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Yıldırım M, Altıntaş M, Uysal E, Bektaş Ö, Teber S. Predictors of medical intractability in children with epilepsy onset during the first two years of life, excluding infantile epileptic spasm syndrome. Seizure 2024; 117:206-212. [PMID: 38479206 DOI: 10.1016/j.seizure.2024.03.005] [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: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE Early childhood epilepsy presents a significant challenge, with approximately 30 % of individuals experiencing treatment failure. This study aimed to identify predictors of medical intractability in children with epilepsy onset during the first two years of life, excluding infantile epileptic spasm syndrome. METHODS A total of 323 children were retrospectively evaluated. The analyses included a review of medical records for demographic, laboratory, radiological, and electroencephalographic (EEG) findings. Children were diagnosed with drug-resistant epilepsy (DRE) according to the ILAE diagnostic criteria. Twenty-one potential prognostic predictors were examined in relation to medical intractability. RESULTS Among the 323 children (56.7 % male), 119 (36.8 %) had unknown epilepsy, 131 (40.6 %) had structural epilepsy, 53 (16.4 %) had genetic epilepsy, and 20 (6.2 %) had metabolic epilepsy. Over a median follow-up of 68 months, 55.4 % of the children achieved ≥6 months of seizure freedom, 33.1 % developed DRE, and the remaining 11.5 % had rare ongoing seizures but did not meet the criteria for DRE because they were only treated with one antiseizure medication at the last follow-up. Univariate logistic regression analyses identified ten risk factors significantly associated with DRE. Multivariate logistic regression analyses revealed that the presence of developmental delay at epilepsy onset (p = 0.000; OR 7.890; 95 %CI 2.713 to 22.945), history of status epilepticus (p = 0.000; OR 8.247; 95 %CI 3.619 to 18.793), number of antiseizure medications (ASMs) at the sixth month of diagnosis (p = 0.000; OR 20.585; 95 %CI 8.993 to 47.117), and initial EEG findings (p = 0.046; OR 2.366; 95 %CI 1.015 to 5.518) were predictors of medical intractability. Nineteen (5.9 %) children died during follow-up for various reasons, including progressive neurogenetic or neurodegenerative disorders. CONCLUSION Developmental delay at epilepsy onset, a history of status epilepticus, the use of two or more ASMs in the sixth month of diagnosis, and abnormal initial EEG findings were associated with medical intractability.
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Affiliation(s)
- Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Mert Altıntaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ece Uysal
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Turkey
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Bayanova M, Bolatov AK, Bazenova A, Nazarova L, Nauryzbayeva A, Tanko NM, Rakhimova S, Satvaldina N, Samakyzy D, Kozhamkulov U, Kairov U, Akilzhanova A, Sarbassov D. Whole-Genome Sequencing Among Kazakhstani Children with Early-Onset Epilepsy Revealed New Gene Variants and Phenotypic Variability. Mol Neurobiol 2023; 60:4324-4335. [PMID: 37095367 PMCID: PMC10293429 DOI: 10.1007/s12035-023-03346-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
In Kazakhstan, there is insufficient data on genetic epilepsy, which has its own clinical and management implications. Thus, this study aimed to use whole genome sequencing to identify and evaluate genetic variants and genetic structure of early onset epilepsy in the Kazakhstani pediatric population. In this study, for the first time in Kazakhstan, whole genome sequencing was carried out among epilepsy diagnosed children. The study involved 20 pediatric patients with early onset epilepsy and no established cause of the disease during the July-December, 2021. The average age at enrolment was 34.5 months, with a mean age at seizure onset of 6 months. Six patients (30%) were male, and 7 were familial cases. We identified pathogenic and likely pathogenic variants in 14 (70%) cases, among them, 6 novel disease gene variants (KCNQ2, CASK, WWOX, MT-CO3, GRIN2D, and SLC12A5). Other genes associated with the disease were SCN1A (x2), SLC2A1, ARX, CACNA1B, PCDH19, KCNT1, and CHRNA2. Identification of the genetic causes in 70% of cases confirms the general structure of the etiology of early onset epilepsy and the necessity of using NGS in diagnostics. Moreover, the study describes new genotype-phenotypic correlations in genetic epilepsy. Despite certain limitations of the study, it can be concluded that the genetic etiology of pediatric epilepsy in Kazakhstan is very broad and requires further research.
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Affiliation(s)
- Mirgul Bayanova
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
| | - Aidos K. Bolatov
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
- Astana Medical University, Beybitshilik St. 49A, Z10K9D9, Astana, Kazakhstan
| | - Assiya Bazenova
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
| | - Lyazzat Nazarova
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
| | - Alissa Nauryzbayeva
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
| | - Naanlep Matthew Tanko
- University Medical Center CF, Kerey-Zhanibek Handar St. 5/1, Z05P3Y4, Astana, Kazakhstan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, Kazakhstan 010000
| | - Saule Rakhimova
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Nazerke Satvaldina
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Diana Samakyzy
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Ulan Kozhamkulov
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Ulykbek Kairov
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Ainur Akilzhanova
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
| | - Dos Sarbassov
- Center for Life Sciences, National Laboratory Astana, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
- School of Sciences and Humanities, Nazarbayev University, Kabanbay batyr Ave 53, Astana, Kazakhstan 010000
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Arai Y, Okanishi T, Noma H, Kanai S, Kawaguchi T, Sunada H, Fujimoto A, Maegaki Y. Prognostic factors for employment outcomes in patients with a history of childhood-onset drug-resistant epilepsy. Front Pediatr 2023; 11:1173126. [PMID: 37576149 PMCID: PMC10419209 DOI: 10.3389/fped.2023.1173126] [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: 02/24/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The employment outcomes of childhood-onset drug-resistant epilepsy (DRE) has not been studied enough. The aim of this retrospective cohort study is to investigate the employment outcomes of childhood-onset DRE in June 2022 and identify the risk factors associated with non-employment. Materials and methods The sample consisted of 65 participants ≥18 years of age with a history of childhood-onset DRE. Fifty participants (77%) were salaried employees and 15 participants (23%) were non-employed. Clinical and psychosocial information were evaluated for calculating the relative risk (RR) of non-employment. Results Regarding medical factors, lower IQ [RR, 0.645; 95% confidence interval (CI), 0.443-0.938; p = 0.022] was positively associated with employment. In contrast, age at follow-up (RR, 1.046; 95% CI, 1.009-1.085; p = 0.014); number of ASMs at follow-up (RR, 1.517; 95% CI, 1.081-2.129; p = 0.016); use of medications such as phenobarbital (RR, 3.111; 95% CI, 1.383-6.997; p = 0.006), levetiracetam (RR, 2.471; 95% CI, 1.056-5.782; p = 0.037), and topiramate (RR, 3.576; 95% CI, 1.644-7.780; p = 0.001) were negatively associated with employment. Regarding psychosocial factor, initial workplace at employment support facilities (RR, 0.241; 95% CI, 0.113-0.513; p < 0.001) was positively associated with employment. In contrast, complication of psychiatric disorder symptoms (RR, 6.833; 95% CI, 2.141-21.810; p = 0.001) was negatively associated with employment. Regarding educational factor, graduating schools of special needs education (RR, 0.148; 95% CI, 0.061-0.360; p < 0.001) was positively associated with employment. Conclusions Specific medical, psychosocial, and educational factors may influence the employment outcomes of childhood-onset DRE. Paying attention to ASMs' side effects, adequately preventing the complications of psychiatric disorder symptoms, and providing an environment suitable for each patient condition would promote a fine working status for people with childhood-onset DRE.
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Affiliation(s)
- Yuto Arai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Sotaro Kanai
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Tatsuya Kawaguchi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroshi Sunada
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Yonago, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
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Cerovic M, Di Nunzio M, Craparotta I, Vezzani A. An in vitro model of drug-resistant seizures for selecting clinically effective antiseizure medications in Febrile Infection-Related Epilepsy Syndrome. Front Neurol 2023; 14:1129138. [PMID: 37034097 PMCID: PMC10074483 DOI: 10.3389/fneur.2023.1129138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction FIRES is a rare epileptic encephalopathy induced by acute unremitting seizures that occur suddenly in healthy children or young adults after a febrile illness in the preceding 2 weeks. This condition results in high mortality, neurological disability, and drug-resistant epilepsy. The development of new therapeutics is hampered by the lack of validated experimental models. Our goal was to address this unmet need by providing a simple tool for rapid throughput screening of new therapies that target pathological inflammatory mechanisms in FIRES. The model was not intended to mimic the etiopathogenesis of FIRES which is still unknown, but to reproduce salient features of its clinical presentation such as the age, the cytokine storm and the refractoriness of epileptic activity to antiseizure medications (ASMs). Methods We refined an in vitro model of mouse hippocampal/temporal cortex acute slices where drug-resistant epileptic activity is induced by zero Mg2+/100 μM 4-aminopirydine. Clinical evidence suggests that acute unremitting seizures in FIRES are promoted by neuroinflammation triggered in the brain by the preceding infection. We mimicked this inflammatory component by exposing slices for 30 min to 10 μg/ml lipopolysaccharide (LPS). Results LPS induced a sustained neuroinflammatory response, as shown by increased mRNA levels of IL-1β, CXCL1 (IL-8), TNF, and increased IL-1β/IL-1Ra ratio. Epileptiform activity was exacerbated by neuroinflammation, also displaying increased resistance to maximal therapeutic concentrations of midazolam (100 μM), phenytoin (50 μM), sodium valproate (800 μM), and phenobarbital (100 μM). Treatment of LPS-exposed slices with two immunomodulatory drugs, a mouse anti-IL-6 receptor antibody (100 μM) corresponding to tocilizumab in humans, or anakinra (1.3 μM) which blocks the IL-1 receptor type 1, delayed the onset of epileptiform events and strongly reduced the ASM-resistant epileptiform activity evoked by neuroinflammation. These drugs were shown to reduce ASM-refractory seizures in FIRES patients. Discussion The neuroinflammatory component and the pharmacological responsiveness of epileptiform events provide a proof-of-concept validation of this in vitro model for the rapid selection of new treatments for acute ASM-refractory seizures in FIRES.
