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Yu X, Yang H, Lv H, Lu H, Zhao H, Xu Z. Age-Dependent Phenomena of 6-Hz Corneal Kindling Model in Mice. Mol Neurobiol 2024; 61:5601-5613. [PMID: 38214837 DOI: 10.1007/s12035-024-03934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
Although numerous studies have acknowledged disparities in epilepsy-related disease processes between young and aged animals, little is known about how epilepsy changes from young adulthood to middle age. This study investigates the impact of aging on 6-Hz corneal kindling in young-adult mice and middle-aged mice. We found that the kindling acquisition of the 6-Hz corneal kindling model was delayed in middle-aged mice when compared to young-adult mice. While the seizure stage and incidence of generalized seizures (GS) were similar between the two age groups, the duration of GS in the kindled middle-aged mice was shorter than that in the kindled young-adult mice. Besides, all kindled mice, regardless of age, were resistant to phenytoin sodium (PHT), valproate sodium (VPA), and lamotrigine (LGT), whereas middle-aged mice exhibited higher levetiracetam (LEV) resistance compared to young-adult mice. Both age groups of kindled mice displayed hyperactivity and impaired memory, which are common behavioral characteristics associated with epilepsy. Furthermore, middle-aged mice displayed more pronounced astrogliosis in the hippocampus. Additionally, the expression of Brain-Derived Neurotrophic Factor (BDNF) was lower in middle-aged mice than in young-adult mice prior to kindling. These data demonstrate that both the acquisition and expression of 6-Hz corneal kindling are attenuated in middle-aged mice, while hippocampal astrogliosis and pharmacological resistance are more pronounced in this age group. These results underscore the importance of considering age-related factors when utilizing the 6-Hz corneal kindling model in mice of varying age groups.
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Affiliation(s)
- Xiu Yu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Han Yang
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - HongJie Lv
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haimei Lu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huawei Zhao
- Department of Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Zhenghao Xu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China.
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Gruenbaum BF, Schonwald A, Boyko M, Zlotnik A. The Role of Glutamate and Blood-Brain Barrier Disruption as a Mechanistic Link between Epilepsy and Depression. Cells 2024; 13:1228. [PMID: 39056809 DOI: 10.3390/cells13141228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
Epilepsy is associated with substantial neuropsychiatric impairments that persist long after the onset of the condition, significantly impacting quality of life. The goal of this review was to uncover how the pathological consequences of epilepsy, such as excessive glutamate release and a disrupted blood-brain barrier (BBB), contribute to the emergence of neuropsychiatric disorders. We hypothesize that epilepsy induces a dysfunctional BBB through hyperexcitation, which then further amplifies post-ictal glutamate levels and, thus, triggers neurodegenerative and neuropsychiatric processes. This review identifies the determinants of glutamate concentration levels in the brain and explores potential therapeutic interventions that restore BBB integrity. Our focus on therapeutic BBB restoration is guided by the premise that it may improve glutamate regulation, consequently mitigating the neurotoxicity that contributes to the onset of neuropsychiatric symptoms.
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Affiliation(s)
- Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
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Kerr WT, McFarlane KN, Figueiredo Pucci G. The present and future of seizure detection, prediction, and forecasting with machine learning, including the future impact on clinical trials. Front Neurol 2024; 15:1425490. [PMID: 39055320 PMCID: PMC11269262 DOI: 10.3389/fneur.2024.1425490] [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: 04/29/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
Seizures have a profound impact on quality of life and mortality, in part because they can be challenging both to detect and forecast. Seizure detection relies upon accurately differentiating transient neurological symptoms caused by abnormal epileptiform activity from similar symptoms with different causes. Seizure forecasting aims to identify when a person has a high or low likelihood of seizure, which is related to seizure prediction. Machine learning and artificial intelligence are data-driven techniques integrated with neurodiagnostic monitoring technologies that attempt to accomplish both of those tasks. In this narrative review, we describe both the existing software and hardware approaches for seizure detection and forecasting, as well as the concepts for how to evaluate the performance of new technologies for future application in clinical practice. These technologies include long-term monitoring both with and without electroencephalography (EEG) that report very high sensitivity as well as reduced false positive detections. In addition, we describe the implications of seizure detection and forecasting upon the evaluation of novel treatments for seizures within clinical trials. Based on these existing data, long-term seizure detection and forecasting with machine learning and artificial intelligence could fundamentally change the clinical care of people with seizures, but there are multiple validation steps necessary to rigorously demonstrate their benefits and costs, relative to the current standard.
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Affiliation(s)
- Wesley T. Kerr
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
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Faught E, Besson H, D'Souza W, Klein P, Reuber M, Rosenow F, Salas-Puig J, Insuga VS, Steinhoff BJ, Strzelczyk A, Szaflarski JP, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Brivaracetam effectiveness and tolerability in older and younger adults with epilepsy: EXPERIENCE, a pooled analysis of international data from retrospective studies. Epilepsy Behav 2024; 158:109922. [PMID: 38970892 DOI: 10.1016/j.yebeh.2024.109922] [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: 03/28/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
This analysis assessed the effectiveness and tolerability of brivaracetam (BRV) in older (≥65 years of age) and younger (≥16 to <65 years of age) adults with epilepsy. This was a subgroup analysis from EXPERIENCE/EPD332, a pooled analysis of individual patient records from multiple independent, non-interventional studies of patients with epilepsy starting BRV in Australia, Europe, and the United States. Included patients had ≥6 months of follow-up data. Outcomes included responders (≥50 % reduction from baseline in seizure frequency), seizure freedom (no seizures within 3 months before the time point), and continuous seizure freedom (no seizures from baseline) at 12 months; BRV discontinuation during the whole study follow-up; and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were deemed non-responders/not seizure-free. Analysis populations included the Full Analysis Set (FAS; patients who received ≥1 BRV dose and had seizure type and age documented at baseline) and the modified FAS (FAS patients who had ≥1 seizure recorded during baseline). The FAS was used for all outcomes except seizure reduction. The FAS included 147 (8.9 %) patients aged ≥65 years and 1497 (91.1 %) aged ≥16 to <65 years. Compared with the younger subgroup, patients aged ≥65 years had a longer median epilepsy duration (33.0 years [n = 144] vs 17.0 years [n = 1460]) and lower median seizure frequency at index (2.0 seizures/28 days [n = 129] vs 4.0 seizures/28 days [n = 1256]), and less commonly had >1 prior antiseizure medication (106/141 [75.2 %] vs 1265/1479 [85.5 %]). At 12 months, a numerically higher percentage of patients aged ≥65 years versus the younger subgroup achieved ≥50 % seizure reduction (46.5 % [n = 71] vs 36.0 % [n = 751]), seizure freedom (26.0 % [n = 100] vs 13.9 % [n = 1011]), and continuous seizure freedom (22.0 % [n = 100] vs 10.7 % [n = 1011]). During the whole study follow-up, 43/147 (29.3 %) patients aged ≥65 years and 508/1492 (34.0 %) aged ≥16 to <65 years discontinued BRV. The incidence of TEAEs since the prior visit was similar in both subgroups at 3 months (≥65 years vs ≥16 to <65 years: 38/138 [27.5 %] vs 356/1404 [25.4 %]), 6 months (19/119 [16.0 %] vs 176/1257 [14.0 %]), and 12 months (8/104 [7.7 %] vs 107/1128 [9.5 %]). This real-world analysis suggests BRV was effective in patients aged ≥65 years and ≥16 to <65 years, with numerically higher effectiveness in the older subgroup. BRV was well tolerated in both subgroups.
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Affiliation(s)
- Edward Faught
- Emory University, Emory Epilepsy Center, 12 Executive Park Drive NE, Atlanta, GA 30329, United States.
| | - Hervé Besson
- UCB Pharma, Hoge Mosten, 2, 4822 NH Breda, Netherlands.
| | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, Suite 610, Bethesda, MD 20817, United States.
| | - Markus Reuber
- The University of Sheffield, Department of Neuroscience, Academic Neurology Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
| | - Felix Rosenow
- Goethe University Frankfurt, University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16, Haus 95, 60528 Frankfurt am Main, Germany.
| | - Javier Salas-Puig
- Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Avenida de Menéndez Pelayo, 65, Retiro, 28009 Madrid, Spain.
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Landstr. 1, 77694 Kehl-Kork and Medical Faculty, University of Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.
| | - Adam Strzelczyk
- Goethe University Frankfurt, University Hospital Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Schleusenweg 2-16, Haus 95, 60528 Frankfurt am Main, Germany.
| | - Jerzy P Szaflarski
- Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, SC 350, 1720 2nd Ave South, Birmingham, AL 35294, United States.
| | | | - Tony Daniels
- UCB Pharma, 4000 Paramount Parkway, Suite 200, Morrisville, NC 27560, United States.
| | - Florin Floricel
- UCB Pharma, Alfred-Nobel-Str. 10, 40789 Monheim am Rhein, Germany.
| | - David Friesen
- UCB Pharma, 216 Bath Road, Slough SL1 3WE, United Kingdom.
| | - Cédric Laloyaux
- UCB Pharma, Allée de la Recherche, 60, 1070 Brussels, Belgium.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EPICARE Member, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain.
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Maritan BS, Favaretto G, Tarifa B, de Faria FM, Antônio LF, Ricci MF, de Araújo Filho GM. Clinical and sociodemographic characteristics of patients with epilepsy attended at a regional reference psychiatric emergency unit. Epilepsy Res 2024; 203:107369. [PMID: 38701645 DOI: 10.1016/j.eplepsyres.2024.107369] [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: 01/15/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Epilepsy is one of the most prevalent chronic neurological diseases, presenting a high frequency of psychiatric disorders (PD). This study sought to evaluate the clinical and sociodemographic profile of patients with epilepsy (PWE) attended at a regional reference psychiatric emergency unit. METHODS A retrospective, cross-sectional, and descriptive observational study was conducted utilizing a patient record database of individuals with epilepsy who were attended in a regional reference psychiatric emergency unit between January 2018 and August 2022. RESULTS Out of the 31,800 psychiatric emergency visits, 260 (0.8 %) were of patients with epilepsy (ICD-10: G40). The majority were males (63.5 %) with a mean age of 42.11±15.39 years, single marital status (154; 59.25 %) and elementary education (75; 28.9 %). Most of them (203; 78.1 %) presented at least one psychiatric comorbidity at the emergency visit, but 109 (41.9 %) were not receiving any psychiatric follow-up. A total of 106 patients (40.8 %) had experienced at least one past psychiatric hospitalization. CONCLUSIONS The occurrence of PD is highly prevalent in PWE, and probably with a high frequency of psychiatric emergencies occurring among them. Further studies are needed to assess such patient profile, particularly involving data from psychiatric emergency units.
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Affiliation(s)
- Bruno Soleman Maritan
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil.
| | - Giovanna Favaretto
- Hospital Psiquiátrico Dr. Adolfo Bezerra de Menezes, R. Major João Batista França, 298 - Vila Esplanada, São José do Rio Preto, SP 15010-100, Brazil
| | - Bruna Tarifa
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Fernanda Menezes de Faria
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Leonardo Ferreira Antônio
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
| | - Mayra Folgosi Ricci
- Hospital Psiquiátrico Dr. Adolfo Bezerra de Menezes, R. Major João Batista França, 298 - Vila Esplanada, São José do Rio Preto, SP 15010-100, Brazil
| | - Gerardo Maria de Araújo Filho
- Department of Neurological Sciences, Psychiatry and Medical Psychology, Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), Av. Brg. Faria Lima, 5416 - Vila Sao Pedro, São José do Rio Preto, SP 15090-000, Brazil
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Li JB, Jiang J, Xue L, Zhao S, Liu HQ. Clinical efficacy of Baijin pills in the treatment of generalized tonic-clonic seizure epilepsy with cognitive impairment. World J Psychiatry 2024; 14:938-944. [PMID: 38984341 PMCID: PMC11230082 DOI: 10.5498/wjp.v14.i6.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The generalized tonic-clonic seizure (GTCS) is the most usual variety of epileptic seizure. It is mainly characterized by strong body muscle rigidity, loss of consciousness, a disorder of plant neurofunction, and significant damage to cognitive function. The effect of antiepileptic drugs on cognition should also be considered. At present, there is no effective treatment for patients with epilepsy, but traditional Chinese medicine has shown a significant effect on chronic disease with fewer harmful side effects and should, therefore, be considered for the therapy means of epilepsy with cognitive dysfunction. AIM To investigate the clinical efficacy of Baijin pills for treating GTCS patients with cognitive impairment. METHODS This prospective study enrolled patients diagnosed with GTCS between January 2020 and December 2023 and separate them into two groups (experimental and control) using random number table method. The control group was treated with sodium valproate, and the experimental group was Baijin pills and sodium valproate for three months. The frequency and duration of each seizure, the Montreal Cognitive Assessment Scale (MoCA), and the Quality of Life Rating Scale (QOLIE-31) were recorded before and after treatment. RESULTS There were 85 patients included (42 in the control group and 43 in the experimental group). After treatment, the seizure frequency in the experimental group was significantly reduced (P < 0.05), and seizure duration was shortened (P < 0.01). The total MoCA score in the experimental group significantly increased compared to before treatment (P < 0.01), and the sub-item scores, except naming and abstract generalization ability, significantly increased (P < 0.05), whereas the total MoCA score in the control group significantly decreased after treatment (P < 0.05). The QOLIE-31 score of the experimental group increased significantly after treatment compared to before treatment (P < 0.01). CONCLUSION Baijin pills have a good clinical effect on epilepsy with cognitive dysfunction.
