiseizure medication (p < .05) implying a more drug-resistant epilepsy. SIGNIFICANCE In our study, we found a high rate of cognitive and psychiatric comorbidities and high refractoriness. These data support the concept of EEM as an intermediate entity between idiopathic generalized epilepsy and epileptic and/or neurodevelopmental encephalopathy. Making a proper diagnosis and management of these comorbidities is necessary to improve prognosis and quality of life in EEM.
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Affiliation(s)
| | | | - Eva Gutiérrez Delicado
- Video-EEG Monitoring Unit, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | | | - Anna Duat Rodríguez
- Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | | | - Victor Soto Insuga
- Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
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21
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Carr HR, Brandt VC, Golm D, Hall JE. Linked head injury and conduct problem symptom pathways from early childhood to adolescence and their associated risks: Evidence from the millennium cohort study. Dev Psychopathol 2023:1-9. [PMID: 37665097 DOI: 10.1017/s0954579423001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Conduct problems and head injuries increase the risk of delinquency and share a bidirectional association. However, how they link across development is unknown. The present study aimed to identify their linked developmental pathways and associated risk factors. Latent class analysis was modeled from Millennium Cohort Study data (n = 8,600) to identify linked pathways of conduct problem symptoms and head injuries. Head injuries were parent-reported from ages 3 to 14 and conduct problems from ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ). Multinomial logistic regression then identified various risk factors associated with pathway membership. Four distinct pathways were identified. Most participants displayed low-level conduct problem symptoms and head injuries (n = 6,422; 74.7%). Three groups were characterized by clinically relevant levels of conduct problem symptoms and high-risk head injuries in childhood (n = 1,422; 16.5%), adolescence (n = 567; 6.6%), or persistent across development (n = 189; 2.2%). These clinically relevant pathways were associated with negative maternal parenting styles. These findings demonstrate how pathways of conduct problem symptoms are uniquely linked with distinct head injury pathways. Suggestions for general preventative intervention targets include early maternal negative parenting styles. Pathway-specific interventions are also required targeting cumulative risk at different ecological levels.
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Affiliation(s)
- Hannah R Carr
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
| | - Valerie C Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Dennis Golm
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, Southampton, UK
| | - James E Hall
- Southampton Education School, University of Southampton, Southampton, UK
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22
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Lu M, Feng R, Zhang C, Xiao Y, Yin C. Identifying Novel Drug Targets for Epilepsy Through a Brain Transcriptome-Wide Association Study and Protein-Wide Association Study with Chemical-Gene-Interaction Analysis. Mol Neurobiol 2023; 60:5055-5066. [PMID: 37246165 PMCID: PMC10415436 DOI: 10.1007/s12035-023-03382-z] [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: 11/23/2022] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Abstract
Epilepsy is a severe neurological condition affecting 50-65 million individuals worldwide that can lead to brain damage. Nevertheless, the etiology of epilepsy remains poorly understood. Meta-analyses of genome-wide association studies involving 15,212 epilepsy cases and 29,677 controls of the ILAE Consortium cohort were used to conduct transcriptome-wide association studies (TWAS) and protein-wide association studies (PWAS). Furthermore, a protein-protein interaction (PPI) network was generated using the STRING database, and significant epilepsy-susceptible genes were verified using chip data. Chemical-related gene set enrichment analysis (CGSEA) was performed to determine novel drug targets for epilepsy. TWAS analysis identified 21,170 genes, of which 58 were significant (TWASfdr < 0.05) in ten brain regions, and 16 differentially expressed genes were verified based on mRNA expression profiles. The PWAS identified 2249 genes, of which 2 were significant (PWASfdr < 0.05). Through chemical-gene set enrichment analysis, 287 environmental chemicals associated with epilepsy were identified. We identified five significant genes (WIPF1, IQSEC1, JAM2, ICAM3, and ZNF143) that had causal relationships with epilepsy. CGSEA identified 159 chemicals that were significantly correlated with epilepsy (Pcgsea < 0.05), such as pentobarbital, ketone bodies, and polychlorinated biphenyl. In summary, we performed TWAS, PWAS (for genetic factors), and CGSEA (for environmental factors) analyses and identified several epilepsy-associated genes and chemicals. The results of this study will contribute to our understanding of genetic and environmental factors for epilepsy and may predict novel drug targets.
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Affiliation(s)
- Mengnan Lu
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710054, Shanxi, China
| | - Ruoyang Feng
- Department of Joint Surgery, HongHui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shanxi, China
| | - Chenglin Zhang
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710054, Shanxi, China
| | - Yanfeng Xiao
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710054, Shanxi, China.
| | - Chunyan Yin
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710054, Shanxi, China.
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23
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Xie K, Royer J, Larivière S, Rodriguez-Cruces R, Frässle S, Cabalo DG, Ngo A, DeKraker J, Auer H, Tavakol S, Weng Y, Abdallah C, Horwood L, Frauscher B, Caciagli L, Bernasconi A, Bernasconi N, Zhang Z, Concha L, Bernhardt BC. Atypical connectome topography and signal flow in temporal lobe epilepsy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.23.541934. [PMID: 37292996 PMCID: PMC10245853 DOI: 10.1101/2023.05.23.541934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Temporal lobe epilepsy (TLE) is one of the most common pharmaco-resistant epilepsies in adults. While hippocampal pathology is the hallmark of this condition, emerging evidence indicates that brain alterations extend beyond the mesiotemporal epicenter and affect macroscale brain function and cognition. We studied macroscale functional reorganization in TLE, explored structural substrates, and examined cognitive associations. We investigated a multisite cohort of 95 patients with pharmaco-resistant TLE and 95 healthy controls using state-of-the-art multimodal 3T magnetic resonance imaging (MRI). We quantified macroscale functional topographic organization using connectome dimensionality reduction techniques and estimated directional functional flow using generative models of effective connectivity. We observed atypical functional topographies in patients with TLE relative to controls, manifesting as reduced functional differentiation between sensory/motor networks and transmodal systems such as the default mode network, with peak alterations in bilateral temporal and ventromedial prefrontal cortices. TLE-related topographic changes were consistent in all three included sites and reflected reductions in hierarchical flow patterns between cortical systems. Integration of parallel multimodal MRI data indicated that these findings were independent of TLE-related cortical grey matter atrophy, but mediated by microstructural alterations in the superficial white matter immediately beneath the cortex. The magnitude of functional perturbations was robustly associated with behavioral markers of memory function. Overall, this work provides converging evidence for macroscale functional imbalances, contributing microstructural alterations, and their associations with cognitive dysfunction in TLE.
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Affiliation(s)
- Ke Xie
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Raul Rodriguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stefan Frässle
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Donna Gift Cabalo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Alexander Ngo
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jordan DeKraker
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Hans Auer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Shahin Tavakol
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Yifei Weng
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chifaou Abdallah
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Linda Horwood
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Birgit Frauscher
- Analytical Neurophysiology Laboratory, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Lorenzo Caciagli
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Luis Concha
- Brain Connectivity Laboratory, Institute of Neurobiology, Universidad Nacional Autónoma de Mexico (UNAM), Mexico
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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24
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Kral A. Hearing and Cognition in Childhood. Laryngorhinootologie 2023; 102:S3-S11. [PMID: 37130527 PMCID: PMC10184669 DOI: 10.1055/a-1973-5087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The human brain shows extensive development of the cerebral cortex after birth. This is extensively altered by the absence of auditory input: the development of cortical synapses in the auditory system is delayed and their degradation is increased. Recent work shows that the synapses responsible for corticocortical processing of stimuli and their embedding into multisensory interactions and cognition are particularly affected. Since the brain is heavily reciprocally interconnected, inborn deafness manifests not only in deficits in auditory processing, but also in cognitive (non-auditory) functions that are affected differently between individuals. It requires individualized approaches in therapy of deafness in childhood.