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Affiliation(s)
- Milica Cerovic
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- *Correspondence: Milica Cerovic
| | - Martina Di Nunzio
- Department of Acute Brain Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ilaria Craparotta
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Annamaria Vezzani
- Department of Acute Brain Injury, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Annamaria Vezzani
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Janmohamed M, Hakeem H, Ooi S, Hakami S, Vu L, Perucca P, O'Brien TJ, Antonic-Baker A, Chen Z, Kwan P. Treatment Outcomes of Newly Diagnosed Epilepsy: A Systematic Review and Meta-analysis. CNS Drugs 2023; 37:13-30. [PMID: 36542274 DOI: 10.1007/s40263-022-00979-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding the multi-faceted treatment outcomes of newly diagnosed epilepsy is critical for developing rational therapeutic strategies. A meta-analysis was conducted to derive pooled estimates of a range of seizure outcomes in children and adults with newly diagnosed epilepsy commenced on antiseizure medication treatment, and to identify factors associated with different outcomes. METHODS PubMed/EMBASE were screened for eligible articles between 1 January, 1995 and 1 May, 2021 to include unselected cohort studies with a ≥ 12-month follow-up of seizure outcomes. Proportions of patients seizure free at different follow-up timepoints and their characteristics at the study population level were extracted. The patients were group-wise aggregated using a random-effects model. Primary outcomes were proportions of patients with cumulative 1-year seizure freedom (C1YSF), and 1-year and 5-year terminal seizure freedom (T1YSF and T5YSF). Secondary outcomes included the proportions of patients with early sustained seizure freedom, drug-resistant epilepsy and seizure-free off antiseizure medication at the last follow-up (off antiseizure medications). A separate random-effects meta-analysis was performed for nine predictors of importance. RESULTS In total, 39 cohorts (total n = 21,139) met eligibility criteria. They included 15 predominantly adult cohorts (n = 12,024), 19 children (n = 6569), and 5 of mixed-age groups (n = 2546). The pooled C1YSF was 79% (95% confidence interval [CI] 74-83). T1YSF was 68% (95% CI 63-72) and T5YSF was 69% (95% CI 62-75). Children had higher C1YSF (85% vs 68%, p < 0.001) and T1YSF than adult cohorts (74% vs 61%, p = 0.007). For secondary outcomes, 33% (95% CI 27-39) of patients achieved early sustained seizure freedom, 17% (95% CI 13-21) developed drug resistance, and 39% (95% CI 30-50) were off antiseizure medications at the last follow-up. Studies with a longer follow-up duration correlated with higher C1YSF (p < 0.001) and being off antiseizure medications (p = 0.045). Outcomes were not associated with study design (prospective vs retrospective), cohort size, publication year, or the earliest date of recruitment. Predictors of importance in newly diagnosed epilepsy include etiology, epilepsy type, abnormal diagnostics (neuroimaging, examination, and electroencephalogram findings), number of seizure types, and pre-treatment seizure burden. CONCLUSIONS Seizure freedom is achieved with currently available antiseizure medications in most patients with newly diagnosed epilepsy, yet this is often not immediate, may not be sustainable, and has not improved over recent decades. Symptomatic etiology, abnormal neuro-diagnostics, and increased pre-treatment seizure burden and seizure types are important predictors for unfavorable outcomes in newly diagnosed epilepsy. The study findings may be used as a quantitative benchmark on the efficacy of future antiseizure medication therapy for this patient population.
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Affiliation(s)
- Mubeen Janmohamed
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia. .,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.
| | - Haris Hakeem
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
| | - Suyi Ooi
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Suhailah Hakami
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Lily Vu
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia.,Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia.,Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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6
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Braathen G, Zelano J. Long-term seizure and psychosocial outcome in childhood epilepsy of unknown cause. Acta Neurol Scand 2021; 143:653-660. [PMID: 33772757 DOI: 10.1111/ane.13414] [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: 11/18/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose was to investigate long-term prognosis of epilepsy of unknown cause with onset between ages 2 and 16 in children without any major disability, by evaluation of a previously described prognostic model and long-term follow-up of a study on the impact of duration of initial antiseizure medication (ASM) treatment. METHODS Patients included in a randomized controlled trial (RCT) of either one or three years of ASM therapy prior to withdrawal (if seizure-free for at least 6 months) were contacted after 29-35 years and asked to complete a survey. Potential prognostic factors were evaluated: duration of initial ASM treatment, seizure type, seizure frequency, and score in a prognostic model developed in the initial publication. RESULTS One hundred and forty-nine subjects answered the questionnaire (response rate 65%). Seizure freedom without treatment was found in 110 responders (77%, 95%CI: 73-81). There was no significant difference in score in the prognostic model between responders with and without epilepsy at follow-up. Those with active epilepsy were unemployed significantly more often and perceived their mental health significantly more affected than those seizure-free without treatment. CONCLUSIONS Duration of initial ASM treatment was not associated with any difference in subsequent epilepsy risk. This indicates that the timing of withdrawal attempts is unlikely to alter the long-term prognosis of uncomplicated childhood epilepsy. The failure of the prognostic model from the initial study to predict long-term outcome argues that although prediction of relapse risk in the shorter term may be possible, the bearing of such models on long-term epilepsy risk is more questionable.
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Affiliation(s)
| | - Johan Zelano
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Clinical Neuroscience Sahlgrenska Academy Gothenburg Sweden
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Morningstar M, French RC, Mattson WI, Englot DJ, Nelson EE. Social brain networks: Resting-state and task-based connectivity in youth with and without epilepsy. Neuropsychologia 2021; 157:107882. [PMID: 33964273 DOI: 10.1016/j.neuropsychologia.2021.107882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
Individuals with epilepsy often experience social difficulties and deficits in social cognition. It remains unknown how disruptions to neural networks underlying such skills may contribute to this clinical phenotype. The current study compared the organization of relevant brain circuits-the "mentalizing network" and a salience-related network centered on the amygdala-in youth with and without epilepsy. Functional connectivity between the nodes of these networks was assessed, both at rest and during engagement in a social cognitive task (facial emotion recognition), using functional magnetic resonance imaging. There were no group differences in resting-state connectivity within either neural network. In contrast, youth with epilepsy showed comparatively lower connectivity between the left posterior superior temporal sulcus and the medial prefrontal cortex-but greater connectivity within the left temporal lobe-when viewing faces in the task. These findings suggest that the organization of a mentalizing network underpinning social cognition may be disrupted in youth with epilepsy, though differences in connectivity within this circuit may shift depending on task demands. Our results highlight the importance of considering functional task-based engagement of neural systems in characterizations of network dysfunction in epilepsy.
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Affiliation(s)
- M Morningstar
- Department of Psychology, Queen's University, Kingston, ON, Canada; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - R C French
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - W I Mattson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - D J Englot
- Department of Neurological Surgery, Radiology and Radiological Sciences, and Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - E E Nelson
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Record EJ, Bumbut A, Shih S, Merwin S, Kroner B, Gaillard WD. Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy Behav 2021; 115:107716. [PMID: 33444988 DOI: 10.1016/j.yebeh.2020.107716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The Seizures and Outcomes Study in Children (SOS-KIDS) identifies risk factors, etiologies, and comorbidities in a pediatric epilepsy population in a major city with diversity in socioeconomic levels. A thorough understanding of the range of issues impacting children with epilepsy is critical to establishing treatment that will produce better health outcomes. SOS-KIDS is a cross-sectional cohort study of pediatric epilepsy patients who live in Washington D.C. and are evaluated at Children's National Hospital. Families were recruited at the time of the child's routine clinic appointment or inpatient visit. Information was extracted from participants' electronic medical records (EMR) and parent reports; participants were screened for comorbidities using standardized screening measures. Data were collected from 289 participants (47% female, 53% male), and mean age was 7.9 years (2 months to 17 years). Twenty-nine percent of participants had primary generalized epilepsy, 63% focal epilepsy, 0.3% combined generalized and focal epilepsy, and 8% could not be distinguished. There were a variety of epilepsy risk factors including prematurity (10%), intraventricular hemorrhage (7%), neonatal seizures (8%), and febrile seizures (17%). The most common etiologies were cerebral malformations (13%) and genetic disorders (25%). Numerous participants had documented comorbidities including developmental delay (56%), intellectual disability (20%), headaches (16%), attention-deficit hyperactivity disorder (23%), and autism (7%). Of participants aged six years and older, depression, and anxiety were reported in 5% and 6% within the EMR, 14% and 19% in parent surveys, and 22% and 33% with standardized screening measures. We identified a wide variety of risk factors and etiologies among urban pediatric epilepsy patients, with genetic and structural being the most common. Neurologic and psychiatric comorbidities were common, but the prevalence of several psychiatric disorders reported within the EMR was substantially lower compared to that found when using parent surveys and standardized screening measures.