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Affiliation(s)
- Jing-Bo Li
- Department of Neurology, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- Department of Neurology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Jing Jiang
- Department of Neurology, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- Department of Neurology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Lian Xue
- Department of Neurology, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- Department of Neurology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Shuai Zhao
- Department of Neurology, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- Department of Neurology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Hong-Quan Liu
- Department of Neurology, The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
- Department of Neurology, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210000, Jiangsu Province, China
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Liu S, Cao Z, He Z, Shi W, Li J. Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study. Epilepsy Behav 2024; 155:109775. [PMID: 38640724 DOI: 10.1016/j.yebeh.2024.109775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities. METHODS A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms. RESULTS A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01). DISCUSSION Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.
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Affiliation(s)
- Shengyi Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhen Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Geriatrics, The Second People's Hospital of Yibin, Yibin, China.
| | - Zihua He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, China.
| | - Wenyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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Tantillo GB, Sullivan-Baca E, Rehman R, López MR, Haneef Z. Health care utilization of Hispanic/Latino veterans with epilepsy: A national population-based study. Epilepsia 2024; 65:1668-1678. [PMID: 38557951 DOI: 10.1111/epi.17948] [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: 11/27/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Hispanic/Latino people with epilepsy are a growing population that has been understudied in clinical epilepsy research. U.S. veterans are at a higher risk of epilepsy due to greater exposures including traumatic brain injury. Hispanic/Latino Veterans with Epilepsy (HL-VWEs) represent a growing population; however the treatment utilization patterns of this population have been vastly understudied. METHODS HL-VWE were identified from administrative databases during fiscal year 2019. Variables compared between Hispanic and non-Hispanic VWEs included demographics, rurality, service era, utilization of clinical services/investigations, and service-connected injury. Chi-square and Student's t tests were used for comparisons. RESULTS Among 56 556 VWEs, 3247 (5.7%) were HL. HL-VWEs were younger (59.2 vs 63.2 years; p < .01) and more commonly urban-dwelling (81.6% vs 63.2%, p < .01) compared to non-HL-VWEs. They were also more likely to have served in recent missions such as the Persian Gulf War and post- 9/11 wars (p < .01). HL-VWEs had a higher utilization of all neurology services examined including neurology clinic visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalography (EEG), epilepsy monitoring, and comprehensive epilepsy care (p < .01 for all). HL-VWEs were more likely to visit an emergency room or have seizure-related hospitalizations (p < .01). HL-VWEs were more likely to have a service-connected disability greater or equal to 50% (p < .01). SIGNIFICANCE This study is one of the largest cohorts examining HL-VWEs. We found higher utilization of services in neurology, epilepsy, and neuroimaging by HL-VWEs. HL-VWE are younger, more commonly urban-dwelling, and more likely to have served during recent combat periods and have higher amounts of service-connected disability. Given that the proportion of Hispanic veterans is projected to rise over time, more research is needed to provide the best interventions and mitigate the long-term impact of epilepsy on this diverse patient group.
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Affiliation(s)
| | - Erin Sullivan-Baca
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Houston VA Medical Center, Houston, Texas, USA
| | - Rizwana Rehman
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
- Durham VA Medical Center, Durham, North Carolina, USA
| | - María Raquel López
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
- University of Miami Medical Center, Miami, Florida, USA
| | - Zulfi Haneef
- Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey Houston VA Medical Center, Houston, Texas, USA
- Veterans' Administration Epilepsy Centers of Excellence (VA ECoE), Washington DC, USA
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Szaflarski JP, Besson H, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Soto Insuga V, Steinhoff BJ, Strzelczyk A, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Effectiveness and tolerability of brivaracetam in patients with epilepsy stratified by comorbidities and etiology in the real world: 12-month subgroup data from the international EXPERIENCE pooled analysis. J Neurol 2024; 271:3169-3185. [PMID: 38436680 PMCID: PMC11136785 DOI: 10.1007/s00415-024-12253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of brivaracetam (BRV) in adults with epilepsy by specific comorbidities and epilepsy etiologies. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from several non-interventional studies of patients with epilepsy initiating BRV in clinical practice. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within prior 3 months), continuous seizure freedom (no seizures since baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Analyses were performed for all adult patients (≥ 16 years of age) and stratified by comorbidity and by etiology at baseline (patients with cognitive/learning disability [CLD], psychiatric comorbidity, post-stroke epilepsy, brain tumor-related epilepsy [BTRE], and traumatic brain injury-related epilepsy [TBIE]). RESULTS At 12 months, ≥ 50% seizure reduction was achieved in 35.6% (n = 264), 38.7% (n = 310), 41.7% (n = 24), 34.1% (n = 41), and 50.0% (n = 28) of patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, respectively; and continuous seizure freedom was achieved in 5.7% (n = 318), 13.7% (n = 424), 29.4% (n = 34), 11.4% (n = 44), and 13.8% (n = 29), respectively. During the study follow-up, in patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, 37.1% (n = 403), 30.7% (n = 605), 33.3% (n = 51), 39.7% (n = 68), and 27.1% (n = 49) of patients discontinued BRV, respectively; and TEAEs since prior visit at 12 months were reported in 11.3% (n = 283), 10.0% (n = 410), 16.7% (n = 36), 12.5% (n = 48), and 3.0% (n = 33), respectively. CONCLUSIONS BRV as prescribed in the real world is effective and well tolerated among patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE.
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Affiliation(s)
- Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Valencia, Spain
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10
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Kanner AM, Carrazana E, Munger Clary HM, Rabinowicz AL, Faught E. Anticipatory anxiety of seizures in epilepsy: A common, complex, and underrecognized phenomenon? Epileptic Disord 2024; 26:273-281. [PMID: 38624139 DOI: 10.1002/epd2.20224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/01/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
The diagnosis of epilepsy is associated with loss of predictability, which invariably results in the fear of when and if future seizures will occur. For a subset of patients with epilepsy (PWE), there may be a pathological persistent fear of seizure occurrence, resulting in limitations to daily activities through avoidant behaviors. Paradoxically, the research of anticipatory anxiety of seizures (AAS; also referred to as seizure phobia) has been practically nonexistent and, not surprisingly, this condition remains underrecognized by clinicians. The available data are derived from three small case series of patients followed in tertiary epilepsy centers. In this study, we review the available data on the reported clinical manifestations of AAS in PWE, and of the potential role of variables associated with it, such as personal and family psychosocial and psychiatric history and epilepsy-related variables. In addition, we review the need for the creation of screening tools to identify patients at risk of AAS and discuss potential treatment strategies, which could be considered as part of the comprehensive management for PWE.
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Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Enrique Carrazana
- Neurelis, Inc., San Diego, California, USA
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Edward Faught
- Emory Epilepsy Program, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Alturaifi A, Alshaikh H, Khojah O, Alqarni A, Albedaiwi T, Albluwi A, Alqurashi E, Kecheck H, Fallatah H, Almakati R, Gahtani R, Aljohani R, Alhubayshi M, Makkawi S. Drug-Resistant Epilepsy: Experience From a Tertiary Care Center in Saudi Arabia. Cureus 2024; 16:e61913. [PMID: 38975393 PMCID: PMC11227904 DOI: 10.7759/cureus.61913] [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] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Objectives This study aimed to describe the clinical characteristics, investigational results, and management strategies in patients with drug-resistant epilepsy (DRE). Methods This retrospective cohort study included all adult and adolescent patients (aged 14 years or older) diagnosed with DRE who visited the adult neurology clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia from January 2019 to December 2021. DRE was defined as failure to achieve seizure freedom despite undergoing adequate trials of two well-tolerated and appropriately selected antiseizure medications. Results This study included 299 patients with DRE. Most patients were in their second to fourth decade, with a mean age of 37 ± 17 years. Focal onset epilepsy was diagnosed in 52.5% of the patients, and an etiology for epilepsy was determined in 44.1% of the patients. Findings in brain magnetic resonance imaging were abnormal in 49% of the patients, whereas abnormal findings in electroencephalograms were found in 27.5%. The most common antiseizure medication was levetiracetam (67.6% of cases). Conclusion The findings of this study confirm the challenges in diagnosing and managing patients with DRE and emphasize the necessity for careful and comprehensive patient evaluation. Further research is needed to investigate the effectiveness, safety, and accessibility of diagnostic and therapeutic resources for patients with DRE.
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Affiliation(s)
- Adilah Alturaifi
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatoon Alshaikh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Abdulaziz Alqarni
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Tarfah Albedaiwi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Amira Albluwi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Elaf Alqurashi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Husun Kecheck
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Halah Fallatah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Reuof Almakati
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Raghad Gahtani
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Rahaf Aljohani
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Madihah Alhubayshi
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- Department of Neuroscience, Ministry of National Guard Health Affairs, Jeddah, SAU
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12
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Gammoh O, Ennab W. The prevalence and correlates of PTSD, insomnia, and fatigue among people with epilepsy during Oct.7th war on Gaza: A study from Jordan. Epilepsy Behav 2024; 155:109768. [PMID: 38636138 DOI: 10.1016/j.yebeh.2024.109768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/23/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
Jordan and Palestine are tightly related countries as the same families live in the two adjacent countries. The present study sought to examine the prevalence and determinants of Post-Traumatic Stress Disorder (PTSD)symptoms, insomnia, and fatigue among a cohort of People with Epilepsy (PWE) in Jordan. This is a cross-sectional study with inclusion criteria. PTSD, insomnia, and fatigue were assessed using validated scales. Data were analyzed from 109 PWE, PTSD symptoms were screened in (35.5 %), and Insomnia was screened in 51.8 %, moreover, fatigue mean score ± SD was 44.64 ± 26.96. PTSD symptoms were significantly associated with "females" and "age above 30 years" Insomnia severity was associated with "females". Also, the regression results demonstrated that "abstinence from social media" was significantly related to lower insomnia severity. Higher fatigue severity was associated with "married" and "Generalized Tonic-Clonic Seizures", whereas, lower fatigue severity was associated with "males", and with "levetiracetam". Our findings indicate the need for actions to alleviate mental health deterioration in PWE.
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Affiliation(s)
- Omar Gammoh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, P.O. Box 566, Irbid 21163, Jordan.
| | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
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13
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Gopaul M, Altalib H. Do psychotropic drugs cause seizures? Epilepsy Behav Rep 2024; 27:100679. [PMID: 38881884 PMCID: PMC11179069 DOI: 10.1016/j.ebr.2024.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Patients with epilepsy often present with concurrent psychiatric disorders, posing unique challenges for healthcare providers. This review explores the intricate relationship between psychiatric comorbidities, epilepsy, and psychotropic medications to inform clinical decision-making. The bidirectional association between epilepsy and psychiatric conditions complicates treatment, with psychiatric symptoms preceding or following seizure onset. The review discusses the seizure risks associated with antidepressants, CNS stimulants, and antipsychotics, shedding light on both historical perspectives and recent empirical evidence. Antidepressants, particularly tricyclic antidepressants (TCAs), are known to pose seizure risks, while newer agents like selective serotonin reuptake inhibitors (SSRIs) exhibit lower incidences and even potential anticonvulsant effects. Contrary to common beliefs, CNS stimulants used in attention-deficit/hyperactivity disorder (ADHD) treatment show efficacy without significantly increasing seizure risk. However, the association between ADHD and seizures warrants careful consideration. Among antipsychotics, clozapine stands out for its heightened seizure risks, especially during titration and at high doses, necessitating close monitoring and individualized approaches. Understanding the nuanced seizure risks associated with different psychotropic medications is crucial for optimizing patient care and minimizing iatrogenic seizures in this vulnerable population. By recognizing the complexities of psychiatric comorbidities in epilepsy and considering the unique challenges they pose, healthcare providers can make informed decisions to enhance patient safety and treatment outcomes. This review offers practical insights to guide clinicians in navigating the intricate landscape of managing psychiatric comorbidities in patients with epilepsy.