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Affiliation(s)
- Andrej Kral
- Institut für AudioNeuroTechnologie (VIANNA) & Abt. für experimentelle Otologie, Exzellenzcluster Hearing4All, Medizinische Hochschule Hannover (Abteilungsleiter und Institutsleiter: Prof. Dr. A. Kral) & Australian Hearing Hub, School of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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25
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Maher C, Yang Y, Truong ND, Wang C, Nikpour A, Kavehei O. Seizure detection with reduced electroencephalogram channels: research trends and outlook. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230022. [PMID: 37153360 PMCID: PMC10154941 DOI: 10.1098/rsos.230022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
Epilepsy is a prevalent condition characterized by recurrent, unpredictable seizures. Monitoring with surface electroencephalography (EEG) is the gold standard for diagnosing epilepsy, but a time-consuming, uncomfortable and sometimes ineffective process for patients. Further, using EEG over a brief monitoring period has variable success, dependent on patient tolerance and seizure frequency. The availability of hospital resources and hardware and software specifications inherently restrict the options for comfortable, long-term data collection, resulting in limited data for training machine-learning models. This mini-review examines the current patient journey, providing an overview of the current state of EEG monitoring with reduced electrodes and automated channel reduction methods. Opportunities for improving data reliability through multi-modal data fusion are suggested. We assert the need for further research in electrode reduction to advance brain monitoring solutions towards portable, reliable devices that simultaneously offer patient comfort, perform ultra-long-term monitoring and expedite the diagnosis process.
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Affiliation(s)
- Christina Maher
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales 2006, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Yikai Yang
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Nhan Duy Truong
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales 2006, Australia
| | - Chenyu Wang
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales 2006, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2050, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, New South Wales 2050, Australia
| | - Armin Nikpour
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales 2006, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales 2006, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales 2050, Australia
| | - Omid Kavehei
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, New South Wales 2006, Australia
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26
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Wahab A, Iqbal A. Black-Box Warnings of Antiseizure Medications: What is Inside the Box? Pharmaceut Med 2023; 37:233-250. [PMID: 37119452 DOI: 10.1007/s40290-023-00475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/01/2023]
Abstract
Antiseizure medications can cause serious adverse reactions and have deleterious drug interactions that often complicate the clinical management of patients. When the US Food and Drug Administration (FDA) wants to alert healthcare providers and patients about the risk of potentially serious or fatal drug reactions, the FDA requires the manufacturers of these medications to format these warnings within a "black-box" border, and prominently display this box on the first section of the package insert; such warnings are called "black-box warnings (BBWs)". The BBW is a way for the FDA to urge physicians to evaluate patients more rigorously and carefully weigh the risks and benefits, before prescribing medication that has the potential to cause serious adverse reactions, and to formulate a plan for close monitoring during therapy. The FDA BBW provides the extra layer of safety but many healthcare providers fail to comply with these warnings. Currently, there are 26 FDA-approved antiseizure medications in the US market, 38% of which have received BBWs, and most of the antiseizure medications with BBWs are older-generation drugs. Some antiseizure medications have multiple BBWs; for example, valproic acid has three BBWs including hepatotoxicity, fetal risk, and pancreatitis, carbamazepine has BBWs of serious skin and hematological reactions, and felbamate also has two BBWs including hepatic failure and aplastic anemia. The purpose of this review is to provide insight into each BBW received by antiseizure medications and discuss the FDA recommendations for evaluating the drug benefit/risk, and for monitoring parameters before the initiation of and during treatment.
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Affiliation(s)
- Abdul Wahab
- Department of Pharmacy, Emory Healthcare, Emory Decatur Hospital, Decatur, GA, 30033, USA.
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27
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Tschamper MK, Larsen MH, Wahl AK, Jakobsen R. Developing and maintaining health literacy: A continuous emotional, cognitive, and social process for parents of children with epilepsy-A qualitative study. Epilepsy Behav 2023; 142:109222. [PMID: 37088063 DOI: 10.1016/j.yebeh.2023.109222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
Childhood epilepsy is often complicated by neurobehavioral comorbidities, and parents are expected to actively engage in managing the condition. Insufficient parental health literacy (HL) has been associated with reduced health outcomes for children with epilepsy. Little is known about the parents' experiences of information seeking, social support, navigating the healthcare system, and interactions with healthcare professionals and how these skills may contribute to the development of sufficient HL. This study explored parents' experiences of their caregiver responsibility and the development of their HL in relation to caring for their child with epilepsy. Ten parents of children under 12 years of age with epilepsy were purposedly sampled and interviewed individually, using semi-structured interviews. The interviews were analyzed using qualitative content analysis, in line with Graneheim & Lundman. The analyses resulted in three themes, each comprising two sub-themes. The themes were: (1) Alone with the responsibility, (2) The combat for information and support, and (3) Developing vigilance and distrust in system competence. Lack of flexibility in healthcare services, insufficient multidisciplinary collaboration, and unclear treatment provider responsibility made the parents feel alone in the caregiver's responsibility. Poor local provider competence related to childhood epilepsy was a barrier to developing sufficient HL. A trusting relationship with professionals and timely access to competent health services were facilitators for developing HL. Higher HL made the parents more critical for the healthcare services, which triggered vigilance and reduced their trust in the professionals' information. For the parents, developing and maintaining HL was a continuous emotional, cognitive, and social process. Health information and care support need to be adjusted to the severity of the child's condition, the resources are available, and the parent's HL. The results of this study may contribute to the development of future interventions for strengthening parental HL in the childhood epilepsy context.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway; National Centre for Epilepsy, Department of Neurology, Oslo University Hospital, Norway.
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway.
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28
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Tartibzadeh G, Feizollahzadeh H, Shabanloei R, Mwamba B. Epilepsy risk awareness and background factors in patients with epilepsy and family caregivers. Epilepsy Res 2023; 193:107146. [PMID: 37121025 DOI: 10.1016/j.eplepsyres.2023.107146] [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: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients with epilepsy are at risk of various injuries throughout their lives. Awareness of patients and family caregivers about risk factors and self-care prevents potential injuries. This study aimed to investigate epilepsy risk awareness and background factors in patients with epilepsy and family caregivers. METHODS This descriptive study was conducted with the recruitment of 120 patients with epilepsy and 120 family caregivers who were referred to the Neurological Clinic of Tabriz Razi Hospital in Iran. Data was collected using Persian version of the epilepsy risk awareness questionnaires for patients (3rd Edition) and family caregivers. RESULTS The average age of the patients (65.8% women) was 29.2 and of the family caregivers (58.3% women) 41.5 years. The average score of risk awareness in family caregivers was 82.6 ± 8.8 and higher than that in patients with epilepsy 84.9 ± 8.5 (obtainable score: 0-120). Compared to the maximum score, the average scores of both groups in all domains including epilepsy, personal security, physical health, and mental health were low. A statistically significant relationship was observed between the mean scores of risk awareness and some background variables. CONCLUSION The results showed that epilepsy risk awareness in patients and family caregivers is low and there is a need for education and support. By developing education programs for the patient and their family and increasing epilepsy risk awareness, patients can be protected from potential risks and their safety and quality of life can be improved.