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Affiliation(s)
- E Justine Record
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA.
| | - Adrian Bumbut
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Sharon Shih
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Stephanie Merwin
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Barbara Kroner
- RTI International, 701 13th St NW #750, Washington, DC 20005, USA
| | - William D Gaillard
- Children's National Hospital, Center for Neuroscience, 111 Michigan Avenue NW, Washington, DC 20010, USA
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9
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Effects of resective epilepsy surgery on the social determinants of health. Epilepsy Res 2020; 163:106338. [DOI: 10.1016/j.eplepsyres.2020.106338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023]
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10
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Friefeld Kesselmayer R, McMillan T, Lee B, Almane D, Hermann BP, Jones JE. Psychosocial and functional outcomes in young adults with childhood-onset epilepsy: a 10-year follow-up. Dev Med Child Neurol 2020; 62:587-592. [PMID: 31985053 PMCID: PMC7781097 DOI: 10.1111/dmcn.14477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 11/29/2022]
Abstract
AIM To compare long-term psychosocial and functional outcomes of young adults with uncomplicated childhood-onset epilepsy (COE) to population norm controls utilizing a controlled prospective cohort study. METHOD Psychosocial and functional outcomes were assessed at 10-year follow-up. Fifty-three young adults (27 males, 26 females) with COE (n=21 remission; 18y 1mo-30y 9mo; mean age 23y 4mo [SD 3y 4mo]; mean age of epilepsy onset 12y [SD 3y 2mo]) were compared to 55 (23 males, 32 females) first-degree cousin controls (18y 5mo-29y 8mo; mean age 23y 6mo [SD 3y]). Seizure remission status and baseline comorbidities (attention-deficit/hyperactivity disorder [ADHD], depressive disorders, anxiety disorders, and academic problems) were examined as possible risk factors for significant differences in functional outcomes. RESULTS Poorer functional outcomes, indicated by patient rated cognition and overall disability, were evident among young adults with epilepsy compared to controls (all p<0.05). These difficulties were due to baseline comorbid ADHD and academic problems. Remission status was not related to measured cognition and overall disability. INTERPRETATION Psychosocial outcomes of young adults with COE were similar to controls. In contrast, functional outcomes were worse in epilepsy across cognition and overall disability. Baseline comorbid ADHD and academic problems were identified as risk factors at 10-year follow-up suggesting that these early recognized comorbidities at or near diagnosis have long-term impacts. WHAT THIS PAPER ADDS Young adults with childhood-onset epilepsy (COE) and controls have similar psychosocial outcomes 10 years after diagnosis. Young adults with COE report greater limitations in cognition and overall disability than controls. Baseline presence of attention-deficit/hyperactivity disorder and academic problems significantly affect cognitive and overall disability scores.
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Affiliation(s)
- Rachel Friefeld Kesselmayer
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Taylor McMillan
- Department of Psychology, University of Maine, Orono, ME, USA
| | - Beatrice Lee
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
| | - Dace Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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11
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Mohamed IN, Osman AH, Mohamed S, Hamid EK, Hamed AA, Alsir A, Gerais YA, Bakhiet AM, Elsadig SM, Elseed MA. Intelligence quotient (IQ) among children with epilepsy: National epidemiological study - Sudan. Epilepsy Behav 2020; 103:106813. [PMID: 31937511 DOI: 10.1016/j.yebeh.2019.106813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many studies of selected groups of children with epilepsy have demonstrated an association between epilepsy and cognitive deficits. The aim of this study was to assess the intellectual skills of children with epilepsy and to investigate the influence of gender, age at seizure onset, type of epilepsy, antiepileptic drug used, and control of epilepsy on their intellectual function. METHODS This is a descriptive prospective study in which one hundred and eighty-seven patients at school age (6-14 years) were recruited. Epilepsy was classified using the International League Against Epilepsy (ILAE) Commission on Classification and Terminology 2005-2009 report. An intelligence quotient (IQ) test was conducted to all patients using Stanford-Binet Fifth Edition (SB5)/Arabic version. RESULTS Eighty-eight (47.1%) patients had an average score on Full Scale IQ (FSIQ), 44 (23.5%) had low average, whereas 18 (9.6%) had borderline impaired or delayed score. In the nonverbal IQ (NVIQ) score, the majority 84 (44.9%) had average score. The performance of the patients in the nonverbal score is better than in the verbal score, which was found to be statistically significant (P-value = 0.01). The FSIQ score was negatively affected by younger age at onset of epilepsy, polytherapy, and uncontrolled seizures. CONCLUSIONS Most of children with epilepsy had an average FSIQ; uncontrolled seizure had worse effect on overall FSIQ and memory. Interventions to support children with epilepsy should focus on epilepsy management and school psychosocial domains.
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Affiliation(s)
- Inaam N Mohamed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan.
| | - Abdelgadir H Osman
- Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Somia Mohamed
- Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan
| | - Emtinan K Hamid
- Department of Community Medicine- Biostatistics Division, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ahlam A Hamed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Soba University Hospital, Sudan
| | - Ali Alsir
- Neurology Unit, Soba University Hospital, Sudan
| | - Yasmin A Gerais
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Aisha M Bakhiet
- Department of Psychiatry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Sarah M Elsadig
- Department of Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Maha A Elseed
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Neurology Unit, Gafer Ibn Auf Specialized hospital for Children, Sudan
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Kaur J, Paul BS, Goel P, Singh G. Educational achievement, employment, marriage, and driving in adults with childhood-onset epilepsy. Epilepsy Behav 2019; 97:149-153. [PMID: 31252270 DOI: 10.1016/j.yebeh.2019.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/11/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND People with epilepsy (PWE) beginning in childhood often experience psychological and social hold-ups in addition to seizures. The hold-ups relate to education, employment, driving, and marriage. OBJECTIVE The objective of this study was to document the impact of long-standing, childhood-onset epilepsy on sociopersonal accomplishments of adults pertaining to education, employment, marriage, and driving. METHODS A prospective, questionnaire-based survey was undertaken in a hospital-based sample of PWE and their unaffected (by epilepsy) older siblings within the immediate/extended family unit. RESULTS People with epilepsy were significantly more likely to abandon formal education after primary (6; 2.4% compared to none in controls) or secondary (69; 31.1% compared with controls 58; 26.1%) school, less likely to be currently married (97; 43.7%) when compared with their elder siblings (158; 71.2%) (P = 0.0001), and less likely to be currently employed (103; 46.4%) (P = 0.0001) or driving (111; 50%) (P = 0.0001) compared with the older same-gender siblings (employed: 148; 66.7%; driving: 165; 74.3%). In multivariate models, having epilepsy and age were associated with employment status, whereas age and education and employment status were associated with both marriage and driving. CONCLUSION Notwithstanding the influence of a number of socioeconomic and epilepsy-related variables, childhood-onset epilepsy stands apart in exerting a huge negative impact on educational achievement, employability, marital status, and driving in adulthood.
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Affiliation(s)
- Jaslovleen Kaur
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana - 141001, India
| | - Birinder S Paul
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana - 141001, India
| | - Parveen Goel
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana - 141001, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana - 141001, India.
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Caplan R. Epilepsy, language, and social skills. BRAIN AND LANGUAGE 2019; 193:18-30. [PMID: 28987707 DOI: 10.1016/j.bandl.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 08/10/2017] [Accepted: 08/27/2017] [Indexed: 06/07/2023]
Abstract
Language and social skills are essential for intrapersonal and interpersonal functioning and quality of life. Since epilepsy impacts these important domains of individuals' functioning, understanding the psychosocial and biological factors involved in the relationship among epilepsy, language, and social skills has important theoretical and clinical implications. This review first describes the psychosocial and biological factors involved in the association between language and social behavior in children and in adults and their relevance for epilepsy. It reviews the findings of studies of social skills and the few studies conducted on the inter-relationship of language and social skills in pediatric and adult epilepsy. The paper concludes with suggested future research and clinical directions that will enhance early identification and treatment of epilepsy patients at risk for impaired language and social skills.
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Affiliation(s)
- Rochelle Caplan
- UCLA David Geffen School of Medicine, Department of Psychiatry, United States.
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Starck C, Nevalainen O, Auvinen A, Eriksson K. Fertility and marital status in adults with childhood onset epilepsy: A population‐based cohort study. Epilepsia 2019; 60:1438-1444. [DOI: 10.1111/epi.16018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Christian Starck
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Olli Nevalainen
- Hatanpää Health Center City of Tampere Tampere Finland
- Faculty of Social Sciences Unit of Health Sciences Tampere University Tampere Finland
| | - Anssi Auvinen
- Faculty of Social Sciences Unit of Health Sciences Tampere University Tampere Finland
- Child Health Research Center Pirkanmaa Hospital District/TA4 Tampere University Hospital Tampere Finland
| | - Kai Eriksson
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Tampere Center for Child Health Research School of Medicine Tampere University Tampere Finland
- Department of Pediatric Neurology Tampere University HospitalTampere University Hospital Tampere Finland
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15
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Ma Y, Zhao F, Yu D. Cleidocranial dysplasia syndrome with epilepsy: a case report. BMC Pediatr 2019; 19:97. [PMID: 30961565 PMCID: PMC6452517 DOI: 10.1186/s12887-019-1472-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cleidocranial dysplasia is a rare autosomal dominant disorder resulting in skeletal and dental abnormalities due to the disturbance in ossification of the bones. The prevalence of CCD is one in a million of live births, and epileptic seizures are rarer in this disease. Case presentation Herein, we present a case of a 10-year-old girl, who not only suffered with cleidocranial dysplasia, but experienced frequent seizures. We initiated an anti-epileptic treatment for this patient with dose adjustments to her weight of levetiracetam (10 mg/kg, bid) for 3 months. The epileptic seizures were controlled, but the intelligence level and control of epilepsy need to be followed up for a longer duration. Conclusions In clinical practice, if a patient has unusual facies, typical clavicle defect, skull bone enlargement, and unclosed anterior fontanelle, we should consider the possibility of cleidocranial dysplasia, genetic detection are helpful to make a confirmed diagnosis. In such cases, early diagnosis and treatment is important to correct deformities and improve the quality of life of patients.