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Affiliation(s)
- Margaret Gopaul
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
| | - Hamada Altalib
- Yale Comprehensive Epilepsy Center, Dept. of Neurology, Yale University School of Medicine New Haven, CT, USA
- Veteran Administration (VA) Epilepsy Center of Excellence in West Haven, CT, USA
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14
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Hingray C, Javelot H, Lach F, Tarrada A. Anticipatory anxiety of seizures: What is the best treatment? Epilepsy Behav Rep 2024; 27:100673. [PMID: 38841320 PMCID: PMC11152698 DOI: 10.1016/j.ebr.2024.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Anxiety disorders affect roughly 25% of people with epilepsy (PWE), and are associated with a strong impairment of quality of life and a poorer stabilization of epilepsy. Anticipatory anxiety of seizure (AAS), defined by the persistent worry or fear to have another seizure, is highly frequent and associated with avoidant behavior. Unfortunately, AAS is often overlooked and untreated. Here, we present the case of a 35-year-old patient suffering from AAS secondary to focal epilepsy. We aimed to provide practical guidelines and tools for the screening and treatment of anxiety disorders in PWE. Regarding psychotropic medication, Sertraline or Citalopram might be good options for first-line treatment of AAS, since they are efficient against anxiety and well-tolerated in epilepsy.
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Affiliation(s)
- Coraline Hingray
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
- Université de Lorraine, Faculté de Médecine, 545000 Vandoeuvre-lès-Nancy, France
| | - Herve Javelot
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
- Centre de Ressources et d’Expertise en Psychopharmacologie (CREPP) Grand Est, 141, Avenue de Strasbourg B.P. 83 67173, Brumath, France
| | - Frank Lach
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
- Centre de Ressources et d’Expertise en Psychopharmacologie (CREPP) Grand Est, 141, Avenue de Strasbourg B.P. 83 67173, Brumath, France
| | - Alexis Tarrada
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France
- Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
- Université de Lorraine, Faculté de Médecine, 545000 Vandoeuvre-lès-Nancy, France
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15
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Gammoh O, Al-Smadi A, Mansour M, Ennab W, AL Hababbeh S, Al-Taani G, Alsous M, Aljabali AAA, Tambuwala MM. The relationship between psychiatric symptoms and the use of levetiracetam in people with epilepsy. Int J Psychiatry Med 2024; 59:360-372. [PMID: 37837222 PMCID: PMC11044508 DOI: 10.1177/00912174231206056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Background: Mental health in people with epilepsy (PWE) is often overlooked, especially in developing countries.Purpose: Consequently, the current work had two objectives: (1) to estimate the burden of depression, anxiety, insomnia, and stress, and (2) to examine the association of these psychiatric/psychological symptoms with levetiracetam and other relevant clinical factors in a cohort of Jordanian PWE.Research Design: This is a cross-sectional study. The demographic and clinical data were recorded. Depression was measured by the Patient Health Questionnaire-9 (PHQ-9, Arabic-validated version) and anxiety by the General Anxiety Disorder-7 (GAD-7, Arabic-validated version). The insomnia severity index (ISI-A, Arabic version) was used to assess sleep quality, and the Perceived Stress Scale (PSS-A, Arabic version) was used to measure perceived stress.Study Sample: Data were analyzed from 280 patients, of which 178 (63.6%) received levetiracetam as monotherapy or as adjuvant.Results: Depression was reported in 150 (53.6%), anxiety in 110 (39.3%), insomnia in 131 (46.8%), and clinically significant stress in 211 (75.4%). At univariate analysis, levetiracetam was not associated with psychiatric symptoms. Multivariate logistic regression revealed that severe depressive symptoms were associated with family history (OR = 2.47, 95% CI = 1.42-4.33, P = .001) and seizure type (OR = 1.69, 95% CI = 1.01-2.80, P = .04), severe anxiety symptoms were associated with family history (OR = 1.90, 95% CI = 1.12-3.23, P = .01), severe insomnia was associated with seizure type (OR = 2.16, 95% CI = 1.33-3.5, P = .002) and severe stress was associated with marital status (OR = 2.37, 95% CI = 1.31-4.29, P = .004).Conclusions: The high psychological burden of PWE is a challenging issue that requires attention and prompt action to control its risk factors. Levetiracetam was not associated with psychiatric symptoms in this study.
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Affiliation(s)
- Omar Gammoh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Ahmed Al-Smadi
- Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
| | | | - Wail Ennab
- Department of Neurology, Al-Bashir Hospital, Amman, Jordan
| | | | - Ghaith Al-Taani
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Mervat Alsous
- Faculty of Pharmacy, Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan
| | - Alaa AA Aljabali
- Faculty of Pharmacy, Department of Pharmaceutics and Pharmaceutical Technology, Yarmouk University, Irbid, Jordan
| | - Murtaza M Tambuwala
- Lincoln Medical School, Brayford Pool Campus, University of Lincoln, Lincoln, Lincolnshire, UK
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16
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Campbell IH, Campbell H. The metabolic overdrive hypothesis: hyperglycolysis and glutaminolysis in bipolar mania. Mol Psychiatry 2024; 29:1521-1527. [PMID: 38273108 PMCID: PMC11189810 DOI: 10.1038/s41380-024-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Evidence from diverse areas of research including chronobiology, metabolomics and magnetic resonance spectroscopy indicate that energy dysregulation is a central feature of bipolar disorder pathophysiology. In this paper, we propose that mania represents a condition of heightened cerebral energy metabolism facilitated by hyperglycolysis and glutaminolysis. When oxidative glucose metabolism becomes impaired in the brain, neurons can utilize glutamate as an alternative substrate to generate energy through oxidative phosphorylation. Glycolysis in astrocytes fuels the formation of denovo glutamate, which can be used as a mitochondrial fuel source in neurons via transamination to alpha-ketoglutarate and subsequent reductive carboxylation to replenish tricarboxylic acid cycle intermediates. Upregulation of glycolysis and glutaminolysis in this manner causes the brain to enter a state of heightened metabolism and excitatory activity which we propose to underlie the subjective experience of mania. Under normal conditions, this mechanism serves an adaptive function to transiently upregulate brain metabolism in response to acute energy demand. However, when recruited in the long term to counteract impaired oxidative metabolism it may become a pathological process. In this article, we develop these ideas in detail, present supporting evidence and propose this as a novel avenue of investigation to understand the biological basis for mania.
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Affiliation(s)
- Iain H Campbell
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK.
| | - Harry Campbell
- Usher Institute, Centre for Global Health Research, University of Edinburgh, Craigour House, 450 Old Dalkeith Rd, Edinburgh, EH16 4SS, UK
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17
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Kaur A, Raji, Verma V, Goel RK. Strategic pathway analysis for dual management of epilepsy and comorbid depression: a systems biology perspective. In Silico Pharmacol 2024; 12:36. [PMID: 38699778 PMCID: PMC11061056 DOI: 10.1007/s40203-024-00208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Depression is a common psychiatric comorbidity among patients with epilepsy (PWE), affecting more than a third of PWE. Management of depression may improve quality of life of epileptic patients. Unfortunately, available antidepressants worsen epilepsy by reducing the seizure threshold. This situation demands search of new safer target for combined directorate of epilepsy and comorbid depression. A system biology approach may be useful to find novel pathways/markers for the cure of both epilepsy and associated depression via analyzing available genomic and proteomic information. Hence, the system biology approach using curated 64 seed genes involved in temporal lobe epilepsy and mental depression was applied. The interplay of 600 potential proteins was revealed by the Disease Module Detection (DIAMOnD) Algorithm for the treatment of both epilepsy and comorbid depression using these seed genes. The gene enrichment analysis of seed and diamond genes through DAVID suggested 95 pathways. Selected pathways were refined based on their syn or anti role in epilepsy and depression. In conclusion, total 8 pathways and 27 DIAMOnD genes/proteins were finally deduced as potential new targets for modulation of selected pathways to manage epilepsy and comorbid depression. Supplementary Information The online version contains supplementary material available at 10.1007/s40203-024-00208-1.
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Affiliation(s)
- Arvinder Kaur
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab India 147002
| | - Raji
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab India 147002
| | - Varinder Verma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab India 147002
| | - Rajesh Kumar Goel
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala, Punjab India 147002
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18
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Niu C, Li P, Du X, Zhao M, Wang H, Yang D, Wu M, Jing W. Risk factors for anxiety in patients with epilepsy: A meta-analysis. Epilepsy Behav 2024; 153:109665. [PMID: 38368787 DOI: 10.1016/j.yebeh.2024.109665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Epilepsy is a very common neurological disease, and it is important to focus on both controlling seizures and alleviating the psychological problems associated with this disease.Anxiety is an important risk factor for epilepsy and seriously affects the quality of life of patients with epilepsy (PWE). However, several risk factors for anxiety in PWE are relatively controversial and understudied. This meta-analysis was performed to identify potential risk factors for anxiety in PWE with the aim of reducing the incidence of anxiety and improving the quality of life among the individuals. METHOD The PubMed, Embase and Cochrane Library databases were systematically searched up to July 2023 to find eligible original English studies. All the search results were reviewed based on our inclusion and exclusion criteria. We calculated the combined odds ratios (ORs), standard mean differences (SMDs) and their corresponding 95% confidence intervals (CIs) to evaluate the effect of the included risk factors on anxiety in PWE. RESULTS Twenty-four studies involving 5,403 PWE were ultimately included. The pooled results of our meta-analysis showed that female sex (OR = 1.67; 95 % CI: 1.30,2.15; p < 0.001), unmarried/divorced/widowed (OR = 0.83; 95 % CI: 0.72,0.96; p = 0.011), low socioeconomic status (OR = 0.47; 95 % CI: 0.33,0.67; p < 0.001), education levels below high school (OR = 1.74; 95 % CI: 1.36,2.23; p < 0.001), a history of trauma (OR = 2.53; 95 % CI: 1.69,3.78; p < 0.001), monotherapy (OR = 0.49; 95 % CI: 0.39,0.62; p < 0.001), AED-induced psychiatric side effects (OR = 2.45; 95 % CI: 1.20,4.98); p = 0.014), depression (OR = 5.45 95 % CI: 2.49,11.94; p < 0.001), a history of suicide (OR = 3.56; 95 % CI: 1.72,7.38; p = 0.001), and illness-related shame (OR = 2.76; 95 % CI: 2.17,3.52; p < 0.001) were risk factors for anxiety. CONCLUSION This meta-analysis showed that female, unmarried, low socioeconomic status, education level below senior high school, a history of trauma, monotherapy, AED-induced psychiatric side effects, depression, a history of suicide, and shame were risk factors for anxiety in PWE. However, further research is needed to determine the effect of other potential risk factors on anxiety in PWE. In addition, most of the studies included in this meta-analysis were not uniform in scale, and the risk factors were not comprehensive; therefore, larger prospective studies in different countries are needed to further investigate these risk factors.
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Affiliation(s)
- Cailang Niu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Penghong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Xueqing Du
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Mina Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Haobo Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Debo Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Maolin Wu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China.