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Affiliation(s)
- Golzar Tartibzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Feizollahzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Reza Shabanloei
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bupe Mwamba
- Midwifery and Neonatal Nursing Science, RM, RM, Lecturer, Clinical and Health Sciences, University of South Australia, Adelaide. Australia
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29
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Zhao J, Liang D, Xie T, Qiang J, Sun Q, Yang L, Wang W. Nicorandil Exerts Anticonvulsant Effects in Pentylenetetrazol-Induced Seizures and Maximal-Electroshock-Induced Seizures by Downregulating Excitability in Hippocampal Pyramidal Neurons. Neurochem Res 2023:10.1007/s11064-023-03932-w. [PMID: 37076745 DOI: 10.1007/s11064-023-03932-w] [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: 01/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
N-(2-hydroxyethyl) nicotinamide nitrate (nicorandil), a nitrate that activates adenosine triphosphate (ATP)-sensitive potassium (KATP) channels, is generally used in the treatment of angina and offers long-term cardioprotective effects. It has been reported that several KATP channel openers can effectively alleviate the symptoms of seizure. The purpose of this study was to investigate the improvement in seizures induced by nicorandil. In this study, seizure tests were used to evaluate the effect of different doses of nicorandil by analysing seizure incidence, including minimal clonic seizure and generalised tonic-clonic seizure. We used a maximal electroshock seizure (MES) model, a metrazol maximal seizure (MMS) model and a chronic pentylenetetrazol (PTZ)-induced seizure model to evaluate the effect of nicorandil in improving seizures. Each mouse in the MES model was given an electric shock, while those in the nicorandil group received 0.5, 1, 2, 3 and 6 mg/kg of nicorandil by intraperitoneal injection, respectively. In the MMS model, the mice in the PTZ group and the nicorandil group were injected subcutaneously with PTZ (90 mg/kg), and the mice in the nicorandil group were injected intraperitoneally with 1, 3 and 5 mg/kg nicorandil, respectively. In the chronic PTZ-induced seizure model, the mice in the PTZ group and the nicorandil group were injected intraperitoneally with PTZ (40 mg/kg), and the mice in the nicorandil group were each given 1 and 3 mg/kg of PTZ at a volume of 200 nL. Brain slices containing the hippocampus were prepared, and cell-attached recording was used to record the spontaneous firing of pyramidal neurons in the hippocampal CA1 region. Nicorandil (i.p.) significantly increased both the maximum electroconvulsive protection rate in the MES model and the seizure latency in the MMS model. Nicorandil infused directly onto the hippocampal CA1 region via an implanted cannula relieved symptoms in chronic PTZ-induced seizures. The excitability of pyramidal neurons in the hippocampal CA1 region of the mice was significantly increased after both the acute and chronic administration of PTZ. To a certain extent, nicorandil reversed the increase in both firing frequency and proportion of burst spikes caused by PTZ (P < 0.05). Our results suggest that nicorandil functions by downregulating the excitability of pyramidal neurons in the hippocampal CA1 region of mice and is a potential candidate for the treatment of seizures.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Dan Liang
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Tao Xie
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Jing Qiang
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Qian Sun
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Lan Yang
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Weiping Wang
- Department of Neurology, Key Laboratory of Neurology of Hebei Province, The Second Hospital of Hebei Medical University, No. 361 Zhongshan East Road, Shijiazhuang, 050000, Hebei, People's Republic of China.
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Burgos DF, Sciaccaluga M, Worby CA, Zafra-Puerta L, Iglesias-Cabeza N, Sánchez-Martín G, Prontera P, Costa C, Serratosa JM, Sánchez MP. Epm2a R240X knock-in mice present earlier cognitive decline and more epileptic activity than Epm2a -/- mice. Neurobiol Dis 2023; 181:106119. [PMID: 37059210 DOI: 10.1016/j.nbd.2023.106119] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023] Open
Abstract
Lafora disease is a rare recessive form of progressive myoclonic epilepsy, usually diagnosed during adolescence. Patients present with myoclonus, neurological deterioration, and generalized tonic-clonic, myoclonic, or absence seizures. Symptoms worsen until death, usually within the first ten years of clinical onset. The primary histopathological hallmark is the formation of aberrant polyglucosan aggregates called Lafora bodies in the brain and other tissues. Lafora disease is caused by mutations in either the EPM2A gene, encoding laforin, or the EPM2B gene, coding for malin. The most frequent EPM2A mutation is R241X, which is also the most prevalent in Spain. The Epm2a-/- and Epm2b-/- mouse models of Lafora disease show neuropathological and behavioral abnormalities similar to those seen in patients, although with a milder phenotype. To obtain a more accurate animal model, we generated the Epm2aR240X knock-in mouse line with the R240X mutation in the Epm2a gene, using genetic engineering based on CRISPR-Cas9 technology. Epm2aR240X mice exhibit most of the alterations reported in patients, including the presence of LBs, neurodegeneration, neuroinflammation, interictal spikes, neuronal hyperexcitability, and cognitive decline, despite the absence of motor impairments. The Epm2aR240X knock-in mouse displays some symptoms that are more severe that those observed in the Epm2a-/- knock-out, including earlier and more pronounced memory loss, increased levels of neuroinflammation, more interictal spikes and increased neuronal hyperexcitability, symptoms that more precisely resemble those observed in patients. This new mouse model can therefore be specifically used to evaluate how new therapies affects these features with greater precision.
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Affiliation(s)
- Daniel F Burgos
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain; Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid 28029, Spain
| | - Miriam Sciaccaluga
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy; Fondazione Malattie Rare Mauro Baschirotto BIRD Onlus, Longare (VI), Italy
| | - Carolyn A Worby
- University of California at San Diego, 9500 Gilman Drive, La Jolla CA92093-0721, USA
| | - Luis Zafra-Puerta
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain; Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid 28029, Spain; Fondazione Malattie Rare Mauro Baschirotto BIRD Onlus, Longare (VI), Italy
| | - Nerea Iglesias-Cabeza
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Gema Sánchez-Martín
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Paolo Prontera
- Medical Genetics Unit, S. Maria della Misericordia Hospital, Perugia 06132, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia 06132, Italy
| | - José M Serratosa
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain
| | - Marina P Sánchez
- Laboratory of Neurology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain.
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Living with Epilepsy in Adolescence in Italy: Psychological and Behavioral Impact. Healthcare (Basel) 2023; 11:healthcare11050687. [PMID: 36900691 PMCID: PMC10000857 DOI: 10.3390/healthcare11050687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND People with epilepsy have a higher prevalence of behavioral and neuropsychiatric comorbidities compared to the general population and those with other chronic medical conditions, although the underlying clinical features remain unclear. The goal of the current study was to characterize behavioral profiles of adolescents with epilepsy, assess the presence of psychopathological disorders, and investigate the reciprocal interactions among epilepsy, psychological functioning, and their main clinical variables. METHODS Sixty-three adolescents with epilepsy were consecutively recruited at the Epilepsy Center, Childhood and Adolescence Neuropsychiatry Unit of Santi Paolo e Carlo hospital in Milan (five of them were excluded) and assessed with a specific questionnaire for psychopathology in adolescence, such as the Questionnaire for the Assessment of Psychopathology in Adolescence (Q-PAD). Q-PAD results were then correlated with the main clinical data. RESULTS 55.2% (32/58) of patients presented at least one emotional disturbance. Body dissatisfaction, anxiety, interpersonal conflicts, family problems, uncertainty about the future, and self-esteem/well-being disorders were frequently reported. Gender and poor control of seizures are associated with specific emotional features (p < 0.05). CONCLUSIONS These findings highlight the importance of screening for emotional distress, recognition of the impairments, and provision of adequate treatment and follow-up. A pathological score on the Q-PAD should always require the clinician to investigate the presence of behavioral disorders and comorbidities in adolescents with epilepsy.
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Salpietro V, Galassi Deforie V, Efthymiou S, O'Connor E, Marcé‐Grau A, Maroofian R, Striano P, Zara F, Morrow MM, Reich A, Blevins A, Sala‐Coromina J, Accogli A, Fortuna S, Alesandrini M, Au PYB, Singhal NS, Cogne B, Isidor B, Hanna MG, Macaya A, Kullmann DM, Houlden H, Männikkö R. De novo KCNA6 variants with attenuated K V 1.6 channel deactivation in patients with epilepsy. Epilepsia 2023; 64:443-455. [PMID: 36318112 PMCID: PMC10108282 DOI: 10.1111/epi.17455] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Mutations in the genes encoding neuronal ion channels are a common cause of Mendelian neurological diseases. We sought to identify novel de novo sequence variants in cases with early infantile epileptic phenotypes and neurodevelopmental anomalies. METHODS Following clinical diagnosis, we performed whole exome sequencing of the index cases and their parents. Identified channel variants were expressed in Xenopus oocytes and their functional properties assessed using two-electrode voltage clamp. RESULTS We identified novel de novo variants in KCNA6 in four unrelated individuals variably affected with neurodevelopmental disorders and seizures with onset in the first year of life. Three of the four identified mutations affect the pore-lining S6 α-helix of KV 1.6. A prominent finding of functional characterization in Xenopus oocytes was that the channel variants showed only minor effects on channel activation but slowed channel closure and shifted the voltage dependence of deactivation in a hyperpolarizing direction. Channels with a mutation affecting the S6 helix display dominant effects on channel deactivation when co-expressed with wild-type KV 1.6 or KV 1.1 subunits. SIGNIFICANCE This is the first report of de novo nonsynonymous variants in KCNA6 associated with neurological or any clinical features. Channel variants showed a consistent effect on channel deactivation, slowing the rate of channel closure following normal activation. This specific gain-of-function feature is likely to underlie the neurological phenotype in our patients. Our data highlight KCNA6 as a novel channelopathy gene associated with early infantile epileptic phenotypes and neurodevelopmental anomalies.