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Affiliation(s)
- Yimei Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Fumin Zhao
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Dan Yu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
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16
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Na JH, Lee YM. Transient and Adult Patients with Neurologic Diseases in the Pediatric Emergency Department: Trends and Characteristics. J Clin Neurol 2019; 15:191-204. [PMID: 30877696 PMCID: PMC6444142 DOI: 10.3988/jcn.2019.15.2.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE There is an increasing rate of presentations by transient and adult patients (TAPs) to pediatric emergency departments (PED-EDs). TAPs with neurologic diseases (N-TAPs) comprise most of these patients. We investigated this trend and compared the characteristics of N-TAPs with those of pediatric patients with neurologic diseases (N-PEDs) who presented to the PED-ED of a tertiary-care hospital in Korea. METHODS We reviewed the medical records of neurologic patients who presented to the PED-ED of a single tertiary-care hospital from 2013 to 2017. We included patients with neurologic symptoms or diseases and those who were treated in the pediatric neurology department and underwent neurologic evaluations and treatment in the PED-ED. RESULTS Presentations by N-TAPs to the PED-ED increased over time, whereas the number of N-PEDs gradually decreased, with a significant difference between the groups (p<0.001). The number of N-TAPs who presented to the PED-ED almost tripled from 2013 to 2017. N-TAPs had significantly more acute symptoms than N-PEDs, and a significantly higher proportion of N-TAPs were insured by Medical Aid compared to N-PEDs (p<0.001). The admission rate was significantly higher (p<0.001) and the mean hospital stay was longer (p=0.046) for N-TAPs. Epilepsy and neurometabolic diseases were mainly responsible for the increased presentations by N-TAPs. CONCLUSIONS We have clarified the status of N-TAPs in the PED-ER and the role of pediatric neurologists who manage them. Multidisciplinary treatments focusing on the role of pediatric neurologists should be developed to that systematic long-term care plans are applied to N-TAPs.
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Affiliation(s)
- Ji Hoon Na
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Young Mock Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Epilepsy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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17
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Puka K, Tavares TP, Speechley KN. Social outcomes for adults with a history of childhood-onset epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2019; 92:297-305. [PMID: 30731296 DOI: 10.1016/j.yebeh.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This review aimed to describe social outcomes in adulthood for people with a history of childhood-onset epilepsy and identify factors associated with these outcomes; focused on educational attainment, employment, income/financial status, independence/living arrangement, romantic relationships, parenthood, and friendships. METHODS A comprehensive search of MEDLINE, EMBASE, and PsycINFO was conducted, as well as forward and backward citation tracking. A total of 45 articles met inclusion criteria. Random effects meta-analyses were conducted, and subgroup analyses evaluated outcomes for people with epilepsy (PWE) with good prognosis (e.g., normal intelligence, 'epilepsy-only') and poor prognosis (e.g., intellectual disability, Dravet syndrome), and those who underwent epilepsy surgery in childhood. RESULTS Among all PWE, 73% (95% confidence interval [CI]: 64-82%) completed secondary school education, 63% (95%CI: 56-70%) were employed; 74% (95%CI: 68-81%) did not receive governmental financial assistance; 32% (95%CI: 25-39%) were in romantic relationships; 34% (95%CI: 24-45%) lived independently; 21% (95%CI:12-33%) had children, and 79% (95%CI: 71-87%) had close friend(s). People with epilepsy often fared worse relative to healthy controls. Among PWE with a good prognosis, a comparable number of studies reported similar/better outcomes relative to controls as reported poorer outcomes. The most consistent predictor of poorer outcomes was the presence of cognitive problems; results of studies evaluating seizure control were equivocal. CONCLUSION People with epilepsy with a good prognosis may show similar social outcomes as controls, though robust conclusions are difficult to make given the extant literature. Seizure control does not guarantee better outcomes. There is a need for more studies evaluating prognostic factors and studies with control groups to facilitate appropriate comparisons.
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Affiliation(s)
- Klajdi Puka
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Tamara P Tavares
- Department of Neuroscience, Western University, London, ON, Canada; Brain and Mind Institute, Western University, London, ON, Canada
| | - Kathy N Speechley
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Department of Paediatrics, Western University, London, ON, Canada
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Sillanpää M, Saarinen MM, Karrasch M, Schmidt D, Hermann BP. Neurocognition in childhood epilepsy: Impact on mortality and complete seizure remission 50 years later. Epilepsia 2018; 60:131-138. [PMID: 30565654 DOI: 10.1111/epi.14606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study associations of the severity of impairment in childhood neurocognition (NC) with long-term mortality and complete seizure remission. METHODS A population-based cohort of 245 subjects with childhood onset epilepsy was followed up for 50 years (median = 45, range = 2-50). Childhood NC before age 18 years was assessed as a combination of formal intelligence quotient scores and functional criteria (school achievement, working history, and psychoneurological development). Impaired NC was categorized with respect to definitions of intellectual functioning in International Classification of Diseases, 10th revision (R41.83, F70-F73). The outcome variables, defined as all-cause mortality and 10-year terminal remission with the 5 past years off medication (10YTR), were analyzed with Cox regression models. RESULTS Of the 245 subjects, 119 (49%) had normal childhood NC, whereas 126 (51%) had various degrees of neurocognitive impairment. During the 50-year observation period, 71 (29%) of the subjects died, 13% of those with normal and 44% of those with impaired NC. The hazard of death increased gradually in line with more impaired cognition, reaching significance in moderate, severe, and profound impairment versus normal NC (hazard ratio [Bonferroni corrected 95% confidence interval] = 3.3 [1.2-9.2], 4.2 [1.2-14.2], and 5.5 [2.4-12.3], respectively). The chance for 10YTR was highest among subjects with normal NC (61%), whereas none of those with profound impairment reached 10YTR. In the intermediate categories, the chance was, however, not directly related to the increasing severity of impairment. SIGNIFICANCE The severity of neurocognitive impairment during childhood shows a parallel increase in the risk of death. In comparison with normal NC, subjects with lower childhood NC are less likely to enter seizure remission. However, normal NC does not guarantee complete remission or prevent premature death in some individuals with childhood onset epilepsy.
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Affiliation(s)
- Matti Sillanpää
- Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Maiju M Saarinen
- Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | | | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Gatta M, Raffagnato A, Mannarini S, Balottin L, Toldo I, Vecchi M, Boniver C. Pediatric epilepsy and psychiatric comorbidity: preliminary observational data from a prospective study. Minerva Pediatr 2018; 70:501-512. [DOI: 10.23736/s0026-4946.17.04753-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okamoto K, Fukuda M, Saito I, Horiuchi I, Okazawa T, Ishii E. Incidence of childhood epilepsy: A population-based study in rural Japan. Brain Dev 2018; 40:904-908. [PMID: 29934113 DOI: 10.1016/j.braindev.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/10/2017] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Epilepsy is a common childhood neurological condition and a major public health concern worldwide. A higher incidence of epilepsy is reported in low- and middle-income countries, particularly in rural areas. However, no Japanese reports on the incidence of childhood epilepsy have been published in the past 25 years. We estimated the annual incidence of epilepsy in children aged 1-14 years in Uwajima, a city in a rural, relatively isolated area of Japan. METHODS Candidates were extracted from Japan's public insurance database following the International Classification of Diseases code for epilepsy. Epilepsy was defined as two or more unprovoked seizures more than 24 hours apart, as per the International League Against Epilepsy definition. The study sample was divided into three cohorts based on age at diagnosis: 1-4, 5-9, and 10-14 years. The incidence of epilepsy was calculated as the number of children with epilepsy divided by the person-years in each cohort. RESULTS The annual incidence rate of epilepsy in children aged 1-14 years was 70.4/100,000 children (95% confidence interval, 44.8-96.0). There was no significant difference in incidence between boys and girls. This rate was similar to those reported in other countries, although the incidence in children aged 1-4 years was slightly higher in our study than in other countries. CONCLUSION The annual incidence of childhood epilepsy in rural areas of Japan is generally comparable with rates of childhood epilepsy reported in other countries.
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Affiliation(s)
- Kentaro Okamoto
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan; Department of Pediatrics, Uwajima City Hospital, 1-1 Gotenmachi, Uwajima, Ehime 798-8510, Japan.
| | - Mitsumasa Fukuda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Isaku Horiuchi
- Department of Pediatrics, Asahigawasou South Ehime Hospital, 607, Naganoichi, Kihoku, Ehime 798-1333, Japan
| | - Tomoko Okazawa
- Okazawa clinic, 1976, Mishohirajo, Ainan, Ehime 798-4110, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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Grebenyuk OV, Kazennykh TV, Alifirova VM, Svetlik MV, Bokhan NA. [Gender aspects of medico-social adaptation in adults with early onset of epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:53-58. [PMID: 28745672 DOI: 10.17116/jnevro20171176153-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the relationship between indicators of clinical picture and social adaptation in idiopathic and symptomatic epilepsies with onset before adulthood depending on patient's gender. MATERIAL AND METHODS The cross-sectional study was carried out. The study group included 212 women and 171 men, aged 24-60 years, with confirmed diagnosis of epilepsy with onset before 18 years. Seventy-three patients were diagnosed with symptomatic epilepsy, 310 with idiopathic epilepsy. In 120 patients, the frequency of seizures was rarer than once a year. All patients had secondary education and were on treatment with antiepileptic drugs. RESULTS AND CONCLUSION In symptomatic epilepsy with early onset, gender differences in family and educational status were not identified. Regardless of gender, patients with myoclonus had higher education more frequently than patients with absence and tonic-clonic seizures. Patients with the combination of different types of seizures, irrespective from etiology and gender, had secondary education more frequently. Women with rare generalized seizures more frequently had higher education and were married. Unmarried men with rare generalized seizures lived separately from their relatives more frequently. To author's opinion, the contradiction in indicators of social adaptation in men with rare generalized seizures, to the great extent, is related to the phenomenon of self-stigmatization than to the influence of disease. The results can be used in rehabilitation of patients with idiopathic epilepsy syndromes.