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19
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De Aveiro B, Winsor A, Davies J, Nicholson TR, Pal DK, Richardson MP, Pick S. Mental health and neurodevelopmental patient-reported outcome measures (PROMs) for children and young people with epilepsy: A systematic review. Epilepsy Behav 2024; 153:109671. [PMID: 38368788 DOI: 10.1016/j.yebeh.2024.109671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Children and young people with epilepsy are at higher risk of mental health disorders and atypical neurodevelopmental outcomes compared to the general population. It is essential to detect such comorbidities early in children with epilepsy and provide appropriate interventions, to improve clinical outcomes. We aimed to identify and evaluate the measurement properties of Patient-Reported Outcome Measures (PROMs) that have been validated specifically to measure mental health and neurodevelopmental outcomes in children and/or young people with epilepsy. We searched Embase, Medline, and PsycINFO in May 2023 for relevant studies. Mental health was defined as psychological symptoms (e.g., anxiety, depression, psychosis) and/or behavioural difficulties (e.g., conduct disorders). Neurodevelopmental outcomes included neurodevelopmental disorder traits such as attention-deficit hyperactivity disorder (ADHD) and autistic spectrum disorders. We assessed methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twelve papers were identified that psychometrically evaluated 13 relevant PROMs (two epilepsy-specific, eleven generic). The appraisal of the PROMs was limited by the availability of only one or two published articles for each, and incomplete psychometric evaluations in some cases. The tool demonstrating the strongest evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth. The ADHD Rating Scale-IV and The Paediatric Symptom Checklist -17 demonstrated good evidence in favour of at least two measurement properties. This review identified only a small number of mental health and neurodevelopmental PROMs evaluated specifically in paediatric epilepsy. There is a need for further validation of mental health and neurodevelopmental PROMs in children with epilepsy.
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Affiliation(s)
- Bianca De Aveiro
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Winsor
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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20
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Chu H, Wang B, Zhao X, Mu L. Epilepsy and psychiatric comorbidities: A bidirectional mendelian randomization study. J Affect Disord 2024; 350:774-783. [PMID: 38272360 DOI: 10.1016/j.jad.2024.01.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
STUDY OBJECTIVES Psychiatric comorbidities are relatively common among patients with epilepsy; however, the underlying mechanisms of this association remain largely unknown. The objective of this Mendelian randomization (MR) study was to analyze the genetic correlations and causality underlying these reciprocal associations. METHODS Single-nucleotide polymorphisms associated with epilepsy (29,677 controls and 15,212 cases) and seven psychiatric comorbidities (485,436 controls and 269,495 cases) were identified from genome-wide association studies. Causal significance was estimated using inverse variance weighting. Sensitivity analyses included the weighted median, MR-Egger, and MR-PRESSO. The psychiatric comorbidities analyzed in this study included attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, bipolar disorder, schizophrenia, obsessive-compulsive disorder (OCD), and anorexia nervosa. RESULTS Both forward and reverse genetic associations were observed for the selected psychiatric disorders. Notably, ADHD was significantly associated with an increased risk of generalized epilepsy (odds ratio [OR], 1.09; 95 % confidence interval [CI], 1.01-1.18; p = 0.013). However, MR-PRESSO detected the existence of pleiotropy (p = 0.001). Additionally, focal epilepsy was significantly associated with a higher risk of OCD (OR, 1.44; 95 % CI, 1.08-1.92; p = 0.013), and all sensitivity tests yielded favorably nonsignificant results. There was no significant genetic association between epilepsy and other examined psychiatric disorders. However, due to the detection of pleiotropy by MR-Egger and considerations related to the threshold for genetic instruments, a cautious approach is warranted in interpreting some of the results. CONCLUSIONS This study revealed significant genetic causality between focal epilepsy and OCD, as well as between ADHD and generalized epilepsy. However, no casual significance was observed with other psychiatric comorbidities examined. Considering the inherent limitations of MR studies, further research is warranted to definitively clarify these genetic causal associations.
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Affiliation(s)
- Hongyuan Chu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bing Wang
- Department of Radiotherapy, Jilin Cancer Hospital, Changchun, China
| | - Xinyu Zhao
- Department of Neurology, The People's Hospital of Shuangyashan, Shuangyashan, China
| | - Li Mu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China; Key Laboratory of Brain and Cognitive Neuroscience, Liaoning Province, Dalian, China.
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21
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de Toffol B. Epilepsy and psychosis. Rev Neurol (Paris) 2024; 180:298-307. [PMID: 38336524 DOI: 10.1016/j.neurol.2023.12.005] [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: 10/01/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Abstract
Psychotic disorders are eight times more frequent in epilepsy than in the general population. The various clinical syndromes are classified according to their chronology of onset in relation to epileptic seizures: ictal psychoses (during epileptic discharge), post-ictal psychoses (PIP, after a seizure), interictal psychoses (IIP, with no chronological link) and those related to complete seizure control. Antiepileptic drugs can cause psychotic disorders in all these situations. Post-ictal psychoses (PIP) are affective psychoses that occur after a lucid interval lasting 12 to 120hours following a cluster of seizures. They last an average of 10days, with an abrupt beginning and end. PIP are directly linked to epileptic seizures, and disappear when the epilepsy is controlled. Interictal psychoses are schizophrenias. The management of psychotic disorders in epilepsy is neuropsychiatric, and requires close collaboration between epileptologists and psychiatrists. Antipsychotics can be prescribed in persons with epilepsy. Even today, psychotic disorders in epilepsy are poorly understood, under-diagnosed and under-treated.
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Affiliation(s)
- B de Toffol
- Université des Antilles, Neurology Department, Centre Hospitalier de Cayenne, CIC Inserm 1424, rue des Flamboyants, 97300 Cayenne, French Guiana.
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22
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Kanner AM, Shankar R, Margraf NG, Schmitz B, Ben-Menachem E, Sander JW. Mood disorders in adults with epilepsy: a review of unrecognized facts and common misconceptions. Ann Gen Psychiatry 2024; 23:11. [PMID: 38433207 PMCID: PMC10910742 DOI: 10.1186/s12991-024-00493-2] [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: 09/26/2023] [Accepted: 02/03/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.
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Affiliation(s)
- Andres M Kanner
- Epilepsy Division and Department of Neurology, Miller School of Medicine, University of Miami, 1120 NW, 14th Street, Room 1324, Miami, FL, 33136, USA.
| | - Rohit Shankar
- University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Nils G Margraf
- Department of Neurology, Christian-Albrechts University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Josemir W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, 2103SW, The Netherlands
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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23
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Yilgör A, Kurhan F. Is Childhood Trauma a Risk Factor for Resistant Epilepsy? JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1228-1244. [PMID: 37815052 DOI: 10.1177/08862605231203964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Childhood traumas have been considered risk factors for many psychiatric disorders. Recent studies demonstrated that childhood traumas can also be considered risk factors for neurological diseases. In this context, the objective of this study is to investigate the effects of childhood traumas on treatment resistance in patients with epilepsy. The study sample consisted of 85 epilepsy patients, 40 male and 45 female, who were diagnosed and followed up by a neurologist. Of these patients, 45 were being followed up with the diagnosis of refractory epilepsy, and 40 were being followed up with the diagnosis of treatment-responsive epilepsy. Cranial magnetic resonance imaging and electroencephalography were performed on all patients. In addition, all patients were administered childhood trauma questionnaire (CTQ) and Hamilton depression rating scale (HAM-D). Epilepsy patients included in the study were divided into refractory epilepsy and treatment-responsive epilepsy groups. There was no significant difference between the groups in sociodemographic characteristics. On the other hand, total CTQ and all CTQ subscale scores and HAM-D scores were significantly higher in the refractory epilepsy group than in the treatment-responsive epilepsy group. This study demonstrates that childhood traumas may contribute to treatment resistance in epilepsy patients. Therefore, it is recommended that a history of childhood traumas be routinely queried in the treatment of epilepsy patients.
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Affiliation(s)
- Abdullah Yilgör
- Faculty of Medicine, Department of Neurology, Van Yuzuncu Yil University, Turkey
| | - Faruk Kurhan
- Faculty of Medicine, Department of Psychiatry, Van Yuzuncu Yil University, Turkey
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Singh GK, Kumari B, Das N, Zaman K, Prasad P, Singh RB. Design, synthesis, molecular docking and pharmacological evaluation of some thiadiazole based nipecotic acid derivatives as a potential anticonvulsant and antidepressant agents. 3 Biotech 2024; 14:71. [PMID: 38362592 PMCID: PMC10864245 DOI: 10.1007/s13205-023-03897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
In our continuous effort to develop novel antiepileptic drug, a new series of nipecotic acid derivatives having1,3,4-thiadiazole nucleus were designed and synthesized. This study aims to improve the lipophilicity of nipecotic acid by attaching some lipophilic anchors like thiadiazole and substituted aryl acid derivatives. In our previous study, we noticed that the N-substituted oxadiazole derivative of nipecotic acid exhibited significant antiepileptic activity in the rodent model. The synthesized compounds were characterized by FT-IR, 1H-NMR, 13C-NMR, Mass, and elemental analysis. The anticonvulsant activity was evaluated by using the maximal electroshock-induced seizure model in rats (MES) and the subcutaneous pentylenetetrazol (scPTZ) test in mice. None of the compounds were found to be active in the MES model whereas compounds (TN2, TN9, TN12, TN13, and TN15) produced significant protection against the scPTZ-induced seizures model. The compounds showing antiepileptic activity were additionally evaluated for antidepressant activity by using the forced swim test, 5-hydroxytryptophan (5-HTP)-induced head twitch test, and learned helplessness test. All the molecules that showed anticonvulsant activity (TN2, TN9, TN12, TN13, and TN15), also exerted significant antidepressant effects in the animal models. The selected compounds were subjected to different toxicity studies. Compounds were found to have no neurotoxicity in the rota-rod test and devoid of hepatic and renal toxicity in 30 days repeated oral toxicity test. Further, a homology model was developed to perform the in-silico molecular docking and dynamics studies which revealed the similar binding of compound TN9 within the active binding pocket and were found to be the most potent anti-epileptic agent. The market expectation for newly developed antiepileptic thiadiazole-based nipecotic acid derivatives is significant, driven by their potential to offer improved therapeutic outcomes and reduced side effects, addressing a critical need in epilepsy treatment. These innovative compounds hold promise for meeting the demand for more effective and safer antiepileptic medications. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-023-03897-1.
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Affiliation(s)
- Gireesh Kumar Singh
- Department of Pharmacy, School of Health Sciences, Central University of South Bihar, Gaya, Bihar 824236 India
| | - Bindu Kumari
- Department of Pharmacy, School of Health Sciences, Central University of South Bihar, Gaya, Bihar 824236 India
| | - Nirupam Das
- Department of Pharmaceutical Science, SSMPS, Assam University, Silchar, Assam 788151 India
| | - Kamaruz Zaman
- Department of Pharmaceutical Sciences, Dibrugarh University, Dibrugarh, Assam 786004 India
| | - Pratibha Prasad
- Department of Neurology, All India Institute of Medical Sciences, Deoghar, Jharkhand 814142 India
| | - Ravi Bhushan Singh
- Institute of Pharmacy, Harischandra P.G. College, Bawanbeegha, Azamgarh Road, Varanasi, 221002 India
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25
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Dell'Osso L, Nardi B, Massoni L, Gravina D, Benedetti F, Cremone IM, Carpita B. Neuroprotective Properties of Antiepileptics: What are the Implications for Psychiatric Disorders? Curr Med Chem 2024; 31:3447-3472. [PMID: 37226791 DOI: 10.2174/0929867330666230523155728] [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: 12/31/2022] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Abstract
Since the discovery of the first antiepileptic compound, increasing attention has been paid to antiepileptic drugs (AEDs), and recently, with the understanding of the molecular mechanism underlying cells death, a new interest has revolved around a potential neuroprotective effect of AEDs. While many neurobiological studies in this field have focused on the protection of neurons, growing data are reporting how exposure to AEDs can also affect glial cells and the plastic response underlying recovery; however, demonstrating the neuroprotective abilities of AEDs remains a changeling task. The present work aims to summarize and review the literature available on the neuroprotective properties of the most commonly used AEDs. Results highlighted how further studies should investigate the link between AEDs and neuroprotective properties; while many studies are available on valproate, results for other AEDs are very limited and the majority of the research has been carried out on animal models. Moreover, a better understanding of the biological basis underlying neuro-regenerative defects may pave the way for the investigation of further therapeutic targets and eventually lead to an improvement in the actual treatment strategies.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56127, Italy
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26
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Wheless JW, Gidal B, Rabinowicz AL, Carrazana E. Practical Questions About Rescue Medications for Acute Treatment of Seizure Clusters in Children and Adolescents with Epilepsy in the USA: Expanding Treatment Options to Address Unmet Needs. Paediatr Drugs 2024; 26:49-57. [PMID: 37902940 PMCID: PMC10769986 DOI: 10.1007/s40272-023-00601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/01/2023]
Abstract
Epilepsy is a common pediatric neurological condition, affecting approximately 470,000 children in the USA and having a prevalence of 0.9% in the global population of approximately 2.6 billion children. Epilepsy is associated with disruptions in several areas of a child's life, including medical burden, quality of life, cognitive outcomes, and higher risk of mortality. Additionally, some pediatric patients may experience acute seizure emergencies such as seizure clusters (also called acute repetitive seizures), which are intermittent increases in seizure activity that differ from the patient's usual seizure pattern and may occur despite daily antiseizure drug administration. Seizure clusters increase a patient's risk for status epilepticus and emergency room visits. Benzodiazepines are the main category of drugs used as acute seizure therapies for seizure clusters. This narrative review provides a practical discussion of care for pediatric patients with epilepsy and seizure clusters exploring such topics as details about the US Food and Drug Administration-approved acute seizure therapies, safety and ease of use of these medications, benefits of seizure action plans to help ensure optimal treatment, and considerations for transitioning a pediatric patient with acute seizure therapy to adult healthcare management.