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Affiliation(s)
- Vincenzo Salpietro
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
- Department of Biotechnological and Applied Clinical Sciences (DISCAB)University of L'AquilaL'AquilaItaly
| | | | - Stephanie Efthymiou
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
| | - Emer O'Connor
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
| | - Anna Marcé‐Grau
- Department of Paediatric Neurology, University Hospital Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Reza Maroofian
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of Genoa16124 GenoaItaly
- Unit of Pediatric NeurologyIRCCS, Istituto “Giannina Gaslini”Genoa 16123Italy
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of Genoa16124 GenoaItaly
- Medical Genetics UnitIRCCS, Istituto “Giannina Gaslini”Genoa 16123Italy
| | | | | | | | | | - Júlia Sala‐Coromina
- Department of Paediatric Neurology, University Hospital Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Andrea Accogli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI)University of Genoa16124 GenoaItaly
- Medical Genetics UnitIRCCS, Istituto “Giannina Gaslini”Genoa 16123Italy
| | | | - Marie Alesandrini
- Neuropediatrics UnitCentre Hospitalier Universitaire NantesNantesFrance
| | - P. Y. Billie Au
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryAlbertaCalgaryCanada
| | - Nilika Shah Singhal
- Departments of Neurology and Pediatrics, UCSF Benioff Children's HospitalUniversity of CaliforniaCaliforniaSan FranciscoUSA
| | - Benjamin Cogne
- Centre Hospitalier Universitaire NantesService de Génétique MédicaleNantesFrance
- Université de Nantes, CNRS, INSERML'Institut du ThoraxNantesFrance
| | - Bertrand Isidor
- Centre Hospitalier Universitaire NantesService de Génétique MédicaleNantesFrance
- Université de Nantes, CNRS, INSERML'Institut du ThoraxNantesFrance
| | - Michael G. Hanna
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
- Queen Square Centre for Neuromuscular DiseasesNational Hospital for Neurology and NeurosurgeryLondonUK
| | - Alfons Macaya
- Department of Paediatric Neurology, University Hospital Vall d'HebronUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Dimitri M. Kullmann
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, University College LondonLondonUK
| | - Henry Houlden
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
| | - Roope Männikkö
- Department of Neuromuscular DiseaseUCL Institute of Neurology, University College LondonLondonUK
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Luo X, Li C, Yu X, Kuang G, Wang X, Liang J, Jiang J. The effect of hippocampal NR2B-containing NMDA receptors on chronic cognitive dysfunction in rats with temporal lobe epilepsy. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-022-00111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
We have previously reported that hippocampal long-term potentiation (LTP) was suppressed in temporal lobe epilepsy (TLE) rats. The N-methyl-D-aspartic acid receptors containing 2B subunit (NR2B-NMDARs) are indispensable to induce the LTP of hippocampus. However, it is still unknown whether the NR2B-NMDARs are implied with the cognitive dysfunction in TLE rats.
Methods
The TLE model was lithium chloride-pilocarpine (li-pilo) model. Morris water maze test was used to evaluate the cognitive function of epileptic rats. Expression of hippocampal NR2B-NMDAs was evaluated by western blotting. Stereotactic injection of NMDA, an agonist of NR2B-NMDARs, into the hippocampus of TLE rats was used to investigate the role of NR2B-NMDARs on cognitive dysfunction.
Results
Cognitive function TLE rats was significantly reduced compared with controls in the Morris water maze test (P < 0.05). Western blotting data showed the down-expression of hippocampal NR2B-NMDARs and p-NR2B in TLE rats compared with the control (P < 0.05). In addition, hippocampal stereolocalization of NMDA injection improved partially the learning and memory in TLE rats (P < 0.05).
Conclusions
Down-expression and low activity of hippocampal NR2B-NMDARs may be implied with chronic cognitive dysfunction in TLE rats.
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Andrews JP, Wozny TA, Yue JK, Wang DD. Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22362. [PMID: 36443957 PMCID: PMC9705519 DOI: 10.3171/case22362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
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Affiliation(s)
- John P. Andrews
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Doris D. Wang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Hagemann A, Lahr D, May TW, Speicher P, Hausfeld H, Coban I, Müffelmann B, Bien CG, Specht U. Efficacy of a specialized inpatient rehabilitation program in patients with early versus chronic epilepsy. Epilepsy Behav 2022; 142:108999. [PMID: 36446667 DOI: 10.1016/j.yebeh.2022.108999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a specialized inpatient rehabilitation program in patients with early in comparison with chronic epilepsy. METHODS We performed a prospective, open pre/post study using a parallel group design. Patients with early epilepsy (EE, treatment with anti-seizure medication [ASM] ≤ 1 year) or with chronic epilepsy (CE, ASM treatment > 5 years) completed questionnaires at the time of their admission to the rehabilitation program and at discharge. Outcome measures comprised scales from the PESOS questionnaire (PErformance, SOciodemographic aspects, Subjective estimation; e.g., emotional adaptation to epilepsy) as well as screening instruments for depression (Neurological Disorders Depression Inventory for Epilepsy, NDDI-E) and anxiety (Generalized Anxiety Disorder Scale, GAD-7). Linear mixed models (LMMs) were used to determine the effects of the program in the total group and to compare the effects between patients with EE and CE. RESULTS The analyses included 79 patients with EE and 157 patients with CE. Baseline comparisons revealed differences in disease-related and sociodemographic variables (e.g., patients with EE were older, those with CE had a higher seizure frequency and a higher rate of unemployment; all p < .01). LMMs showed significant improvements in emotional adaptation to epilepsy, depression, anxiety, overall quality of life and overall health as well as in perceived overall restrictions because of epilepsy and the subjective level of information about epilepsy (all p < .001). Despite the different duration of epilepsy, baseline levels as well as improvements did not differ between patients with EE and CE (all p > .05) except for the perceived level of information, which was significantly lower in patients with EE at admission and improved to a higher extent in this group (both p < .001). CONCLUSION Both patients with EE and patients with CE who are referred to a specialized comprehensive rehabilitation program benefit from the participation in this program with respect to emotional adaptation to epilepsy, aspects of quality of life, and level of information about epilepsy.
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Affiliation(s)
- Anne Hagemann
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Denise Lahr
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Theodor W May
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany.
| | - Pascal Speicher
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Heiko Hausfeld
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ingrid Coban
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Birgitt Müffelmann
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Christian G Bien
- Society for Epilepsy Research, Maraweg 21, 33617 Bielefeld, Germany; Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
| | - Ulrich Specht
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Maraweg 21, 33617 Bielefeld, Germany.
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Okadome T, Yamaguchi T, Mukaino T, Sakata A, Ogata K, Shigeto H, Isobe N, Uehara T. The effect of interictal epileptic discharges and following spindles on motor sequence learning in epilepsy patients. Front Neurol 2022; 13:979333. [PMID: 36438951 PMCID: PMC9686303 DOI: 10.3389/fneur.2022.979333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Interictal epileptic discharges (IEDs) are known to affect cognitive function in patients with epilepsy, but the mechanism has not been elucidated. Sleep spindles appearing in synchronization with IEDs were recently demonstrated to impair memory consolidation in rat, but this has not been investigated in humans. On the other hand, the increase of sleep spindles at night after learning is positively correlated with amplified learning effects during sleep for motor sequence learning. In this study, we examined the effects of IEDs and IED-coupled spindles on motor sequence learning in patients with epilepsy, and clarified their pathological significance. MATERIALS AND METHODS Patients undergoing long-term video-electroencephalography (LT-VEEG) at our hospital from June 2019 to November 2021 and age-matched healthy subjects were recruited. Motor sequence learning consisting of a finger-tapping task was performed before bedtime and the next morning, and the improvement rate of performance was defined as the sleep-dependent learning effect. We searched for factors associated with the changes in learning effect observed between the periods of when antiseizure medications (ASMs) were withdrawn for LT-VEEG and when they were returned to usual doses after LT-VEEG. RESULTS Excluding six patients who had epileptic seizures at night after learning, nine patients and 11 healthy subjects were included in the study. In the patient group, there was no significant learning effect when ASMs were withdrawn. The changes in learning effect of the patient group during ASM withdrawal were not correlated with changes in sleep duration or IED density; however, they were significantly negatively correlated with changes in IED-coupled spindle density. CONCLUSION We found that the increase of IED-coupled spindles correlated with the decrease of sleep-dependent learning effects of procedural memory. Pathological IED-coupled sleep spindles could hinder memory consolidation, that is dependent on physiological sleep spindles, resulting in cognitive dysfunction in patients with epilepsy.