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Affiliation(s)
| | | | | | - M V Svetlik
- Siberian State Medical University, Tomsk, Russia
| | - N A Bokhan
- Mental Health Research Institute, Tomsk, Russia
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Hosoyama H, Matsuda K, Mihara T, Usui N, Baba K, Inoue Y, Tottori T, Otsubo T, Kashida Y, Iida K, Hirano H, Hanaya R, Arita K. Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey. J Neurosurg Pediatr 2017; 19:606-615. [PMID: 28291425 DOI: 10.3171/2016.12.peds16197] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of seizure control and social adaptation, resective surgery yielded longitudinal benefits in children with intractable epilepsy, especially those with a lesional pathology in a single lobe.
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Affiliation(s)
- Hiroshi Hosoyama
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazumi Matsuda
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Tadahiro Mihara
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Naotaka Usui
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Koichi Baba
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Yushi Inoue
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Takayasu Tottori
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka
| | - Toshiaki Otsubo
- Department of Neurosurgery, Fujimoto General Hospital, Miyakonojo, Miyazaki; and
| | - Yumi Kashida
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka.,Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Koji Iida
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima
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Baca CB, Barry F, Vickrey BG, Caplan R, Berg AT. Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study. Epilepsia 2017; 58:781-791. [PMID: 28378439 DOI: 10.1111/epi.13726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to compare long-term social outcomes in young adults with childhood-onset epilepsy (cases) with neurologically normal sibling controls. METHODS Long-term social outcomes were assessed at the 15-year follow-up of the Connecticut Study of Epilepsy, a community-based prospective cohort study of children with newly diagnosed epilepsy. Young adults with childhood-onset epilepsy with complicated (abnormal neurologic exam findings, abnormal brain imaging with lesion referable to epilepsy, intellectual disability (ID; IQ < 60) or informative history of neurologic insults to which the occurrence of epilepsy might be attributed), and uncomplicated epilepsy presentations were compared to healthy sibling controls. Age, gender, and matched-pair adjusted generalized linear models stratified by complicated epilepsy and 5-year seizure-free status estimated adjusted odds ratios (aORs) and 95% confidence intervals [CIs] for each outcome. RESULTS The 15-year follow-up included 361 individuals with epilepsy (59% of initial cases; N = 291 uncomplicated and N = 70 complicated epilepsy; mean age 22 years [standard deviation, SD 3.5]; mean epilepsy onset 6.2 years [SD 3.9]) and 173 controls. Social outcomes for cases with uncomplicated epilepsy with ≥5 years terminal remission were comparable to controls; cases with uncomplicated epilepsy <5 years seizure-free were more likely to be less productive (school/employment < 20 h/week) (aOR 3.63, 95% CI 1.83-7.20) and not to have a driver's license (aOR 6.25, 95% CI 2.85-13.72). Complicated cases with epilepsy <5 years seizure-free had worse outcomes across multiple domains; including not graduating high school (aOR 24.97, 95% CI 7.49-83.30), being un- or underemployed (<20 h/week) (aOR 11.06, 95% CI 4.44-27.57), being less productively engaged (aOR 15.71, 95% CI 6.88-35.88), and not living independently (aOR 10.24, 95% CI 3.98-26.36). Complicated cases without ID (N = 36) had worse outcomes with respect to productive engagement (aOR 6.02; 95% CI 2.48-14.58) compared to controls. Cases with complicated epilepsy were less likely to be driving compared to controls, irrespective of remission status or ID. SIGNIFICANCE In individuals with uncomplicated childhood-onset epilepsy presentations and 5-year terminal remission, young adult social outcomes are comparable to those of sibling controls. Complicated epilepsy, notable for intellectual disability, and seizure remission status are important prognostic indicators for long-term young adult social outcomes in childhood-onset epilepsy.
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Affiliation(s)
- Christine B Baca
- Department of Neurology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, U.S.A.,Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Frances Barry
- Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Barbara G Vickrey
- Department of Neurology, University of California Los Angeles, Los Angeles, California, U.S.A.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Rochelle Caplan
- Department of Psychiatry, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Anne T Berg
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern-Feinberg School of Medicine, Chicago, Illinois, U.S.A
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Hanaoka Y, Yoshinaga H, Kobayashi K. A ten-year follow-up cohort study of childhood epilepsy: Changes in epilepsy diagnosis with age. Brain Dev 2017; 39:312-320. [PMID: 27847129 DOI: 10.1016/j.braindev.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To elucidate all of the characteristics of childhood epilepsy, we performed a long-term follow-up study on the patients who visited Okayama University Hospital. SUBJECTS AND METHODS We retrospectively investigated the patients who were involved in the previous epidemiological study and visited Okayama University Hospital for a period of 10years after December 31, 1999. RESULTS Overall, there were 350 patients' medical records that were evaluated, and 258 patients with complete clinical information available for a 10-year period were enrolled. Ten patients died and the remaining 82 were lost to follow-up. Of 258 patients with complete information, 153 (59.3%) were seizure-free for at least 5years. One hundred thirty (50.4%) had intellectual disabilities and 77 (29.8%) had motor disabilities, including 75 (29.1%) with both disabilities on December 31, 2009. Thirty-four patients of 350 (9.7%) changed the epilepsy classification during follow-up. With regard to ten patients who died, nine of them had symptomatic epilepsy, particularly those with severe underlying disorders with an onset during the first year of life. CONCLUSION Clinical status considerably changed during the decade-long follow-up period in childhood epilepsy. Changes in the epilepsy diagnosis are especially important and should be taken into account in the long-term care of children with epilepsy.
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Affiliation(s)
- Yoshiyuki Hanaoka
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan.
| | - Harumi Yoshinaga
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Katsuhiro Kobayashi
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
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Ashmawi A, Hosny H, Abdelalim A, Bianchi E, Beghi E. The long-term prognosis of newly diagnosed epilepsy in Egypt: A retrospective cohort study from an epilepsy center in Greater Cairo. Seizure 2016; 41:86-95. [DOI: 10.1016/j.seizure.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022] Open
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Sillanpää M, Schmidt D. Long-term outcome of medically treated epilepsy. Seizure 2016; 44:211-216. [PMID: 27646715 DOI: 10.1016/j.seizure.2016.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To review the long-term outcome of epilepsy in population-based studies. METHOD Analysis of population-based studies. RESULTS About two of three patients with new-onset epilepsy will, in the long run, enter five-year terminal remission. Chances for remission are best for those with idiopathic or cryptogenic epilepsy. It is unclear whether the seizure outcome has improved over the last several decades. Social outcome, however, may have become better because of the improved level of knowledge on and public attitudes toward people with epilepsy, and possibly fewer prejudices at home, daycare, school, military and labor market. CONCLUSION While we still do not have a cure for epilepsy for all patients, relief of the medical and social consequences is available for many and hope is on the horizon for people with epilepsy.
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Affiliation(s)
- M Sillanpää
- Departments of Child Neurology and Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - D Schmidt
- Epilepsy Research Group, Berlin, Germany
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Jennum P, Pickering L, Christensen J, Ibsen R, Kjellberg J. Welfare cost of childhood- and adolescent-onset epilepsy: A controlled national study. Epilepsy Behav 2016; 61:72-77. [PMID: 27317897 DOI: 10.1016/j.yebeh.2016.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Epilepsy is associated with a significant burden to patients and society. We calculated the factual excess in direct and indirect costs associated with childhood- and adolescent-onset epilepsy. METHODS Using records from the Danish National Patient Registry (1998-2002), we identified 3123 and 5018 patients with epilepsy aged 0-5years and 6-20years at the time of diagnosis, respectively. The two age groups of patients with epilepsy were matched to 6246 and 10,036 control persons without epilepsy, respectively, by gender, age, and geography. The controls were randomly chosen from the Danish Civil Registration System. Welfare costs included outpatient services, inpatient admissions, and emergency room visits based on the Danish National Patient Registry and information from the primary health-care sector based on data from the Danish Ministry of Health. This allowed the total health-care cost of epilepsy to be estimated. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits to outpatient clinics and hospitalizations and costs from primary sectors were based on data obtained from the National Patient Registry. RESULTS Children with epilepsy had higher welfare costs than controls. The highest cost was found one year after diagnosis, with higher costs up to 10years after diagnosis compared with controls. Children aged 0-5years incurred greater health-care costs than those aged 6-20years. CONCLUSION Epilepsy has major socioeconomic consequences for the individual person with epilepsy and for society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Line Pickering
- Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
| | - Rikke Ibsen
- itracks, Klosterport 4E, 4, Aarhus, Denmark.
| | - Jakob Kjellberg
- Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark.