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Affiliation(s)
- James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, 38105, USA.
| | - Barry Gidal
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Enrique Carrazana
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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27
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Roustaei B, Zarezadeh S, Ghotbi-Ravandi AA. A review on epilepsy, current treatments, and potential of medicinal plants as an alternative treatment. Neurol Sci 2023; 44:4291-4306. [PMID: 37581769 DOI: 10.1007/s10072-023-07010-5] [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: 05/29/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
Epilepsy is considered common neurological diseases that threaten the lives of millions of people all around the world. Since ancient times, different forms of medications have been used to treat this condition. Adverse events associated with treatments and the residence time of available drugs caused to search for safer and more efficient therapies and drugs remain one of the major areas of research interest for scientists. As one of the therapeutics with fewer side effects, plants and their essential oils can be considered replacements for existing treatments. Medicinal plants have proven to be an effective natural source of antiepileptic drugs; most of them have their mechanism of action by affecting GABA receptors in different paths. Cannabis indica and Cymbopogon winterianus are well-known plant species with antiepileptic activities. The current review presenting a list of plants with antiepileptic effects aims to pave the way for finding alternative drugs with fewer side effects for scientists.
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Affiliation(s)
- Bahar Roustaei
- Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Somayeh Zarezadeh
- Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
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28
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Benoist C, Boccaletti S, Leach JP, Cattaneo A, Chaplin A, Antunes L, Heiman F, Sander JW. Characterising people with focal drug-resistant epilepsy: A retrospective cohort study. Epilepsy Behav 2023; 149:109540. [PMID: 38006844 DOI: 10.1016/j.yebeh.2023.109540] [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: 09/04/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, drug treatment outcomes, healthcare resource utilization, and injuries among people with focal drug-resistant epilepsy (F-DRE) analysed separately for six European countries. METHODS We used electronic medical record data from six European (Belgium, Spain, Italy, France, UK and Germany) primary care/specialist care databases to identify antiseizure medication (ASM) treatment-naïve people (aged ≥ 18 years at F-DRE diagnosis). They were followed from their epilepsy diagnosis until death, the date of last record available, or study end. We used descriptive analyses to characterise the F-DRE cohort, and results were reported by country. RESULTS One-thousand-seventy individuals with F-DRE were included (mean age 52.5 years; 55.4 % female). The median follow-up time from the first diagnosis to the end of the follow-up was 95.5 months across all countries. The frequency of F-DRE diagnosis in 2021 ranged from 8.8 % in Italy to 18.2 % in Germany. Psychiatric disorders were the most common comorbidity across all countries. Frequently reported psychiatric disorders were depression (26.7 %) and anxiety (11.8 %). The median time from epilepsy diagnosis to the first ASM failure ranged from 5.9 (4.2-10.2) months in France to 12.6 (5.8-20.4) months in Spain. Levetiracetam and lamotrigine were the most commonly used ASM monotherapies in all countries. Consultation with a general practitioner is sought more frequently after F-DRE diagnosis than after epilepsy diagnosis, except in the UK. SIGNIFICANCE No one ASM is optimal for all people with F-DRE, and the risks and benefits of the ASM must be considered. Comorbidities must be an integral part of the management strategy and drive the choice of drugs.
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Affiliation(s)
| | | | | | | | - Anna Chaplin
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy
| | - Luis Antunes
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy
| | - Franca Heiman
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy.
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, the Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China
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29
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Jhaveri DJ, McGonigal A, Becker C, Benoliel JJ, Nandam LS, Soncin L, Kotwas I, Bernard C, Bartolomei F. Stress and Epilepsy: Towards Understanding of Neurobiological Mechanisms for Better Management. eNeuro 2023; 10:ENEURO.0200-23.2023. [PMID: 37923391 PMCID: PMC10626502 DOI: 10.1523/eneuro.0200-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/03/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Stress has been identified as a major contributor to human disease and is postulated to play a substantial role in epileptogenesis. In a significant proportion of individuals with epilepsy, sensitivity to stressful events contributes to dynamic symptomatic burden, notably seizure occurrence and frequency, and presence and severity of psychiatric comorbidities [anxiety, depression, posttraumatic stress disorder (PTSD)]. Here, we review this complex relationship between stress and epilepsy using clinical data and highlight key neurobiological mechanisms including the hypothalamic-pituitary-adrenal (HPA) axis dysfunction, altered neuroplasticity within limbic system structures, and alterations in neurochemical pathways such as brain-derived neurotrophic factor (BNDF) linking epilepsy and stress. We discuss current clinical management approaches of stress that help optimize seizure control and prevention, as well as psychiatric comorbidities associated with epilepsy. We propose that various shared mechanisms of stress and epilepsy present multiple avenues for the development of new symptomatic and preventative treatments, including disease modifying therapies aimed at reducing epileptogenesis. This would require close collaborations between clinicians and basic scientists to integrate data across multiple scales, from genetics to systems biology, from clinical observations to fundamental mechanistic insights. In future, advances in machine learning approaches and neuromodulation strategies will enable personalized and targeted interventions to manage and ultimately treat stress-related epileptogenesis.
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Affiliation(s)
- Dhanisha J Jhaveri
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Aileen McGonigal
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Epilepsy Unit, Department of Neurosciences, Mater Hospital, Brisbane, QLD 4101, Australia
| | - Christel Becker
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
| | - Jean-Jacques Benoliel
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
- Site Pitié-Salpêtrière, Service de Biochimie Endocrinienne et Oncologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, 75651, France
| | - L Sanjay Nandam
- Turner Inst for Brain & Mental Health, Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Melbourne, 3800, Australia
| | - Lisa Soncin
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Côte d'Azur University, Nice, 06300, France
| | - Iliana Kotwas
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
| | - Christophe Bernard
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
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Bjornsdottir G, Chalmer MA, Stefansdottir L, Skuladottir AT, Einarsson G, Andresdottir M, Beyter D, Ferkingstad E, Gretarsdottir S, Halldorsson BV, Halldorsson GH, Helgadottir A, Helgason H, Hjorleifsson Eldjarn G, Jonasdottir A, Jonasdottir A, Jonsdottir I, Knowlton KU, Nadauld LD, Lund SH, Magnusson OT, Melsted P, Moore KHS, Oddsson A, Olason PI, Sigurdsson A, Stefansson OA, Saemundsdottir J, Sveinbjornsson G, Tragante V, Unnsteinsdottir U, Walters GB, Zink F, Rødevand L, Andreassen OA, Igland J, Lie RT, Haavik J, Banasik K, Brunak S, Didriksen M, T Bruun M, Erikstrup C, Kogelman LJA, Nielsen KR, Sørensen E, Pedersen OB, Ullum H, Masson G, Thorsteinsdottir U, Olesen J, Ludvigsson P, Thorarensen O, Bjornsdottir A, Sigurdardottir GR, Sveinsson OA, Ostrowski SR, Holm H, Gudbjartsson DF, Thorleifsson G, Sulem P, Stefansson H, Thorgeirsson TE, Hansen TF, Stefansson K. Rare variants with large effects provide functional insights into the pathology of migraine subtypes, with and without aura. Nat Genet 2023; 55:1843-1853. [PMID: 37884687 PMCID: PMC10632135 DOI: 10.1038/s41588-023-01538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
Migraine is a complex neurovascular disease with a range of severity and symptoms, yet mostly studied as one phenotype in genome-wide association studies (GWAS). Here we combine large GWAS datasets from six European populations to study the main migraine subtypes, migraine with aura (MA) and migraine without aura (MO). We identified four new MA-associated variants (in PRRT2, PALMD, ABO and LRRK2) and classified 13 MO-associated variants. Rare variants with large effects highlight three genes. A rare frameshift variant in brain-expressed PRRT2 confers large risk of MA and epilepsy, but not MO. A burden test of rare loss-of-function variants in SCN11A, encoding a neuron-expressed sodium channel with a key role in pain sensation, shows strong protection against migraine. Finally, a rare variant with cis-regulatory effects on KCNK5 confers large protection against migraine and brain aneurysms. Our findings offer new insights with therapeutic potential into the complex biology of migraine and its subtypes.
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Affiliation(s)
| | - Mona A Chalmer
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | | | | | | | | | | | | | - Bjarni V Halldorsson
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- Reykjavik University, School of Technology, Reykjavik, Iceland
| | - Gisli H Halldorsson
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Hannes Helgason
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Ingileif Jonsdottir
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | - Sigrun H Lund
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Physical Sciences, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Pall Melsted
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | | | | | - Linn Rødevand
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen, Norway
| | - Rolv T Lie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mie T Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine Health, Aarhus University, Aarhus, Denmark
| | - Lisette J A Kogelman
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Unnur Thorsteinsdottir
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Petur Ludvigsson
- Department of Pediatrics, Landspitali University Hostpital, Reykjavik, Iceland
| | - Olafur Thorarensen
- Department of Pediatrics, Landspitali University Hostpital, Reykjavik, Iceland
| | | | | | - Olafur A Sveinsson
- Laeknasetrid Clinic, Reykjavik, Iceland
- Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hilma Holm
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | | | | | - Thomas F Hansen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kari Stefansson
- deCODE Genetics/Amgen, Inc., Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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Silva M, Gonçalves-Pinho M, Ferreira AR, Seabra M, Freitas A, Fernandes L. Epilepsy hospitalizations and mental disorders: A Portuguese population-based observational retrospective study (2008-2015). Epilepsy Behav 2023; 148:109447. [PMID: 37804601 DOI: 10.1016/j.yebeh.2023.109447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Psychiatric comorbidities are highly frequent in people with epilepsy and were found to be markers of poorer prognosis. These comorbidities increase the use of healthcare resources, including emergency department visits and inpatient care. Despite this, there is little information on healthcare utilization associated with a wide range of comorbid mental disorders in people with epilepsy (PWE). OBJECTIVE To characterize registered mental disorders among all hospitalizations with a primary diagnosis of epilepsy and to analyze their association with crucial hospitalization outcomes. METHODS An observational retrospective study was performed using administrative data from hospitalization episodes with epilepsy as the primary diagnosis discharged between 2008 and 2015. Mental disorder categories 650 to 670 from Clinical Classification Software were selected as secondary diagnoses. Mann-Whitney U, Kruskall-Wallis, and Chi-squared tests were used to establish comparisons. For each episode, data regarding hospitalization outcomes was retrieved, including length of stay (LoS), in-hospital mortality (IHM), 8-year period readmissions, and total estimated charges. RESULTS Overall, 27,785 hospitalizations were analyzed and 33.9% had registered mental disorders, with alcohol-related disorders being the most prevalent (11.7%). For episodes with a concomitant register of a mental disorder, LoS was significantly longer (5.0 vs. 4.0 days, P <0.001), and IHM was higher (2.8% vs. 2.2%, P <0.001), as were readmissions (25.5% vs. 23.7%, P <0.001), and median episodes' charges (1,578.7 vs. 1,324.4 euros, P <0.001). CONCLUSION Epilepsy-related hospitalizations with registered mental disorders heightened the utilization of healthcare resources, stressing the importance of diagnosing and treating mental disorders in PWE.