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Affiliation(s)
- Toshiki Okadome
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Yamaguchi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiko Mukaino
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ayumi Sakata
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Katsuya Ogata
- Department of Pharmacy, School of Pharmaceutical Sciences at Fukuoka, International University of Health and Welfare, Okawa, Japan
| | - Hiroshi Shigeto
- Division of Medical Technology, Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taira Uehara
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, School of Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
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Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol 2022; 13:991244. [PMID: 36278161 PMCID: PMC9583251 DOI: 10.3389/fphar.2022.991244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
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Affiliation(s)
- José Manuel Sánchez-Villalobos
- Department of Neurology, University Hospital Complex of Cartagena, Murcia, Spain
- Department of Cell Biology and Histology, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano,
| | | | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Miguel Alcaraz
- Department of Radiology and Physical Medicine, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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Impact of Clinical and Socio-Demographic Factors on the Quality of Life in Romanian People with Epilepsy. Healthcare (Basel) 2022; 10:healthcare10101909. [PMID: 36292357 PMCID: PMC9602014 DOI: 10.3390/healthcare10101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
This study investigates the impact of different clinical and demographic factors on the quality of life in people with epilepsy hospitalized at a health institution of Brasov County, Romania, using a QOLIE-31-P questionnaire and to reflect on the opportunities and limitations of incorporating such an instrument into the clinical practice. Methods: Ninety-one patients with a diagnosis of epilepsy evaluated by video-electroencephalography in the Clinical Hospital of Psychiatry and Neurology in Brasov, Romania, were recruited. After the confirmation of the diagnosis based on clinical, electrophysiological and imagistic examination, and of their compliance with the hospitalization criteria, the patients filled in the QOLIE-31-P questionnaire. Socio-demographic and clinical data were collected. Results: The seizure frequency was negatively correlated with almost all QOLIE-31-P domains (p < 0.05). Age, employment status, level of education and uncontrolled disease were significant factors associated with a low quality of life. The mean (SD) QOLIE-31-P scores were 64.89 (14.72), the mean age was 43.04 (14.92) years, with the average age of the first seizure onset 30.66 (17.45) years. Conclusion: The use of measuring instruments to assess the quality of life of patients with epilepsy despite the challenges should become a routine practice, the information collected in this way can improve the outcomes in the care of these patients. In addition to the goal of reducing the frequency of seizures, physicians must also take into account other parts of the experiences of people with epilepsy.
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Wang X, Xiao A, Yang Y, Zhao Y, Wang CC, Wang Y, Han J, Wang Z, Wen M. DHA and EPA Prevent Seizure and Depression-Like Behavior by Inhibiting Ferroptosis and Neuroinflammation via Different Mode-of-actions in a Pentylenetetrazole-Induced Kindling Model in Mice. Mol Nutr Food Res 2022; 66:e2200275. [PMID: 36099650 DOI: 10.1002/mnfr.202200275] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/07/2022] [Indexed: 11/06/2022]
Abstract
SCOPE It has been reported that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anticonvulsant effects, yet the respective mechanism of EPA and DHA on epilepsy are still unclarified. This study aimed to investigate the effect of EPA and DHA on pentylenetetrazol (PTZ) induced seizures and depression. METHODS AND RESULTS The administration of EPA and DHA at a dose of 1% (w/w) significantly inhibited PTZ-induced seizures and depressive-like behavior, whereas EPA outcompetes DHA. Further mechanistic studies revealed that the higher effect of EPA can be partly attributed to the promotion of M2 polarization, inhibition of M1 polarization of microglia, and lower iron content in the brain, resulting from the stronger activation of nuclear factor E2-related factor 2 (Nrf2). We found that DHA and EPA comparably inhibited NLRP3 inflammasome activation but with different mode-of-actions: EPA preferred to inhibit the binding of NLRP3 and ASC, while DHA decreased the protein levels of ASC and Caspase-1. CONCLUSIONS These results indicated that DHA and EPA could efficaciously alleviate PTZ-induced seizure and depressive-like behavior but with different efficiency and molecular mechanisms. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xueyan Wang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
| | - Aiai Xiao
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
| | - Yueqi Yang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
| | - Yingcai Zhao
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Cheng Cheng Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Yuming Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, 266003, China
| | - Jun Han
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
| | - Zhengping Wang
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
| | - Min Wen
- Institute of Biopharmaceutical Research, Liaocheng University, Liaocheng, 252059, China
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Seid J, Mebrahtu K. Prevalence and associated factors of depression among people with epilepsy in Ethiopia: a cross-sectional study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Depression is the most common comorbid psychiatric disorders that affect people with epilepsy. We aim to determine the prevalence of depression and associated factors among people with epilepsy.
Results
The prevalence of depression was found to be 34.8%. Unable to read and write (AOR = 0.400, 95% CI: 0.162, 0.986), long duration of the medication intake at least for 11 years (AOR = 3.715, 95% CI: 1.498, 9.212), absence of improvement with antiepileptic drugs (AOR = 0.216, 95% CI: 0.101, 0.460), feeling of perceived stigma (AOR = 0.244, 95% CI: 0.129, 0.462), stress symptoms (AOR = 0.452, 95% CI: 0.220, 0.928), were significantly associated with depression.
Conclusions
Prevalence of depression among people with epilepsy was high. Therefore, early screening and management is mandatory. This is the first research study, to our knowledge, that evaluates the association between substance use, sexual and physical abuse among people with epilepsy with depression. Therefore, future research needs to investigate the association.
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Zhang Y, Wang Z, Wang R, Xia L, Cai Y, Tong F, Gao Y, Ding J, Wang X. Conditional knockout of ASK1 in microglia/macrophages attenuates epileptic seizures and long-term neurobehavioural comorbidities by modulating the inflammatory responses of microglia/macrophages. J Neuroinflammation 2022; 19:202. [PMID: 35941644 PMCID: PMC9361603 DOI: 10.1186/s12974-022-02560-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Apoptosis signal-regulating kinase 1 (ASK1) not only causes neuronal programmed cell death via the mitochondrial pathway but also is an essential component of the signalling cascade during microglial activation. We hypothesize that ASK1 selective deletion modulates inflammatory responses in microglia/macrophages(Mi/Mϕ) and attenuates seizure severity and long-term cognitive impairments in an epileptic mouse model. Methods Mi/Mϕ-specific ASK1 conditional knockout (ASK1 cKO) mice were obtained for experiments by mating ASK1flox/flox mice with CX3CR1creER mice with tamoxifen induction. Epileptic seizures were induced by intrahippocampal injection of kainic acid (KA). ASK1 expression and distribution were detected by western blotting and immunofluorescence staining. Seizures were monitored for 24 h per day with video recordings. Cognition, social and stress related activities were assessed with the Y maze test and the three-chamber social novelty preference test. The heterogeneous Mi/Mϕ status and inflammatory profiles were assessed with immunofluorescence staining and real-time polymerase chain reaction (q-PCR). Immunofluorescence staining was used to detect the proportion of Mi/Mϕ in contact with apoptotic neurons, as well as neuronal damage. Results ASK1 was highly expressed in Mi/Mϕ during the acute phase of epilepsy. Conditional knockout of ASK1 in Mi/Mϕ markedly reduced the frequency of seizures in the acute phase and the frequency of spontaneous recurrent seizures (SRSs) in the chronic phase. In addition, ASK1 conditional knockout mice displayed long-term neurobehavioral improvements during the Y maze test and the three-chamber social novelty preference test. ASK1 selective knockout mitigated neuroinflammation, as evidenced by lower levels of Iba1+/CD16+ proinflammatory Mi/Mϕ. Conditional knockout of ASK1 increased Mi/Mϕ proportion in contact with apoptotic neurons. Neuronal loss was partially restored by ASK1 selective knockout. Conclusion Conditional knockout of ASK1 in Mi/Mϕ reduced seizure severity, neurobehavioral impairments, and histological damage, at least via inhibiting proinflammatory microglia/macrophages responses. ASK1 in microglia/macrophages is a potential therapeutic target for inflammatory responses in epilepsy. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02560-5.