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Bell GS, Neligan A, Giavasi C, Keezer MR, Novy J, Peacock JL, Johnson AL, Goodridge DMG, Shorvon SD, Sander JW. Outcome of seizures in the general population after 25 years: a prospective follow-up, observational cohort study. J Neurol Neurosurg Psychiatry 2016; 87:843-50. [PMID: 26780937 DOI: 10.1136/jnnp-2015-312314] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/17/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We investigated long-term (to 25 years) seizure prognosis and survival in people with newly diagnosed epilepsy in the community. We explored whether prognosis is different in those with epilepsy (>2 unprovoked seizures) and those with a single seizure at presentation. METHODS This is a prospective observational cohort study of people with newly diagnosed seizures. We investigated seizure outcome and survival in people presenting with a single seizure and in those presenting with >2 seizures (epilepsy). RESULTS 695 people (median follow-up 23.6 years) had unprovoked epileptic seizures. For seizure analysis we excluded 38 people with missing data leaving 657 (309 male, and 249 aged <18 years). Seizures recurred in 67%. The 354 people with epilepsy were only slightly more likely to have further seizure recurrence than the 302 people with a single seizure at presentation (HR 1.32, 95% CI 1.09 to 1.59). In 327 people with complete follow-up, 268 (82%, 95% CI 77% to 86%) were in terminal remission; (80%, (95% CI 73% to 85%) in those with epilepsy at presentation). Premature mortality was increased in people with epilepsy (standardised mortality ratio 1.67; 95% CI 1.40 to 1.99) and those with a single seizure at presentation (standardised mortality ratio 2.65; 95% CI 2.23 to 3.15). It is also high in those with early remission. CONCLUSIONS People with epilepsy and with single seizures at presentation in the community generally have good prognosis for seizure control with prolonged follow-up. The risk of premature mortality is significantly increased in both groups.
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Affiliation(s)
- Gail S Bell
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK
| | - Aidan Neligan
- Department of Neurology, Homerton University Hospital, London, UK
| | - Christina Giavasi
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - Mark R Keezer
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - Jan Novy
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Janet L Peacock
- Division of Health and Social Care Research, King's College London, London UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | | | | | - Simon D Shorvon
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK Epilepsy Society, Chalfont St Peter, Buckinghamshire, UK Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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Barry JM, Tian C, Spinella A, Page M, Holmes GL. Spatial cognition following early-life seizures in rats: Performance deficits are dependent on task demands. Epilepsy Behav 2016; 60:1-6. [PMID: 27152463 PMCID: PMC4912871 DOI: 10.1016/j.yebeh.2016.03.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/26/2016] [Accepted: 03/25/2016] [Indexed: 11/20/2022]
Abstract
Cognitive impairment is a common comorbidity in childhood epilepsy. Studies in rodents have demonstrated that frequent seizures during the first weeks of life result in impaired spatial cognition when the rats are tested as juvenile or adults. To determine if spatial cognitive deficits following early-life seizures are task-specific or similar across spatial tasks, we compared the effects of early-life seizures in two spatial assays: 1) the Morris water maze, a hippocampal-dependent task of spatial cognition and 2) the active avoidance task, a task that associates an aversive shock stimulus with a static spatial location that requires intact hippocampal-amygdala networks. Rats with early-life seizures tested as adults did not differ from control rats in the water maze. However, while animals with early-life seizures showed some evidence of learning the active avoidance task, they received significantly more shocks in later training trials, particularly during the second training day, than controls. One possibility for the performance differences between the tasks is that the active avoidance task requires multiple brain regions and that interregional communication could be affected by alterations in white matter integrity. However, there were no measurable group differences with regard to levels of myelination. The study suggests that elucidation of mild cognitive deficits seen following early-life seizures may be dependent on task features of active avoidance.
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Affiliation(s)
- Jeremy M Barry
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA.
| | - Chengju Tian
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Anthony Spinella
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Matias Page
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT 05405, USA
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What is more harmful, seizures or epileptic EEG abnormalities? Is there any clinical data? Epileptic Disord 2016; 16 Spec No 1:S12-22. [PMID: 25323031 DOI: 10.1684/epd.2014.0686] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cognitive impairment is a common and often devastating co-morbidity of childhood epilepsy. While the aetiology of the epilepsy is a critical determinant of cognitive outcome, there is considerable evidence from both rodent and human studies that indicate that seizures and interictal epileptiform abnormalities can contribute to cognitive impairment. A critical feature of childhood epilepsy is that the seizures and epileptiform activity occur in a brain with developing, plastic neuronal circuits. The consequences of seizures and interictal epileptiform activity in the developing brain differ from similar paroxysmal events occurring in the relatively fixed circuitry of the mature brain. In animals, it is possible to study interictal spikes independently from seizures, and it has been demonstrated that interictal spikes are as detrimental as seizures during brain development. In the clinic, distinguishing the differences between interictal spikes and seizures is more difficult, since both typically occur together. However, both seizures and interictal spikes result in transient cognitive impairment. Recurrent seizures, particularly when frequent, can lead to cognitive regression. While the clinical data linking interictal spikes to persistent cognitive impairment is limited, interictal spikes occurring during the formation and stabilization of neuronal circuits likely contribute to aberrant connectivity. There is insufficient clinical literature to indicate whether interictal spikes are more detrimental than seizures during brain development.
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Abstract
Epilepsy is a complex disorder, which involves much more than seizures, encompassing a range of associated comorbid health conditions that can have significant health and quality-of-life implications. Of these comorbidities, cognitive impairment is one of the most common and distressing aspects of epilepsy. Clinical studies have demonstrated that refractory seizures, resistant to antiepileptic drugs, and occurring early in life have significant adverse effects on cognitive function. Much of what has been learned about the neurobiological underpinnings of cognitive impairment following early-life seizures has come from animal models. Although early-life seizures in rodents do not result in cell loss, seizures cause in changes in neurogenesis and synaptogenesis and alteration of excitatory or inhibitory balance, network connectivity and temporal coding. These morphological and physiological changes are accompanied by parallel impairment in cognitive skills. This increased understanding of the pathophysiological basis of seizure-induced cognitive deficits should allow investigators to develop novel targets for therapeutic interventions.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT.
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Giussani G, Canelli V, Bianchi E, Erba G, Franchi C, Nobili A, Sander JW, Beghi E. Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. Eur J Neurol 2016; 23:1218-27. [DOI: 10.1111/ene.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Giussani
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - V. Canelli
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - E. Bianchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - G. Erba
- Department of Neurology; SEC, University of Rochester; Rochester NY USA
| | - C. Franchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - A. Nobili
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - E. Beghi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
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Puka K, Smith ML. Where are they now? Psychosocial, educational, and vocational outcomes after epilepsy surgery in childhood. Epilepsia 2016; 57:574-81. [DOI: 10.1111/epi.13327] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Klajdi Puka
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Mary Lou Smith
- Department of Psychology; The Hospital for Sick Children; Toronto Ontario Canada
- Department of Psychology; University of Toronto Mississauga; Mississauga Ontario Canada
- Neurosciences and Mental Health Program; The Hospital for Sick Children; Toronto Ontario Canada
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Russo A, Posar A, Conti S, Parmeggiani A. Prognostic factors of drug-resistant epilepsy in childhood: An Italian study. Pediatr Int 2015; 57:1143-8. [PMID: 26010019 DOI: 10.1111/ped.12705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/18/2015] [Accepted: 05/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epilepsy is drug resistant in 30-40% of cases. We studied, retrospectively, the prognostic factors of drug resistance (DR) during a 15 year period, in an Italian sample of patients with childhood epilepsy. METHODS A total of 117 patients were divided into two groups: one with DR, and the other without DR. The two groups were compared at the following time points: epilepsy onset (T0), and at 2, 5, 8 and 10 years after seizure onset (T2, T5, T8 and T10, respectively) using Fisher's exact test and randomization test. Multiple logistic regression analysis was then used to identify the most reliable predictive model of DR. RESULTS Positive neurological examination at onset, symptomatic/probable symptomatic etiology, lack of response to the first drug, seizure clustering during follow up, intelligence quotient ≤ 70, altered neuropsychological examination at onset, and presence of cerebral lesions were predominant in cases of DR. The most reliable combinations of predictors of DR included partial or no response to the first drug, presence of seizure clustering during follow up, altered neurological examination at onset, and long latency between epilepsy onset and first drug at T2; partial or absent response to the first drug and positive magnetic resonance imaging (MRI) at T5; positive MRI and absence of generalized seizures at T8; and positive MRI at T10. DR also sometimes appeared after discontinuation of an effective therapy. CONCLUSIONS Predictive factors of DR can be recognized in a large number of patients with epilepsy at disease onset, although the current possibility of predicting epilepsy outcome remains limited. In the long term, evidence of cerebral lesions appears to become the most significant prognostic factor.