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Affiliation(s)
- Marta Silva
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
| | - Manuel Gonçalves-Pinho
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Ana Rita Ferreira
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Seabra
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Neurology and Neurosurgery Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lia Fernandes
- CINTESIS@RISE, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal; Psychiatry Service, Centro Hospitalar Universitário de São João, Porto, Portugal
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Delgado-García G, Engbers JDT, Wiebe S, Mouches P, Amador K, Forkert ND, White J, Sajobi T, Klein KM, Josephson CB. Machine learning using multimodal clinical, electroencephalographic, and magnetic resonance imaging data can predict incident depression in adults with epilepsy: A pilot study. Epilepsia 2023; 64:2781-2791. [PMID: 37455354 DOI: 10.1111/epi.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study was undertaken to develop a multimodal machine learning (ML) approach for predicting incident depression in adults with epilepsy. METHODS We randomly selected 200 patients from the Calgary Comprehensive Epilepsy Program registry and linked their registry-based clinical data to their first-available clinical electroencephalogram (EEG) and magnetic resonance imaging (MRI) study. We excluded patients with a clinical or Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)-based diagnosis of major depression at baseline. The NDDI-E was used to detect incident depression over a median of 2.4 years of follow-up (interquartile range [IQR] = 1.5-3.3 years). A ReliefF algorithm was applied to clinical as well as quantitative EEG and MRI parameters for feature selection. Six ML algorithms were trained and tested using stratified threefold cross-validation. Multiple metrics were used to assess model performances. RESULTS Of 200 patients, 150 had EEG and MRI data of sufficient quality for ML, of whom 59 were excluded due to prevalent depression. Therefore, 91 patients (41 women) were included, with a median age of 29 (IQR = 22-44) years. A total of 42 features were selected by ReliefF, none of which was a quantitative MRI or EEG variable. All models had a sensitivity > 80%, and five of six had an F1 score ≥ .72. A multilayer perceptron model had the highest F1 score (median = .74, IQR = .71-.78) and sensitivity (84.3%). Median area under the receiver operating characteristic curve and normalized Matthews correlation coefficient were .70 (IQR = .64-.78) and .57 (IQR = .50-.65), respectively. SIGNIFICANCE Multimodal ML using baseline features can predict incident depression in this population. Our pilot models demonstrated high accuracy for depression prediction. However, overall performance and calibration can be improved. This model has promise for identifying those at risk for incident depression during follow-up, although efforts to refine it in larger populations along with external validation are required.
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Affiliation(s)
- Guillermo Delgado-García
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline Mouches
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Amador
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nils D Forkert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James White
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, University of Calgary, Calgary, Alberta, Canada
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Huang Y, Liu Y, Liu Y, Han J, Han H, Li J, Wang T. Differences in the topographical distribution of sleep spindles among adult epilepsy with cognitive impairment. Epilepsia Open 2023; 8:980-990. [PMID: 37259710 PMCID: PMC10472368 DOI: 10.1002/epi4.12768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/26/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Cognitive comorbidities are common in epilepsy; however, symptomatic treatment is currently the only available effective therapy. Sleep, cognition, and epilepsy are closely associated. Therefore, many studies on epilepsy and cognition have focused on sleep structures, such as sleep spindles, which are considered windows to understanding the sleeping brain. This study aimed to investigate the relationship between sleep spindles and the severity of cognitive impairment in adult epilepsy. METHODS Fifty-seven adults with epilepsy underwent overnight sleep electroencephalogram recordings and cognitive testing. Slow (9-12 Hz) and fast (12-15 Hz) spindle characteristics during N2 sleep were calculated using a convolutional neural network-based sleep staging system and automatic spindle detection algorithm. Repeated-measures analysis of variance was used to analyze differences in fast and slow spindle densities among subgroups of patients based on cognitive impairment severity. RESULTS A significant between-group effect was observed for both slow and fast spindle densities. Multiple comparisons showed that slow and fast spindle densities of the severe cognitive impairment subgroup were lower than those of the noncognitive impairment subgroup (P < 0.05). Simple-effect analysis revealed differences in slow spindle density distributed among the EEG channels Fp1, Fp2, F3, C3, P4, O1, O2, F8, T4, T5, T6, Fz, and Cz (P < 0.05). Differences in fast spindle density were distributed among the channels Fp1, Fp2, F3, C3, O1, O2, F7, F8, T4, T5, T6, and Fz (P < 0.05). SIGNIFICANCE Significant differences in topographical distribution of fast and slow spindle densities were observed at the scalp level among patients with different cognitive statuses. Compared with patients with no cognitive impairment, those with severe cognitive impairment had lower slow and fast spindle densities over multiple scalp regions during N2 sleep. This study provides a reference for objective assessment of cognitive dysfunction in epilepsy patients.
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Affiliation(s)
- Yajin Huang
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
| | - Yanjun Liu
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
| | - Yaqing Liu
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
| | - Juping Han
- Department of Rehabilitation MedicineHanzhong Central HospitalHanzhongChina
| | - Hongmei Han
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
| | - Junqiang Li
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
| | - Tiancheng Wang
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Department of Neurology, Epilepsy CenterLanzhou University Second Hospital, Lanzhou UniversityLanzhouChina
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Sarkisova KY, Gabova AV, Fedosova EA, Shatskova AB, Narkevich VB, Kudrin VS. Antidepressant and Anxiolytic Effects of L-Methionine in the WAG/Rij Rat Model of Depression Comorbid with Absence Epilepsy. Int J Mol Sci 2023; 24:12425. [PMID: 37569798 PMCID: PMC10419169 DOI: 10.3390/ijms241512425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
Depression is a severe and widespread psychiatric disease that often accompanies epilepsy. Antidepressant treatment of depression comorbid with epilepsy is a major concern due to the risk of seizure aggravation. SAMe, a universal methyl donor for DNA methylation and the synthesis of brain monoamines, is known to have high antidepressant activity. This study aimed to find out whether L-methionine (L-MET), a precursor of SAMe, can have antidepressant and/or anxiolytic effects in the WAG/Rij rat model of depression comorbid with absence epilepsy. The results indicate that L-MET reduces the level of anxiety and depression in WAG/Rij rats and suppresses associated epileptic seizures, in contrast to conventional antidepressant imipramine, which aggravates absence seizures. The antidepressant effect of L-MET was comparable with that of the conventional antidepressants imipramine and fluoxetine. However, the antidepressant profile of L-MET was more similar to imipramine than to fluoxetine. Taken together, our findings suggest that L-MET could serve as a promising new antidepressant drug with anxiolytic properties for the treatment of depression comorbid with absence epilepsy. Increases in the level of monoamines and their metabolites-DA, DOPAC, HVA, NA, and MHPG-in several brain structures, is suggested to be a neurochemical mechanism of the beneficial phenotypic effect of L-MET.
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Affiliation(s)
- Karine Yu. Sarkisova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Alexandra V. Gabova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Ekaterina A. Fedosova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Alla B. Shatskova
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, Butlerova Str. 5A, Moscow 117485, Russia; (A.V.G.); (E.A.F.); (A.B.S.)
| | - Victor B. Narkevich
- Federal State Budgetary Institution “Scientific Research Institute of Pharmacology named after V.V. Zakusov”, Baltiyskaya Str. 8, Moscow 125315, Russia; (V.B.N.); (V.S.K.)
| | - Vladimir S. Kudrin
- Federal State Budgetary Institution “Scientific Research Institute of Pharmacology named after V.V. Zakusov”, Baltiyskaya Str. 8, Moscow 125315, Russia; (V.B.N.); (V.S.K.)
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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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Narrett JA, Khan W, Funaro MC, Moeller JJ. How do smoking, vaping, and nicotine affect people with epilepsy and seizures? A scoping review protocol. PLoS One 2023; 18:e0288120. [PMID: 37418386 DOI: 10.1371/journal.pone.0288120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Epilepsy is a prevalent disease that requires personalized care to control seizures, reduce side effects, and ameliorate the burden of comorbidities. Smoking is a major cause of preventable death and disease. There is evidence that patients with epilepsy smoke at high rates and that smoking may increase seizure frequency. However, there is a lack systematically synthesized evidence on the interactions between epilepsy and seizures and smoking, tobacco use, vaping, and smoking cessation. METHODS AND ANALYSIS This scoping review protocol guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA Extension for Scoping Reviews will investigate what is known about the interactions between smoking and epilepsy. This review will include the population of persons with all types of epilepsy or seizures and examine an inclusive list of concepts including tobacco use, vaping, nicotine replacement, and smoking cessation. The MEDLINE, Embase, APA Psycinfo, CINAHL, Cochrane, Scopus, and Web of Science databases will be searched. Following systematic screening of records, data will be charted, synthesized, and summarized for presentation and publication. ETHICS AND DISSEMINATION No ethical approval is required for this literature-based study. The results of this scoping review will be submitted for publication in a peer-reviewed journal. This synthesis will be informative to clinicians and direct further research that may improve health outcomes for people with epilepsy. REGISTRATION This protocol is registered with the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/D3ZK8).
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Affiliation(s)
- Jackson A Narrett
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Waleed Khan
- Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, United States of America
| | - Jeremy J Moeller
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, United States of America
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Cuesta P, Bruña R, Shah E, Laohathai C, Garcia-Tarodo S, Funke M, Von Allmen G, Maestú F. An individual data-driven virtual resection model based on epileptic network dynamics in children with intractable epilepsy: a magnetoencephalography interictal activity application. Brain Commun 2023; 5:fcad168. [PMID: 37274829 PMCID: PMC10236945 DOI: 10.1093/braincomms/fcad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 01/24/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
Epilepsy surgery continues to be a recommended treatment for intractable (medication-resistant) epilepsy; however, 30-70% of epilepsy surgery patients can continue to have seizures. Surgical failures are often associated with incomplete resection or inaccurate localization of the epileptogenic zone. This retrospective study aims to improve surgical outcome through in silico testing of surgical hypotheses through a personalized computational neurosurgery model created from individualized patient's magnetoencephalography recording and MRI. The framework assesses the extent of the epileptic network and evaluates underlying spike dynamics, resulting in identification of one single brain volume as a candidate for resection. Dynamic-locked networks were utilized for virtual cortical resection. This in silico protocol was tested in a cohort of 24 paediatric patients with focal drug-resistant epilepsy who underwent epilepsy surgery. Of 24 patients who were included in the analysis, 79% (19 of 24) of the models agreed with the patient's clinical surgery outcome and 21% (5 of 24) were considered as model failures (accuracy 0.79, sensitivity 0.77, specificity 0.82). Patients with unsuccessful surgery outcome typically showed a model cluster outside of the resected cavity, while those with successful surgery showed the cluster model within the cavity. Two of the model failures showed the cluster in the vicinity of the resected tissue and either a functional disconnection or lack of precision of the magnetoencephalography-MRI overlapping could explain the results. Two other cases were seizure free for 1 year but developed late recurrence. This is the first study that provides in silico personalized protocol for epilepsy surgery planning using magnetoencephalography spike network analysis. This model could provide complementary information to the traditional pre-surgical assessment methods and increase the proportion of patients achieving seizure-free outcome from surgery.
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Affiliation(s)
- Pablo Cuesta
- Correspondence to: Pablo Cuesta Pza. Ramón y Cajal, s/n. Ciudad Universitaria 28040 Madrid, Spain E-mail:
| | - Ricardo Bruña
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
| | - Ekta Shah
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | | | - Stephanie Garcia-Tarodo
- Département de la femme, de l'enfant et de l'adolescent, Hôpital des Enfants - Hôpitaux Universitaires de Genève, Geneva, 1211 Genève 14, Switzerland
| | - Michael Funke
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Gretchen Von Allmen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Fernando Maestú
- Center for Cognitive and Computational Neuroscience, Complutense University of Madrid, Madrid, 28040, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, 28040, Spain
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Universidad Complutense de Madrid, Madrid, 28040, Spain
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Wei Z, Wang X, Ren L, Liu C, Liu C, Cao M, Feng Y, Gan Y, Li G, Liu X, Liu Y, Yang L, Deng Y. Using machine learning approach to predict depression and anxiety among patients with epilepsy in China: A cross-sectional study. J Affect Disord 2023; 336:1-8. [PMID: 37209912 DOI: 10.1016/j.jad.2023.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Anxiety and depression are the most prevalent comorbidities among epilepsy patients. The screen and diagnosis of anxiety and depression are quite important for the management of patients with epilepsy. In that case, the method for accurately predicting anxiety and depression needs to be further explored. METHODS A total of 480 patients with epilepsy (PWE) were enrolled in our study. Anxiety and Depressive symptoms were evaluated. Six machine learning models were used to predict anxiety and depression in patients with epilepsy. Receiver operating curve (ROC), decision curve analysis (DCA) and moDel Agnostic Language for Exploration and eXplanation (DALEX) package were used to evaluate the accuracy of machine learning models. RESULTS For anxiety, the area under the ROC curve was not significantly different between models. DCA revealed that random forest and multilayer perceptron has the largest net benefit within different probability threshold. DALEX revealed that random forest and multilayer perceptron were models with best performance and stigma had the highest feature importance. For depression, the results were much the same. CONCLUSIONS Methods created in this study may offer much help identifying PWE with high risk of anxiety and depression. The decision support system may be valuable for the everyday management of PWE. Further study is needed to test the outcome of applying this system to clinical settings.