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Affiliation(s)
- Yiying Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhangyang Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Rongrong Wang
- Department of the State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Lu Xia
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yiying Cai
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Fangchao Tong
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yanqin Gao
- Department of the State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Department of the State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
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Choi IY, Cho ML, Cho KO. Interleukin-17A Mediates Hippocampal Damage and Aberrant Neurogenesis Contributing to Epilepsy-Associated Anxiety. Front Mol Neurosci 2022; 15:917598. [PMID: 35875667 PMCID: PMC9298510 DOI: 10.3389/fnmol.2022.917598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Anxiety disorder is one of the most common comorbidities in temporal lobe epilepsy (TLE), but its neurobiological mechanisms remain unclear. Here we identified a novel target, interleukin-17A (IL-17A), which can contribute to TLE-associated anxiety. Epileptic seizures were induced in 6-week-old IL-17A wild-type (WT) and knockout (KO) mice by pilocarpine injection. To evaluate anxiety level, we subjected mice to open field and elevated plus maze (EPM) tests and measured the time animals spent in center zone or open arms. Epileptic IL-17A WT mice showed thigmotaxis and reluctance to stay in open arms, whereas IL-17A KO mice spent more time in the center area and open arms, suggesting alleviated anxiety in epilepsy. Histological assessments revealed that hippocampal neuronal death as evaluated by Fluoro-Jade B staining was significantly reduced in IL-17A KO mice. Moreover, at 6 weeks after pilocarpine-induced status epilepticus, the number of hilar ectopic granule cells was also markedly decreased by IL-17A deficiency without a difference in the proliferation of neural progenitors or the generation of newborn neurons in the dentate gyrus. Taken together, our data demonstrated that IL-17A deletion mitigates TLE-associated anxiety behavior, possibly via the hippocampal neuroprotection and the reduction of seizure-induced aberrant neurogenesis.
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Affiliation(s)
- In-Young Choi
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mi-La Cho
- Department of Medical Life Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Ok Cho
- Department of Pharmacology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, South Korea.,Catholic Neuroscience Institute, The Catholic University of Korea, Seoul, South Korea.,Institute for Aging and Metabolic Diseases, The Catholic University of Korea, Seoul, South Korea
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Herrman H, Osnes K, Egge A, Konglund A, Ramm‐Pettersen J, Dietrichs E, Taubøll E. ANT-DBS in epilepsy shows no effect on selected neuropsychiatric tests. Acta Neurol Scand 2022; 146:258-264. [PMID: 35649713 PMCID: PMC9545573 DOI: 10.1111/ane.13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
Objectives Deep brain stimulation of the anterior thalamic nucleus (ANT‐DBS) is an established option in treatment‐resistant epilepsy and obtained FDA approval in 2018. Increased psychiatric comorbidity is well known in epilepsy. The main objective of this study was to investigate possible neuropsychiatric treatment‐related changes in patients receiving ANT‐DBS. Materials and Methods Bilateral ANT electrodes were implanted in 18 adult patients with refractory epilepsy in a randomized, double‐blinded study. Immediately after implantation, patients were randomized to stimulation ON (n = 8) or OFF (n = 10) for the first 6 months (blinded phase). During the next six months (open phase), both groups received active stimulation. Neuropsychiatric assessment was conducted before implantation (T1), at the end of the blinded period (T2), and 1 year after implantation (T3). Results Comparing preoperative status (T1) and 12 months (T3), postoperative outcome in all patients did not show significant differences between the two groups for any of the applied tests. Groupwise comparisons across the two first time points (the blinded period, representing the randomized controlled trial) showed no significant differences between the two groups in any of the neuropsychiatric parameters studied. Comparing test results after 6 months of stimulation in both groups (sum of ON group T1 to T2 and OFF group T2 to T3) did not show significant changes for any of the psychiatric assessments. Conclusions Our results indicate that ANT‐DBS has limited effect concerning psychiatric issues. Subjective side effects were, however, reported in individual patients.
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Affiliation(s)
- Helle Herrman
- Department of Neurology Oslo University Hospital‐Rikshospitalet Oslo Norway
- National Center for Epilepsy Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Kåre Osnes
- Division of Mental Health and Substance Abuse Diakonhjemmet Hospital Oslo Norway
| | - Arild Egge
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
| | - Ane Konglund
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
| | - Jon Ramm‐Pettersen
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
| | - Espen Dietrichs
- Department of Neurology Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Erik Taubøll
- Department of Neurology Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
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Streltzov NA, Schmidt SS, Schommer LM, Zhao W, Tosteson TD, Mazanec MT, Kiriakopoulos ET, Chu F, Henninger HL, Nagle K, Roth RM, Jobst B. Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial. Neurology 2022; 98:e2174-e2184. [PMID: 35387855 PMCID: PMC9169940 DOI: 10.1212/wnl.0000000000200346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention. METHODS HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months. RESULTS A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP. DISCUSSION This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov (NCT02394509). CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.
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Affiliation(s)
- Nicholas A Streltzov
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Samantha S Schmidt
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Lindsay M Schommer
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Wenyan Zhao
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Tor D Tosteson
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Morgan T Mazanec
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Elaine T Kiriakopoulos
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Felicia Chu
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Heidi L Henninger
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Keith Nagle
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Robert M Roth
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
| | - Barbara Jobst
- From the Departments of Neurology (N.A.S., S.S.S., L.M.S., M.T.M., E.T.K., B.J.) and Psychiatry (R.M.R.), Dartmouth-Hitchcock Medical Center, Lebanon; Geisel School of Medicine (L.M.S., W.Z., T.D.T., E.T.K., R.M.R., B.J.), Dartmouth College, Hanover, NH; Department of Neurology (F.C.), UMass Medical School, Worcester, MA; Department of Neurology (H.L.H.), Maine Medical Center, Scarborough; and Department of Neurology (K.N.), University of Vermont Medical Center, Burlington
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Park BY, Larivière S, Rodríguez-Cruces R, Royer J, Tavakol S, Wang Y, Caciagli L, Caligiuri ME, Gambardella A, Concha L, Keller SS, Cendes F, Alvim MKM, Yasuda C, Bonilha L, Gleichgerrcht E, Focke NK, Kreilkamp BAK, Domin M, von Podewils F, Langner S, Rummel C, Rebsamen M, Wiest R, Martin P, Kotikalapudi R, Bender B, O’Brien TJ, Law M, Sinclair B, Vivash L, Kwan P, Desmond PM, Malpas CB, Lui E, Alhusaini S, Doherty CP, Cavalleri GL, Delanty N, Kälviäinen R, Jackson GD, Kowalczyk M, Mascalchi M, Semmelroch M, Thomas RH, Soltanian-Zadeh H, Davoodi-Bojd E, Zhang J, Lenge M, Guerrini R, Bartolini E, Hamandi K, Foley S, Weber B, Depondt C, Absil J, Carr SJA, Abela E, Richardson MP, Devinsky O, Severino M, Striano P, Parodi C, Tortora D, Hatton SN, Vos SB, Duncan JS, Galovic M, Whelan CD, Bargalló N, Pariente J, Conde-Blanco E, Vaudano AE, Tondelli M, Meletti S, Kong X, Francks C, Fisher SE, Caldairou B, Ryten M, Labate A, Sisodiya SM, Thompson PM, McDonald CR, Bernasconi A, Bernasconi N, Bernhardt BC. Topographic divergence of atypical cortical asymmetry and atrophy patterns in temporal lobe epilepsy. Brain 2022; 145:1285-1298. [PMID: 35333312 PMCID: PMC9128824 DOI: 10.1093/brain/awab417] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/15/2021] [Accepted: 08/14/2021] [Indexed: 12/20/2022] Open
Abstract
Temporal lobe epilepsy, a common drug-resistant epilepsy in adults, is primarily a limbic network disorder associated with predominant unilateral hippocampal pathology. Structural MRI has provided an in vivo window into whole-brain grey matter structural alterations in temporal lobe epilepsy relative to controls, by either mapping (i) atypical inter-hemispheric asymmetry; or (ii) regional atrophy. However, similarities and differences of both atypical asymmetry and regional atrophy measures have not been systematically investigated. Here, we addressed this gap using the multisite ENIGMA-Epilepsy dataset comprising MRI brain morphological measures in 732 temporal lobe epilepsy patients and 1418 healthy controls. We compared spatial distributions of grey matter asymmetry and atrophy in temporal lobe epilepsy, contextualized their topographies relative to spatial gradients in cortical microstructure and functional connectivity calculated using 207 healthy controls obtained from Human Connectome Project and an independent dataset containing 23 temporal lobe epilepsy patients and 53 healthy controls and examined clinical associations using machine learning. We identified a marked divergence in the spatial distribution of atypical inter-hemispheric asymmetry and regional atrophy mapping. The former revealed a temporo-limbic disease signature while the latter showed diffuse and bilateral patterns. Our findings were robust across individual sites and patients. Cortical atrophy was significantly correlated with disease duration and age at seizure onset, while degrees of asymmetry did not show a significant relationship to these clinical variables. Our findings highlight that the mapping of atypical inter-hemispheric asymmetry and regional atrophy tap into two complementary aspects of temporal lobe epilepsy-related pathology, with the former revealing primary substrates in ipsilateral limbic circuits and the latter capturing bilateral disease effects. These findings refine our notion of the neuropathology of temporal lobe epilepsy and may inform future discovery and validation of complementary MRI biomarkers in temporal lobe epilepsy.