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Affiliation(s)
- Angelo Russo
- Child Neurology and Psychiatry Service, Neurological Clinic, IRCCS Institute of Neurological Sciences of Bologna
| | - Annio Posar
- Child Neurology and Psychiatry Service, Neurological Clinic, IRCCS Institute of Neurological Sciences of Bologna.,Department of Biomedical and Neuromotor Sciences, University of Bologna
| | - Sara Conti
- Child Neurology and Psychiatry Service, Neurological Clinic, IRCCS Institute of Neurological Sciences of Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Antonia Parmeggiani
- Child Neurology and Psychiatry Service, Neurological Clinic, IRCCS Institute of Neurological Sciences of Bologna.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Sillanpää M, Anttinen A, Rinne JO, Joutsa J, Sonninen P, Erkinjuntti M, Hermann B, Karrasch M, Saarinen M, Tiitta P, Shinnar S. Childhood-onset epilepsy five decades later. A prospective population-based cohort study. Epilepsia 2015; 56:1774-83. [PMID: 26434398 DOI: 10.1111/epi.13187] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the impact of childhood-onset epilepsy on a variety of outcomes across the life span. METHODS A population-based cohort of 245 subjects with childhood-onset epilepsy was assessed for outcomes at 45 years. In addition, 51 of 78 surviving subjects with uncomplicated epilepsy and 52 of 99 originally matched controls participated in a detailed evaluation including electroencephalography (EEG), imaging, and laboratory studies at 50 years. RESULTS Of 179 surviving subjects, 61% were in terminal 10-year remission and 43% in remission off medications. At 45 years, 95% of the idiopathic group, 72% of the cryptogenic group, and 47% of the remote symptomatic group were in terminal remission (p < 0.001). Abnormal neurologic signs were significantly more common in subjects with uncomplicated epilepsy than in controls. Mortality during period 1992-2012 was higher in subjects than in controls (9% vs. 1%, p = 0.02). The rate of 3T MRI abnormalities was higher in subjects than in controls (risk ratio [RR] 2.0; 1.3-3.1) specifically including findings considered markers of cerebrovascular disease (RR 2.5; 1.04-5.9). Even subjects with idiopathic epilepsy had higher rates of imaging abnormalities than controls (73% vs. 34%, p = 0.002). SIGNIFICANCE Long-term seizure outcomes are excellent and a function of etiology. The presence of imaging abnormalities suggestive of vascular disease may put these subjects at higher risk for clinically evident stroke and cognitive changes as they age.
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Affiliation(s)
- Matti Sillanpää
- Department of Child Neurology, Turku University Hospital, Turku, Finland
| | - Anu Anttinen
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | | | | | - Matti Erkinjuntti
- Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Mira Karrasch
- Department of Psychology, Abo Akademi University, Turku, Finland
| | - Maiju Saarinen
- Department of Public Health, University of Turku, Turku, Finland
| | - Petri Tiitta
- Turku Teacher Training College, University of Turku, Turku, Finland
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics and Epidemiology and Public Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
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Employability in people with epilepsy: A systematic review. Epilepsy Res 2015; 116:67-78. [DOI: 10.1016/j.eplepsyres.2015.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/12/2015] [Accepted: 06/23/2015] [Indexed: 11/20/2022]
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Developing from child to adult: Risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. Epilepsy Behav 2015; 51:182-90. [PMID: 26291772 DOI: 10.1016/j.yebeh.2015.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/16/2015] [Accepted: 07/28/2015] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Childhood-onset epilepsy during the years of transition to adulthood may affect normal social, physical, and mental development, frequently leading to psychosocial and health-related problems in the long term. OBJECTIVE This study aimed to describe the main characteristics of patients in transition and to identify risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. METHODS Patients with epilepsy, 15-25years of age, who visited the Kempenhaeghe Epilepsy Transition Clinic from March 2012 to December 2014 were included (n=138). Predefined risk scores for medical, educational/occupational status, and independence/separation/identity were obtained, along with individual risk profile scores for poor psychosocial outcome. Multivariate linear regression analysis and discriminant analysis were used to identify variables associated with an increased risk of poor long-term psychosocial outcome. RESULTS Demographic, epilepsy-related, and psychosocial variables associated with a high risk of poor long-term outcome were lower intelligence, higher seizure frequency, ongoing seizures, and an unsupportive and unstable family environment. Using the aforementioned factors in combination, we were able to correctly classify the majority (55.1%) of the patients regarding their risk of poor psychosocial outcome. CONCLUSION Our analysis may allow early identification of patients at high risk of prevention, preferably at pretransition age. The combination of a chronic refractory epilepsy and an unstable family environment constitutes a higher risk of transition problems and poor outcome in adulthood. As a consequence, early interventions should be put into place to protect youth at risk of poor transition outcome.
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Ge Y, Yu P, Ding D, Wang P, Shi Y, Zhao T, Tang X, Hong Z. Etiologic features and utilization of antiepileptic drugs in people with chronic epilepsy in China: Report from the Epilepsy Cohort of Huashan Hospital (ECoH). Epilepsy Res 2015; 116:99-104. [DOI: 10.1016/j.eplepsyres.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/03/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
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Reilly C, Atkinson P, Das KB, Chin RFM, Aylett SE, Burch V, Gillberg C, Scott RC, Neville BGR. Factors associated with quality of life in active childhood epilepsy: a population-based study. Eur J Paediatr Neurol 2015; 19:308-13. [PMID: 25596900 DOI: 10.1016/j.ejpn.2014.12.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/27/2014] [Accepted: 12/31/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Improving health-related quality of life (HRQOL), rather than just reducing seizures, should be the principal goal in comprehensive management of childhood epilepsy. There is a lack of population-based data on predictors of HRQOL in childhood epilepsy. METHODS The Children with Epilepsy in Sussex Schools (CHESS) study is a prospective, population-based study involving school-aged children (5-15 years) with active epilepsy (on one or more AED and/or had a seizure in the last year) in a defined geographical area in the UK. Eighty-five of 115 (74% of eligible population) children underwent comprehensive psychological assessment including measures of cognition, behaviour, and motor functioning. Parents of the children completed the Quality of Life in Childhood Epilepsy (QOLCE).Clinical data on eligible children was extracted using a standardised pro forma. Linear regression analysis was undertaken to identify factors significantly associated with total Quality of Life in this population. RESULTS Factors independently significantly associated (p < .05) with total QOLCE scores were seizures before 24 months, cognitive impairment (IQ < 85), anxiety, and parent reported school attendance difficulty. These factors were also significantly associated with total QOLCE when children with IQ < 50 were excluded from analysis. CONCLUSIONS The majority of factors associated with parent reported HRQOL in active childhood epilepsy are related to neurobehavioural and/or psychosocial aspects of the condition.
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Affiliation(s)
- Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, Gothenburg, Sweden.
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, West Green Drive, Crawley, RH11 7DH, West Sussex, UK
| | - Krishna B Das
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Edinburgh Neurosciences, The University of Edinburgh, Edinburgh, UK
| | - Sarah E Aylett
- Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Victoria Burch
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, Gothenburg, Sweden; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK
| | - Rod C Scott
- College of Medicine, University of Vermont, Burlington, VT, 05405, USA; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Brian G R Neville
- Research Department, Young Epilepsy, Lingfield, Surrey, RH7 6PW, UK; Neurosciences Unit, Institute of Child Health, University College London, 4/5 Long Yard, London, WC1N 3LU, UK
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Consanguinity and epilepsy in Oran, Algeria: A case-control study. Epilepsy Res 2015; 111:10-7. [PMID: 25769368 DOI: 10.1016/j.eplepsyres.2014.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/27/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The goal of this case-control study was to identify the significance of consanguinity and other risk factors for epilepsy in Oran, Algeria. METHODS Unrelated epileptic patients upwards of 16 years, who attended the Neurology Department between October 2013 and March 2014 were included in the study. Controls, matched for age and sex, were selected among non-epileptic patients attending the same department during the same period. The risk factors evaluated were: consanguinity, family history of epilepsy, perinatal complications, infection of the central nervous system, mental retardation, neurological impairment, history of febrile seizures, severe head trauma, cerebrovascular diseases, and addiction. RESULTS 101 cases and 202 controls participated in the study. Multivariate logistic regression identified five factors significantly associated with epilepsy: first-degree of consanguinity (odds ratio (OR)=2.15), history of epilepsy in first-degree relatives (OR=4.03), antecedent of febrile seizures (OR=5.38), severe head injury (OR=2.94) and mental retardation (OR=9.32). CONCLUSION Consanguinity, family history of epilepsy, history of febrile seizures, severe head trauma and mental retardation are risk factors for epilepsy. The implementation of a strategy for prevention and awareness of the impact of consanguineous marriages as well as genetic counseling for couples with a family history of epilepsy are needed.
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Bompori E, Niakas D, Nakou I, Siamopoulou-Mavridou A, Tzoufi MS. Comparative study of the health-related quality of life of children with epilepsy and their parents. Epilepsy Behav 2014; 41:11-7. [PMID: 25269688 DOI: 10.1016/j.yebeh.2014.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to evaluate the health-related quality of life (HRQoL) of schoolchildren with epilepsy and its determinants and the HRQoL of their parents in comparison with those of healthy children and their parents. MATERIALS AND METHODS The study sample comprised 100 children with epilepsy (58 males), 8-16 years of age, diagnosed at least 6 months earlier. The children with epilepsy were divided into two subgroups: A, with well controlled idiopathic epilepsy, and B, with drug-resistant or symptomatic epilepsy and with concomitant neurodevelopmental problems. A control group consisted of 100 healthy age- and gender-matched children. One parent in each family completed two questionnaires standardized for use in Greece: KIDSCREEN-27 (version for parents) to assess the HRQoL of the children and SF-12 to assess the parental HRQoL. For each of the five dimensions of KIDSCREEN-27 and for the physical and mental component scales of the SF-12 tool, the standardized mean difference (SMD) was used for comparison between the various groups and subgroups. Linear regression analysis was used to explore the effect of specific illness-related factors on the five dimensions of KIDSCREEN-27 in the children with epilepsy. RESULTS The parent-reported scores on KIDSCREEN-27 of the children with epilepsy were worse overall than those of healthy children, but the difference reached statistical significance only for the dimensions of "physical well-being" (p = 0.001) and "school environment" (p < 0.001). The differences were greater in adolescents (age group: 13.5-16years). The worst scores were recorded in subgroup B, the children with severe epilepsy, in the dimensions "physical well-being" (p < 0.001), "school environment" (p < 0.0001), and "peers and social support" (p = 0.044). The factors found to have a significant effect on all dimensions were mental retardation, physical disability, abnormal brain imaging findings, learning problems, and, to a lesser degree, administration of a large number of antiepileptic drugs and prolonged treatment. The parents of children with resistant epilepsy and accompanying neurodevelopmental problems scored significantly worse on the SF-12 mental health scale than those of healthy children (p < 0.001). CONCLUSIONS Epilepsy, particularly severe epilepsy with concomitant neurodevelopmental problems, adversely affects the HRQoL of both schoolchildren and their parents.