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Affiliation(s)
- Zihan Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China
| | - Xinpei Wang
- School of Aerospace Medicine, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, People's Republic of China
| | - Lei Ren
- Department of Clinical Psychology, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, People's Republic of China
| | - Chang Liu
- BrainPark, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | - Chao Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China
| | - Mi Cao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China
| | - Yan Feng
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China; Xi'an Medical University, Xi'an 710021, People's Republic of China
| | - Yanjing Gan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China
| | - Guoyan Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China; Xi'an Medical University, Xi'an 710021, People's Republic of China
| | - Xufeng Liu
- Department of Clinical Psychology, Fourth Military Medical University, 169 West Changle Road, Xi'an 710032, People's Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China.
| | - Lei Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China.
| | - Yanchun Deng
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, 127 West Changle Road, Xi'an 710032, People's Republic of China.
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Alyoubi R, Kobeisy SA, Basheikh M, Al-Sharief RA, Al-Hayani MM, Rayes YO, Alharthi A, Alyazidi AS, Alrayes N, Tayeb HO. The Association of Sociodemographic Factors, Postictal Symptoms, and Medical History With Seizure Type in Patients With Epilepsy: A Cross-Sectional Study. Cureus 2023; 15:e39763. [PMID: 37398836 PMCID: PMC10311941 DOI: 10.7759/cureus.39763] [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] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Background Approximately 50 million people globally suffer from epilepsy. The prevalence of epilepsy in Saudi Arabia has been reported at 6.5 per 1,000 persons, affecting nearly 1% of the entire population. However, limited data is available in the country regarding the sociodemographic factors affecting epilepsy and its associated postictal symptoms, which may lead to stigmatization and negatively impact patients. Methods A cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in a survey format. Ethical approval was obtained from the Research Ethics Committee of the Faculty of Medicine at King Abdulaziz University. The study population included patients with epilepsy who visited King Abdulaziz University Hospital's outpatient neurology clinics from October 2021 to March 2022. Results The study participants' average age at the time of the first seizure was 16.5 years, with patients experiencing seizures as early as within the first year of life and as late as 70 years of age. Patients who had had their first seizure during the first year of life did not have any schooling (p<0.0001) and had learning difficulties (p<0.00001). Focal onset impaired awareness seizures were significantly associated with motor weakness (p=0.023) and mood alterations (p=0.014), while postictal fear, anxiety or panic, and sleep disruption were statistically significant for focal onset aware seizures (p=0.015 and p=0.050). Conclusion This study highlights the sociodemographic differences between patients in Saudi Arabia and in other areas. It may also point to novel findings regarding the postictal symptoms associated with the various seizure types.
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Affiliation(s)
- Reem Alyoubi
- Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Mazen Basheikh
- Department of Internal Medicine, University of Jeddah, Jeddah, SAU
| | | | | | - Yousof O Rayes
- Department of Medicine, King Abdulaziz University, Rabigh, SAU
| | - Atheer Alharthi
- Department of Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | - Anas S Alyazidi
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
- Department of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Nuha Alrayes
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
| | - Haythum O Tayeb
- Department of Medicine, Neuroscience Research Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Tartibzadeh G, Feizollahzadeh H, Shabanloei R, Mwamba B. Epilepsy risk awareness and background factors in patients with epilepsy and family caregivers. Epilepsy Res 2023; 193:107146. [PMID: 37121025 DOI: 10.1016/j.eplepsyres.2023.107146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Patients with epilepsy are at risk of various injuries throughout their lives. Awareness of patients and family caregivers about risk factors and self-care prevents potential injuries. This study aimed to investigate epilepsy risk awareness and background factors in patients with epilepsy and family caregivers. METHODS This descriptive study was conducted with the recruitment of 120 patients with epilepsy and 120 family caregivers who were referred to the Neurological Clinic of Tabriz Razi Hospital in Iran. Data was collected using Persian version of the epilepsy risk awareness questionnaires for patients (3rd Edition) and family caregivers. RESULTS The average age of the patients (65.8% women) was 29.2 and of the family caregivers (58.3% women) 41.5 years. The average score of risk awareness in family caregivers was 82.6 ± 8.8 and higher than that in patients with epilepsy 84.9 ± 8.5 (obtainable score: 0-120). Compared to the maximum score, the average scores of both groups in all domains including epilepsy, personal security, physical health, and mental health were low. A statistically significant relationship was observed between the mean scores of risk awareness and some background variables. CONCLUSION The results showed that epilepsy risk awareness in patients and family caregivers is low and there is a need for education and support. By developing education programs for the patient and their family and increasing epilepsy risk awareness, patients can be protected from potential risks and their safety and quality of life can be improved.
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Affiliation(s)
- Golzar Tartibzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Feizollahzadeh
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Reza Shabanloei
- Department of Medical-Surgical Nursing, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bupe Mwamba
- Midwifery and Neonatal Nursing Science, RM, RM, Lecturer, Clinical and Health Sciences, University of South Australia, Adelaide. Australia
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Kim HJ, Jang HN, Ahn HJ, Yum MS, Ko TS. Long-Term Pharmacological and Psychosocial Outcomes of Adolescent-Onset Epilepsy: A Single-Center Experience. ANNALS OF CHILD NEUROLOGY 2023. [DOI: 10.26815/acn.2022.00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Purpose: Despite the high incidence of epilepsy during adolescence, little attention has been paid to the outcomes and prognosis of adolescent-onset epilepsy. The aim of this study was to investigate the long-term pharmacological and psychosocial outcomes of adolescent-onset epilepsy.Methods: From 1993 to 2019, the electronic medical records of adolescent-onset epilepsy patients were retrieved from Asan Medical Center Children’s Hospital. Seizure outcomes were evaluated based on the seizure-free period at last contact. Possible predictors of remission, relapse, and intractability were investigated. Neuropsychiatric comorbidities, socioeconomic status, and transition outcomes were also assessed. Results: In total, 137 patients were enrolled in this study. The median age at diagnosis of epilepsy was 14 years and the mean duration of therapy was 13.0 years. During follow-up, 93 patients (67.9%) achieved terminal remission, of which 27 cases (19.7%) resolved. Relapse after withdrawal of medication occurred in 74 patients (54.0%), and the presence of electroencephalographic abnormalities (odds ratio [OR], 8.23; 95% confidence interval [CI], 1.39 to 48.87; P=0.020), poor adherence (OR, 4.84; 95% CI, 2.13 to 11.02; P=0.000), and history of febrile seizures (OR, 4.10; 95% CI, 1.21 to 13.93; P=0.024) were risk factors for relapse. Neurodevelopmental and psychological comorbidities were documented in 17 (12.4%) and 12 (8.8%) patients, respectively. Thirty-six (26.3%) patients transferred to adult clinics, at a mean age of 21.9 years. Conclusion: This study showed overall favorable seizure outcomes with a high rate of remission, but with frequent relapse after withdrawal.
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Ding R, Han Z, Gui J, Xie L, Yang J, Yang X, Huang D, Luo H, Han W, Jiang L. Inflammatory properties of diet mediate the effect of epilepsy on moderate to severe depression: Results from NHANES 2013-2018. J Affect Disord 2023; 331:175-183. [PMID: 36948467 DOI: 10.1016/j.jad.2023.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Depression is a major public health problem, and epilepsy and a high-inflammatory diet are important causes of depression. We aimed to explore the level of dietary inflammation in epileptic patients and its relationship with moderate to severe depression (MSD). METHODS This cross-sectional study included 12,788 participants aged 20-80 years from the NHANES database from 2013 to 2018. Depressive symptoms were evaluated using the nine-item Patient Health Questionnaire (PHQ-9), and epilepsy was diagnosed based on the use of antiepileptic drugs within the previous 30 days. Dietary inflammatory index (DII) scores and energy-adjusted DII (E-DII) scores were calculated based on dietary recalls of the past 24 h, and average DII (ADII) and energy-adjusted ADII (E-ADII) were calculated based on two 24-hour dietary recalls. RESULTS The DII, E-DII, and ADII scores and prevalence of MSD were significantly increased in epileptic patients compared with non-epilepsy subjects. The E-ADII score (P = 0.078) was weakly associated with comorbid MSD in patients with epilepsy. Mediation models showed that dietary inflammation scores mediated 2.31 % to 12.25 % of epilepsy-related MSD. In stratified analysis, an increased prevalence of MSD was present in the Quartile 2 subgroup based on DII and E-ADII scores and in the Quartile 3 subgroup of epileptic patients based on DII, E-DII, and ADII scores. CONCLUSIONS Epileptics consume more proinflammatory foods and nutrients than control subjects. MSD in patients with epilepsy is associated with their high inflammatory diet. Suggesting an urgent need for rational dietary management in the epileptic population.
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Affiliation(s)
- Ran Ding
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ziyao Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Jianxiong Gui
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Lingling Xie
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Jiaxin Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Xiaoyue Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Dishu Huang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Hanyu Luo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Wei Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China.
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, PR China; National Clinical Research Center for Child Health and Disorders, Chongqing, PR China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China; Chongqing Key Laboratory of Pediatrics, Chongqing, PR China.
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He Z, Li J. The therapeutic effects of lacosamide on epilepsy-associated comorbidities. Front Neurol 2023; 14:1063703. [PMID: 37006477 PMCID: PMC10062524 DOI: 10.3389/fneur.2023.1063703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Epilepsy is a chronic neurological disorder associated with severe social and psychological effects, and most epilepsy patients often report at least one comorbidity. Accumulating evidence have suggested that lacosamide, a new generation of anti-seizure medications, may exhibit efficacy in the management of both epilepsy and its related comorbidities. Therefore, this narrative review aimed to elucidate the recent advancements regarding the therapeutic role of lacosamide in epilepsy-associated comorbidities. The possible pathophysiological mechanisms between epilepsy and epilepsy-associated comorbidities have been also partially described. Whether lacosamide improves cognitive and behavioral functions in patients with epilepsy has not been conclusively established. Some studies support that lacosamide may alleviate anxiety and depression in epilepsy patients. In addition, lacosamide has been found to be safe and effective in the treatment of epilepsy in people with intellectual disabilities, epilepsy of cerebrovascular etiology, and epilepsy associated with brain tumors. Moreover, lacosamide treatment has demonstrated fewer side effects on other systems. Hence, future larger and higher quality clinical studies are needed to further explore both the safety and efficacy of lacosamide in the treatment of epilepsy-associated comorbidities.
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Kanner AM, Saporta AS, Kim DH, Barry JJ, Altalib H, Omotola H, Jette N, O'Brien TJ, Nadkarni S, Winawer MR, Sperling M, French JA, Abou-Khalil B, Alldredge B, Bebin M, Cascino GD, Cole AJ, Cook MJ, Detyniecki K, Devinsky O, Dlugos D, Faught E, Ficker D, Fields M, Gidal B, Gelfand M, Glynn S, Halford JJ, Haut S, Hegde M, Holmes MG, Kalviainen R, Kang J, Klein P, Knowlton RC, Krishnamurthy K, Kuzniecky R, Kwan P, Lowenstein DH, Marcuse L, Meador KJ, Mintzer S, Pardoe HR, Park K, Penovich P, Singh RK, Somerville E, Szabo CA, Szaflarski JP, Lin Thio KL, Trinka E, Burneo JG. Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity. Neurology 2023; 100:e1123-e1134. [PMID: 36539302 PMCID: PMC10074468 DOI: 10.1212/wnl.0000000000201671] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mood, anxiety disorders, and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis are not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts. METHODS The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18-60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, χ2 statistics, and logistic regression analyses. RESULTS A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts. DISCUSSION In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.