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Affiliation(s)
- Bo-yong Park
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Department of Data Science, Inha University, Incheon, Republic of Korea
- Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Republic of Korea
| | - Sara Larivière
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Raul Rodríguez-Cruces
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Jessica Royer
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Shahin Tavakol
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Yezhou Wang
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Lorenzo Caciagli
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Antonio Gambardella
- Neuroscience Research Center, University Magna Græcia, Catanzaro, CZ, Italy
- Institute of Neurology, University Magna Græcia, Catanzaro, CZ, Italy
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de México, Querétaro, México
| | - Simon S Keller
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Fernando Cendes
- Department of Neurology, University of Campinas–UNICAMP, Campinas, São Paulo, Brazil
| | - Marina K M Alvim
- Department of Neurology, University of Campinas–UNICAMP, Campinas, São Paulo, Brazil
| | - Clarissa Yasuda
- Department of Neurology, University of Campinas–UNICAMP, Campinas, São Paulo, Brazil
| | | | | | - Niels K Focke
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Martin Domin
- Institute of Diagnostic Radiology and Neuroradiology, Functional Imaging Unit, University Medicine Greifswald, Greifswald, Germany
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Soenke Langner
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Raviteja Kotikalapudi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Terence J O’Brien
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Meng Law
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Benjamin Sinclair
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
- Departments of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Patricia M Desmond
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Charles B Malpas
- Departments of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elaine Lui
- Department of Radiology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Saud Alhusaini
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Colin P Doherty
- Department of Neurology, St James’ Hospital, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Gianpiero L Cavalleri
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
- FutureNeuro SFI Research Centre, Dublin, Ireland
| | - Reetta Kälviäinen
- Epilepsy Center, Neuro Center, Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Magdalena Kowalczyk
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Mario Mascalchi
- Neuroradiology Research Program, Meyer Children Hospital of Florence, University of Florence, Florence, Italy
| | - Mira Semmelroch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Rhys H Thomas
- Transitional and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hamid Soltanian-Zadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- Departments of Research Administration and Radiology, Henry Ford Health System, Detroit, MI, USA
| | | | - Junsong Zhang
- Department of Artificial Intelligence, Xiamen University, Xiamen, China
| | - Matteo Lenge
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
- Functional and Epilepsy Neurosurgery Unit, Neurosurgery Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Renzo Guerrini
- Child Neurology Unit and Laboratories, Neuroscience Department, Children’s Hospital A. Meyer-University of Florence, Florence, Italy
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - Khalid Hamandi
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical Sciences, Cardiff University, Cardiff, UK
- The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre (CUBRIC), College of Biomedical Sciences, Cardiff University, Cardiff, UK
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah J A Carr
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Eugenio Abela
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Mark P Richardson
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Orrin Devinsky
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Mariasavina Severino
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Costanza Parodi
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Domenico Tortora
- IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Sean N Hatton
- Department of Neurosciences, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christopher D Whelan
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Núria Bargalló
- Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology CDIC, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jose Pariente
- Magnetic Resonance Image Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Anna Elisabetta Vaudano
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, OCB Hospital, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Manuela Tondelli
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, OCB Hospital, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Meletti
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, OCB Hospital, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Xiang‐Zhen Kong
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Clyde Francks
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Benoit Caldairou
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Mina Ryten
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London, London, UK
- Department of Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Angelo Labate
- Neurology, BIOMORF Department, University of Messina, Messina, Italy
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- MRI Unit, Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging and Informatics, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Carrie R McDonald
- Department of Psychiatry, Center for Multimodal Imaging and Genetics, University of California San Diego, La Jolla, CA, USA
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Boris C Bernhardt
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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46
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Caciagli L, Paquola C, He X, Vollmar C, Centeno M, Wandschneider B, Braun U, Trimmel K, Vos SB, Sidhu MK, Thompson PJ, Baxendale S, Winston GP, Duncan JS, Bassett DS, Koepp MJ, Bernhardt BC. Disorganization of language and working memory systems in frontal versus temporal lobe epilepsy. Brain 2022; 146:935-953. [PMID: 35511160 PMCID: PMC9976988 DOI: 10.1093/brain/awac150] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
Cognitive impairment is a common comorbidity of epilepsy and adversely impacts people with both frontal lobe (FLE) and temporal lobe (TLE) epilepsy. While its neural substrates have been investigated extensively in TLE, functional imaging studies in FLE are scarce. In this study, we profiled the neural processes underlying cognitive impairment in FLE and directly compared FLE and TLE to establish commonalities and differences. We investigated 172 adult participants (56 with FLE, 64 with TLE and 52 controls) using neuropsychological tests and four functional MRI tasks probing expressive language (verbal fluency, verb generation) and working memory (verbal and visuo-spatial). Patient groups were comparable in disease duration and anti-seizure medication load. We devised a multiscale approach to map brain activation and deactivation during cognition and track reorganization in FLE and TLE. Voxel-based analyses were complemented with profiling of task effects across established motifs of functional brain organization: (i) canonical resting-state functional systems; and (ii) the principal functional connectivity gradient, which encodes a continuous transition of regional connectivity profiles, anchoring lower-level sensory and transmodal brain areas at the opposite ends of a spectrum. We show that cognitive impairment in FLE is associated with reduced activation across attentional and executive systems, as well as reduced deactivation of the default mode system, indicative of a large-scale disorganization of task-related recruitment. The imaging signatures of dysfunction in FLE are broadly similar to those in TLE, but some patterns are syndrome-specific: altered default-mode deactivation is more prominent in FLE, while impaired recruitment of posterior language areas during a task with semantic demands is more marked in TLE. Functional abnormalities in FLE and TLE appear overall modulated by disease load. On balance, our study elucidates neural processes underlying language and working memory impairment in FLE, identifies shared and syndrome-specific alterations in the two most common focal epilepsies and sheds light on system behaviour that may be amenable to future remediation strategies.