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Affiliation(s)
- Eleni Bompori
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece; Faculty of Social Sciences, Hellenic Open University, Patras, Greece.
| | - Dimitrios Niakas
- Faculty of Social Sciences, Hellenic Open University, Patras, Greece
| | - Iliada Nakou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | | | - Meropi S Tzoufi
- Department of Child Health, Ioannina University School of Medicine, Ioannina, Greece
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Camfield C, Camfield P. Most adults with childhood-onset epilepsy and their parents have incorrect knowledge of the cause 20-30 years later: a population-based study. Epilepsy Behav 2014; 37:100-3. [PMID: 25005325 DOI: 10.1016/j.yebeh.2014.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 11/25/2022]
Abstract
RATIONALE Understanding the cause of childhood-onset epilepsy should be important for families and the patient as he/she becomes an adult. We studied the accuracy of information about the cause that adults with childhood-onset epilepsy and their parents reported many years after the initial diagnosis. METHODS Patients and parents in the Nova Scotia childhood-onset epilepsy population-based study were contacted. All patients developed epilepsy between 1977 and 1985 with follow-up 20-30 years later with a semistructured telephone interview. Of 600 eligible patients, 373 (62%) answered a question about what they thought had caused the epilepsy. RESULTS We identified a cause in 210 of 373 (56%) patients, and no cause was found in 44%. Surprisingly, only 38% of families knew the correct cause. Nearly all had been followed during childhood by a child neurologist, and all adults had a family physician. Responses were concordant in 40% with our causal diagnoses and not concordant in 60%. Responses were divided into 5 categories: (1) In 26%, the family was sure of the cause when no cause had been identified; (2) In 16%, there was a definite known cause, but families did not recall any cause at all; (3) In 18%, we did not identify a cause and neither did the family; (4) In 20%, we identified a definite cause as did the family, but the causes were completely different; and (5) In 20%, we identified a cause, the same one as the family. Correct information did not vary with broad epilepsy syndrome groupings, the presence or absence of intellectual disability, epilepsy remission, parental education, or family income. Those with intractable epilepsy were more likely to be concordant (p=0.002). None of those with Rolandic epilepsy were correct (n=41). CONCLUSIONS Most adults with childhood-onset epilepsy and their parents have a strikingly poor recall of the cause. We suggest that families receive this information in a written document that is periodically updated, can be preserved, and can be referred to over time.
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Affiliation(s)
- Carol Camfield
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Peter Camfield
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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Camfield PR, Camfield CS. What happens to children with epilepsy when they become adults? Some facts and opinions. Pediatr Neurol 2014; 51:17-23. [PMID: 24830766 DOI: 10.1016/j.pediatrneurol.2014.02.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 02/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The adult outcome after childhood onset epilepsy is a complex subject because seizure types and severity are diverse, comorbidities are common, and additional factors influence social outcome. We review selected data about seizure remission or persistence and social outcome in adulthood. METHODS Information came from published literature, especially population-based studies. RESULTS In general, approximately 50-60% of children with epilepsy eventually have complete seizure remission (i.e., seizure free and off antiepileptic drug treatment): with longer follow-up, the remission rate improves. Predicting remission, persistent or intractable epilepsy is often inaccurate for an individual patient. A tiny proportion of children with epilepsy die as the result of seizures or sudden unexpected death in epilepsy patients; however, an otherwise normal child has the same risk of death as the reference population. When uncontrolled epilepsy persists into adulthood, the rate of sudden unexpected death in epilepsy patients possibly increases. Reports about social outcome in adulthood are increasing. For those with intellectual disability, a lifetime of dependency is to be expected. For those with normal intelligence, adult life is often unsatisfactory with high rates of incomplete education, unemployment, poverty, social isolation, inadvertent pregnancy, and psychiatric disorders. Seizure remission does not ensure good adult social outcome. CONCLUSIONS Although seizure control in childhood is important, anticipating poor social outcome in adulthood may allow earlier interventions. A well-orchestrated transition from pediatric to adult health care may be beneficial for the 40-50% with persistent seizures and for the majority who are at risk for adult social difficulties.
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Affiliation(s)
- Peter R Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Carol S Camfield
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada
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Pinquart M. Achievement of Developmental Milestones in Emerging and Young Adults With and Without Pediatric Chronic Illness—A Meta-Analysis. J Pediatr Psychol 2014; 39:577-587. [DOI: 10.1093/jpepsy/jsu017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Jonsson P, Jonsson B, Eeg-Olofsson O. Psychological and social outcome of epilepsy in well-functioning children and adolescents. A 10-year follow-up study. Eur J Paediatr Neurol 2014; 18:381-90. [PMID: 24565749 DOI: 10.1016/j.ejpn.2014.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 12/17/2013] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND From a population based study of epilepsy in Swedish children a subgroup designated well-functioning with an epilepsy diagnosis in 1997 was worked up from a medical point of view 10 years later. AIM To describe the psychological and social outcome in this subgroup. METHODS Thirty-one patients aged 11-22 years and their parents/partners responded to a questionnaire according to Achenbach System of Empirically Based Assessment (ASEBA) to evaluate behavioural and emotional problems, and social competence. RESULTS Active epilepsy, diagnosed in 32%, was related to attention problems, somatic complaints, and school problems. Polytherapy, used in 16%, was related to attention problems and aggressive behaviour. School problems were found in six of seven children younger than 18 years. Internalizing, externalizing, and 'other' syndromes were found in 29% of the individuals, but a grouping of these syndromes in the clinical range only in two (6.5%), a girl with generalized tonic-clonic seizures alone, and a boy with structural focal epilepsy. Both had active epilepsy and were treated with polytherapy. All ten individuals with Rolandic epilepsy were classified as normal. The answers to the ASEBA questionnaire of individuals and parents/partners were inconsistent, and parents generally stated more problems than the individuals. SUMMARY This 10-year follow-up study of psychological and social outcome in well-functioning children and adolescents with childhood onset epilepsy shows some emotional, behavioural, and social problems. Thus, early information to increase knowledge about epilepsy and associated psychological co-morbidities in order to decrease risk of low self-esteem, social anxiety, and depression later in life is of importance.
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Affiliation(s)
- Pysse Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden.
| | - Björn Jonsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
| | - Orvar Eeg-Olofsson
- Department of Women's and Children's Health, Neuropaediatrics, Uppsala University, Uppsala, Sweden
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Thomson L, Fayed N, Sedarous F, Ronen GM. Life quality and health in adolescents and emerging adults with epilepsy during the years of transition: a scoping review. Dev Med Child Neurol 2014; 56:421-33. [PMID: 24237329 DOI: 10.1111/dmcn.12335] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study were to (1) search the literature in order to identify the challenges facing adolescents and emerging adults with epilepsy; and (2) categorize these issues within both the framework of the International Classification of Functioning, Disability and Health (ICF) and an empirical model of quality of life (QOL) in childhood epilepsy. METHOD We systematically searched PsycINFO, Ovid MEDLINE and Web of Science for studies reporting on QOL and health identified in people with epilepsy aged 12 to 29 years. Studies were limited to those that were published in the last 20 years in English, presenting the patient perspective. Data were extracted and charted using a descriptive analytical method. Identified issues were classified according to the ICF and QOL frameworks. RESULTS Fifty four studies were identified. Another 62 studies with potentially useful information were included as an addendum. The studies highlight a range of psychosocial issues emphasizing peer acceptance, social isolation, and feelings of anxiety, fear, and sadness. INTERPRETATION The ICF and QOL constructs represent useful starting points in the analytical classification of the potential challenges faced by adolescents with epilepsy. Progress is needed on fully classifying issues not included under these frameworks. We propose to expand these frameworks to include comorbidities, impending medical interventions, and concerns for future education, employment, marriage, dignity, and autonomy.
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Affiliation(s)
- Lauren Thomson
- Undergraduate Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Shorvon SD, Goodridge DMG. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain 2013; 136:3497-510. [DOI: 10.1093/brain/awt223] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tan M, D’Souza W. Seizure-Related Injuries, Drowning and Vehicular Crashes – A Critical Review of the Literature. Curr Neurol Neurosci Rep 2013; 13:361. [DOI: 10.1007/s11910-013-0361-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Transition from pediatric to adult epilepsy care: a difficult process marked by medical and social crisis. Epilepsy Curr 2013; 12:13-21. [PMID: 23476118 DOI: 10.5698/1535-7511-12.4s.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
When epilepsy does not remit in childhood, transition and transfer to adult care is eventually required. Youth must leave the family-centered approach of pediatric care for the individual focus of adult medicine. Evidence from population-based studies indicates that many of those with childhood-onset epilepsy have major social difficulties in adulthood even if their epilepsy has resolved. Epilepsy may have major effects on normal adolescent development, and societal attitudes confound this difficult period in the lives of young people with epilepsy. Very little objective data are available to assist in the designing of models of care for youth with epilepsy; however, based on our clinical experience and the limited available literature, it appears that a transition program to prepare children for adult care is best started during childhood and adolescence. The formal transfer to adult services may be assisted by a transition clinic jointly attended by pediatric and adult epilepsy specialists.
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Camfield CS, Camfield PR. The adult seizure and social outcomes of children with partial complex seizures. Brain 2013; 136:593-600. [DOI: 10.1093/brain/aws352] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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