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Affiliation(s)
- Lorenzo Caciagli
- Correspondence to: Lorenzo Caciagli, MD, PhD Department of Bioengineering University of Pennsylvania, 240 Skirkanich Hall 210 South 33rd Street, Philadelphia, PA 19104, USA E-mail: ;
| | - Casey Paquola
- Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec H3A 2B4, Canada
| | - Xiaosong He
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Christian Vollmar
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Maria Centeno
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Epilepsy Unit, Hospital Clínic de Barcelona, IDIBAPS, 08036 Barcelona, Spain
| | - Britta Wandschneider
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Urs Braun
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karin Trimmel
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sjoerd B Vos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Centre for Medical Image Computing, University College London, London, UK,Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Meneka K Sidhu
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Pamela J Thompson
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Sallie Baxendale
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Gavin P Winston
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK,Department of Medicine, Division of Neurology, Queen’s University, Kingston, Ontario, Canada
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK,MRI Unit, Epilepsy Society,Chalfont St Peter, Buckinghamshire SL9 0RJ, UK
| | - Dani S Bassett
- Correspondence may also be addressed to: Dani S. Bassett, PhD E-mail:
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Tschamper MK, Wahl AK, Hermansen Å, Jakobsen R, Larsen MH. Parents of children with epilepsy: Characteristics associated with high and low levels of health literacy. Epilepsy Behav 2022; 130:108658. [PMID: 35358855 DOI: 10.1016/j.yebeh.2022.108658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Parents of children with epilepsy play a key role in the management of their child's condition. Their level of health literacy (HL), which refers to their ability to seek, understand, assess, remember, and utilize health information, is essential for handling the child optimally. The aim of this study was to investigate characteristics associated with high and low levels of different dimensions of HL in parents. HL was assessed with the multidimensional Health Literacy Questionnaire (parents' version) and the electronic Health Literacy Scale, using data from a cohort of 254 parents of children <12 years. Bivariate correlation and multiple hierarchal linear regression (STATA version 16 SE) were used to investigate variables associated with HL. Self-efficacy (St. β = 0.14-0.34) was the only variable that predicted higher scores on every HL scale. Being older than 35 years (St. β = 0.18-0.21), level of education (St. β = 0.16-0.27), and the child having a coordinator of services (St. β = 0.16-0.28) were associated with higher scores, while sick leave due to the child's epilepsy (St. β = -0.13 to -0.16), child comorbidities (St. β = -0.15 to -0.19), and higher levels of mental distress (St. β = -0.13 to -0.19) were associated with lower scores in several of the different HL dimensions. A total of 44.8% of the parents scored over the cutoff (≥1.85) predicting a mental disorder on the Hopkins symptom checklist. This is the first study to investigate multidimensional parental HL in a childhood epilepsy context. Our results highlight the need to investigate multiple variables, especially mental distress, to determine characteristics that may predict low parental HL. Further qualitative studies are needed to explore the underlying reasons for the parents' HL scores and to develop inventions tailored to meet different HL needs.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
| | - Åsmund Hermansen
- Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway
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48
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Guarracino I, Pauletto G, Ius T, Palese F, Skrap M, Tomasino B. Presurgical cognitive status in patients with low-grade glioma and epilepsy: Testing the effects of seizures, antiseizure medications, and tumor localization. Brain Behav 2022; 12:e2560. [PMID: 35377547 PMCID: PMC9120733 DOI: 10.1002/brb3.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Low-grade gliomas (LGGs) are frequently associated with epilepsy. There are few studies addressing the impact of seizures, antiseizure medications (ASMs), and lesion localization on presurgery cognitive functioning. METHODS We tested the relation between the above-mentioned variables in a continuous series of 73 young patients (mean age 38.3 years ± 11.7) affected by LGGs and epilepsy. The anatomical areas, involved in this sample, were the left insula with surrounding cortical and subcortical areas, the right precentral gyrus/rolandic operculum, and the white matter and cortical regions beneath. RESULTS Patients' presurgery cognitive status was within the normal range, with borderline performance for some tasks. We tested whether lower scores were related with lesion or with epilepsy-related factors. Multiple regression identified variables that predict test scores. The Token test score was predicted by a model (p = .0078) containing the DT2T1 MRI, corrected for seizure features. Object naming performance was predicted by a model (p = .0113) containing the localization, the DT2T1 MRI, corrected for sex, EEG, and onset. Verbal fluency score was predicted by a model (p = .0056) containing the localization and the DT2T1 MRI, corrected for AEDs and EEG. Working memory score was predicted by a model (p = .0117) containing Engel class, the DT2T1 MRI, corrected for sex. Clock drawing score was predicted by a model (p < .0001) containing the Engel class, AEDs, and EEG. TMT A score was predicted by a model (p = .0022) containing localization, corrected for EEG. TMT B-A score was predicted by a model (p = .0373) containing localization. Voxel Lesion Symptom Mapping analyses carried out on patients' lesion volumes confirmed that patients' level of performance correlated with lesion-related variables. CONCLUSION This preliminary study indicates that the presurgical level of performance for language tasks and for cognitive flexibility and shifting is mainly predicted by lesion-related variables, working memory by both lesion and epilepsy-related variables. Epilepsy clinical and instrumental characteristics predicted performance for visuospatial planning.
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Affiliation(s)
- Ilaria Guarracino
- Polo FVG, San Vito al Tagliamento, PNScientific Institute IRCCS “Eugenio Medea,”Italy
| | - Giada Pauletto
- Unità Operativa di NeurologiaAzienda Sanitaria Universitaria del Friuli CentraleUdineItaly
| | - Tamara Ius
- Unità Operativa di NeurochirurgiaAzienda Sanitaria Universitaria del Friuli CentraleUdineItaly
| | - Francesca Palese
- Servizio di Igiene e Sanità Pubblica Dipartimento di PrevenzioneSan Daniele del FriuliAzienda Sanitaria Universitaria del Friuli CentraleUdineItaly
| | - Miran Skrap
- Unità Operativa di NeurochirurgiaAzienda Sanitaria Universitaria del Friuli CentraleUdineItaly
| | - Barbara Tomasino
- Polo FVG, San Vito al Tagliamento, PNScientific Institute IRCCS “Eugenio Medea,”Italy
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Proost R, Lagae L, Van Paesschen W, Jansen K. Sleep in children with refractory epilepsy and epileptic encephalopathies: A systematic review of literature. Eur J Paediatr Neurol 2022; 38:53-61. [PMID: 35395626 DOI: 10.1016/j.ejpn.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
Children with epilepsy have more sleep disorders compared to healthy children. The bidirectional interaction between epilepsy and sleep is not completely understood. However, disruption of sleep architecture during childhood may have consequences for cognitive development. As children with drug-refractory epilepsy often have intellectual disability, sleep disruption could be an important contributing factor in severity of their cognitive impairment. To better understand these interactions, sleep architecture in children with drug-refractory epilepsy and epileptic encephalopathies should be investigated. In this review, we conducted a systematic literature search on this topic. Articles that investigated sleep macro- and/or microstructure by means of electroencephalogram/polysomnography were included, as well as articles that used validated questionnaires. Sixteen articles were reviewed, eight of which used polysomnography. Only 2 articles examined sleep in children with epileptic encephalopathies. Consistent findings on measures of sleep architecture were a reduction in REM percentage and an increase in sleep fragmentation when comparing drug-refractory patients with non-refractory and healthy subjects. The findings on slow wave sleep were less clear. Studies with questionnaires unambiguously confirmed subjectively more sleep problems in children with drug-refractory epilepsy. This is the first review of literature in this patient population. More good quality sleep studies in children with drug-refractory epilepsy are warranted. The use of wearables in the home setting together with automatic sleep staging could provide more insights.
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Affiliation(s)
- R Proost
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
| | - L Lagae
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium
| | - W Van Paesschen
- Department of Neurology, University Hospital Leuven, Leuven, Belgium
| | - K Jansen
- Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium.
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Mula M, Coleman H, Wilson SJ. Neuropsychiatric and Cognitive Comorbidities in Epilepsy. Continuum (Minneap Minn) 2022; 28:457-482. [PMID: 35393966 DOI: 10.1212/con.0000000000001123] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses psychiatric and cognitive comorbidities of epilepsy over the lifespan and illustrates opportunities to improve the quality of care of children and adults with epilepsy. RECENT FINDINGS One in 3 people with epilepsy have a lifetime history of psychiatric disorders, and they represent an important prognostic marker of epilepsy. Contributors are diverse and display a complex relationship. Cognitive comorbidities are also common among those living with epilepsy and are increasingly recognized as a reflection of changes to underlying brain networks. Among the cognitive comorbidities, intellectual disability and dementia are common and can complicate the diagnostic process when cognitive and/or behavioral features resemble seizures. SUMMARY Comorbidities require consideration from the first point of contact with a patient because they can determine the presentation of symptoms, responsiveness to treatment, and the patient's day-to-day functioning and quality of life. In epilepsy, psychiatric and cognitive comorbidities may prove a greater source of disability for the patient and family than the seizures themselves, and in the case of essential comorbidities, they are regarded as core to the disorder in terms of etiology, diagnosis, and treatment.
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