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Affiliation(s)
- Andres M Kanner
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.
| | - Anita S Saporta
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dong H Kim
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - John J Barry
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hamada Altalib
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hope Omotola
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Nathalie Jette
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Terence J O'Brien
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Siddhartha Nadkarni
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Melodie R Winawer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Sperling
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jacqueline A French
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Bassel Abou-Khalil
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Brian Alldredge
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Martina Bebin
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Gregory D Cascino
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Andrew J Cole
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Mark J Cook
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kamil Detyniecki
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Orrin Devinsky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dennis Dlugos
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Edward Faught
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - David Ficker
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Madeline Fields
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Barry Gidal
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Gelfand
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Simon Glynn
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jonathan J Halford
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Sheryl Haut
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manu Hegde
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manisha G Holmes
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Reetta Kalviainen
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Joon Kang
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Pavel Klein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Robert C Knowlton
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kaarkuzhali Krishnamurthy
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ruben Kuzniecky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patrick Kwan
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Daniel H Lowenstein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Lara Marcuse
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kimford J Meador
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Scott Mintzer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Heath R Pardoe
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kristen Park
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patricia Penovich
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Rani K Singh
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ernest Somerville
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Charles A Szabo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jerzy P Szaflarski
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - K Liu Lin Thio
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Eugen Trinka
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jorge G Burneo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
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Li G, Wang M, Zheng M, Liu X, Yu T, Ren J, Wang Q. Causal effect of psychiatric disorders on epilepsy: A two-sample Mendelian randomization study. Brain Behav 2023; 13:e2939. [PMID: 36860142 PMCID: PMC10097067 DOI: 10.1002/brb3.2939] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND This study aims to explore the relationship between psychiatric disorders and the risk of epilepsy using Mendelian randomization (MR) analysis. METHODS We collected summary statistics of seven psychiatric traits from recent largest genome-wide association study (GWAS), including major depressive disorder (MDD), anxiety disorder, autism spectrum disorder (ASD), bipolar disorder (BIP), attention deficit hyperactivity disorder (ADHD), schizophrenia (SCZ), and insomnia. Then, MR analysis estimates were performed based on International League Against Epilepsy (ILAE) consortium data (ncase = 15,212 and ncontrol = 29,677), the results of which were subsequently validated in FinnGen consortium (ncase = 6260 and ncontrol = 176,107). Finally, a meta-analysis was conducted based on the ILAE and FinnGen data. RESULTS We found significant causal effects of MDD and ADHD on epilepsy in the meta-analysis of the ILAE and FinnGen, with corresponding odds ratios (OR) of 1.20 (95% CI 1.08-1.34, p = .001) and 1.08 (95% CI 1.01-1.16, p = .020) by the inverse-variance weighted (IVW) method respectively. MDD increases the risk of focal epilepsy while ADHD has a risk effect on generalized epilepsy. No reliable evidence regarding causal effects of other psychiatric traits on epilepsy was identified. CONCLUSIONS This study suggests that major depressive disorder and attention deficit hyperactivity disorder may causally increase the risk of epilepsy.
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Affiliation(s)
- Gongfei Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Minghui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Meiqi Zheng
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Yu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiechuan Ren
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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Drees C, Hixon AM, Sillau S, Lopez-Esquibel N, Spitz M, Mohler R, Baca C, Fetrow K, Brown MG, Vaughan C. Physician distress when treatments fail. Survey on physician distress when treating persons with drug-resistant epilepsy and knowledge of neuropalliative care. Epilepsy Behav 2023; 140:108925. [PMID: 36774670 DOI: 10.1016/j.yebeh.2022.108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/02/2022] [Accepted: 09/18/2022] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Drug-resistant epilepsy can be difficult to cure and may pose emotional challenges for epilepsy providers. Neuropalliative care (NPC) can augment quality of life (QOL) in persons with neurological diseases and may add meaningful elements to the treatment repertoire of epilepsy specialists even if seizures continue. However, NPC has not been widely implemented in epilepsy. Our study aimed to determine whether physicians of persons with drug-resistant epilepsy (PWDRE) experience distress when faced with treatment failure (Engel class ≥ 2), either failure of medications-only (PWDREmo) or of both medications and surgery (procedures with curative intent (PWDREms)). Furthermore, we evaluated physician knowledge about and referrals to NPC following treatment failures to help improve patient QOL despite ongoing seizures. METHODS An anonymous online survey was distributed to US epilepsy physicians through the American Epilepsy Society website and personal email to assess levels of distress experienced when caring for PWDREmo and PWDREms (7-point Likert scale ["1" = "no distress", "7" = "most distress ever felt"]), and knowledge and use of NPC. RESULTS Eighty-two physicians completed the survey. Most experienced distress when epilepsy treatments failed: 59% felt moderate distress (≥4) with PWDREmo (median "4", mean 3.74, range 1-7), 90% suffered moderate to severe distress (5, 5.17, 1-7) with PWDREms. Distress over PWDREms was significantly greater than distress over PWDREmo (p < 0.0001). Forty-three percent reported confidence in their knowledge about NPC. Only 15% were likely to refer PWDREmo to NPC, while 44% would consider it for PWDREms. CONCLUSION Among survey responders, physician distress was high when confronted with treatment failures, especially the failure of epilepsy surgery. Fewer than half of responders were likely to refer patients to NPC. Further research is necessary to determine extent, reasons, and effects of physician distress and whether improved understanding of and patient access to NPC would help alleviate physician distress when faced with treatment failures in PWDRE.
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Affiliation(s)
- Cornelia Drees
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Mayo Clinic Arizona, Phoenix, United States(3).
| | - Alison M Hixon
- Department of Neurology, University of Colorado, Denver, United States(2); Barnes-Jewish Hospital, Washington University, St. Louis, United States(3).
| | - Stefan Sillau
- Department of Neurology, University of Colorado, Denver, United States(2).
| | | | - Mark Spitz
- Department of Neurology, University of Colorado, Denver, United States(2).
| | - Ryan Mohler
- Department of Neurology, University of Colorado, Denver, United States(2)
| | - Christine Baca
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Virginia Commonwealth University, Richmond, United States(3).
| | - Kirsten Fetrow
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Denver, United States(3).
| | - Mesha-Gay Brown
- Department of Neurology, University of Colorado, Denver, United States(2); Department of Neurology, Centura Health, Denver, United States(3).
| | - Christina Vaughan
- Department of Neurology, University of Colorado, Denver, United States(2).
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Ilyas A, Alamoudi OA, Riley KO, Pati S. Pro-Ictal State in Human Temporal Lobe Epilepsy. NEJM EVIDENCE 2023; 2:EVIDoa2200187. [PMID: 38320014 DOI: 10.1056/evidoa2200187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: Studies of continuous electroencephalography (EEG) suggest that seizures in individuals with focal-onset epilepsies preferentially occur during periods of heightened risk, typified by pathologic brain activities, termed pro-ictal states; however, the presence of (pathologic) pro-ictal states among a plethora of otherwise physiologic (e.g., sleep–wake cycle) states has not been established. METHODS: We studied a prospective, consecutive series of 15 patients with temporal lobe epilepsy who underwent limbic thalamic recordings in addition to routine (cortical) intracranial EEG for seizure localization. For each participant, pro-ictal (45 minutes before seizure onset) and interictal (4 hours removed from all seizures) EEG segments were divided into 10-minute, nonoverlapping windows, which were randomly distributed into training and validation cohorts in a 1:1 ratio. A deep neural classifier was applied to distinguish pro-ictal from interictal brain activities in a patient-specific fashion. RESULTS: We analyzed 1800 patient-hours of continuous thalamocortical EEG. Distinct pro-ictal states were detected in each participant. The median area under the receiver-operating characteristic curve of the classifier was 0.92 (interquartile range, 0.90–0.96). Pro-ictal states were distinguished at least 45 minutes before seizure onset in 13 of 15 participants; in 2 of 15 participants, they were distinguished up to 35 minutes prior. CONCLUSIONS: On the basis of thalamocortical EEG, pro-ictal states — pathologic brain activities during periods of heightened seizure risk — could be identified in patients with temporal lobe epilepsy and were detected, in our small sample, more than one half hour before seizure onset.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School at UTHealth Houston, Houston
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
| | - Omar A Alamoudi
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston
- Department of Biomedical Engineering, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kristen O Riley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Sandipan Pati
- Texas Institute for Restorative Neurotechnologies, UTHealth Houston, Houston
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston
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Roberts-West L, Vivekananda U, Baxendale S. Anhedonia in epilepsy. Epilepsy Behav 2023; 140:108966. [PMID: 36443164 DOI: 10.1016/j.yebeh.2022.108966] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anhedonia, the impaired ability to experience pleasure, is a core feature of major depressive disorder, one of the most common comorbidities in epilepsy. It is also reported as a clinical feature independent of depression in a number of other neurological conditions. This study aimed to establish the prevalence of anhedonia in a sample of people with epilepsy, with and without a diagnosis of depression, and to examine the clinical and demographic characteristics of those who present with this symptom. METHODS A consecutive sample of 211 people (118 female, 93 male, mean age 38.09 years) completed the Snaith-Hamilton Pleasure Scale (SHAPS) to determine the presence of anhedonia and the Hospital Anxiety and Depression Scale to determine levels of anxiety and depression. The majority of patients had focal epilepsy (n = 165), and the remaining patients had generalized epilepsy (n = 22), or unclassified epilepsy (n = 24). Sixteen percent of the sample had a clinical diagnosis of depression at the time of the study. RESULTS Over one in three of the sample (35%) reported significant anhedonia on the SHAPS. While these patients were more likely to have a diagnosis of depression (p < 0.01), 30% of people without a diagnosis of depression also reported significant anhedonia. Difficulties gaining pleasure on 12 of the 14 items on the SHAPS were associated with cognitive difficulties, with those reporting an inability to feel pleasure on the item scoring significantly lower on tests of cognitive function than those who were able to gain pleasure. Of the three cognitive domains examined (overall intellectual ability, verbal memory, and processing speed), a poor memory had the strongest relationship; with lower memory function associated with an impaired ability to experience pleasure on 9 of the 14 items. CONCLUSION While anhedonia is well recognized as a feature of depression, our data suggests that it can be present in up to a third of people with epilepsy who do not have a diagnosis of depression. Cognitive difficulties, particularly impaired memory function may mediate some features of anhedonia. The implications of these findings for the clinical management of anhedonia in people with epilepsy are discussed.
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Affiliation(s)
| | - Umesh Vivekananda
- University College Hospital, London, United Kingdom; Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, United Kingdom
| | - Sallie Baxendale
- University College Hospital, London, United Kingdom; Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, United Kingdom.
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Varvel NH, Amaradhi R, Espinosa-Garcia C, Duddy S, Franklin R, Banik A, Alemán-Ruiz C, Blackmer-Raynolds L, Wang W, Honore T, Ganesh T, Dingledine R. Preclinical development of an EP2 antagonist for post-seizure cognitive deficits. Neuropharmacology 2023; 224:109356. [PMID: 36460083 PMCID: PMC9894535 DOI: 10.1016/j.neuropharm.2022.109356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
Cognitive comorbidities can substantially reduce quality of life in people with epilepsy. Inflammation is a component of all chronic diseases including epilepsy, as well as acute events like status epilepticus (SE). Neuroinflammation is the consequence of several broad signaling cascades including cyclooxygenase-2 (COX-2)-associated pathways. Activation of the EP2 receptor for prostaglandin E2 appears responsible for blood-brain barrier leakage and much of the inflammatory reaction, neuronal injury and cognitive deficit that follows seizure-provoked COX-2 induction in brain. Here we show that brief exposure of mice to TG11-77, a potent, selective, orally available and brain permeant EP2 antagonist, eliminates the profound cognitive deficit in Y-maze performance after SE and reduces delayed mortality and microgliosis, with a minimum effective i.p. dose (as free base) of 8.8 mg/kg. All in vitro studies required to submit an investigational new drug (IND) application for TG11-77 have been completed, and non-GLP dose range-finding toxicology in the rat identified no overt, organ or histopathology signs of toxicity after 7 days of oral administration at 1000 mg/kg/day. Plasma exposure in the rat was dose-linear between 15 and 1000 mg/kg dosing. TG11-77 thus appears poised to continue development towards the initial clinical test of the hypothesis that EP2 receptor modulation after SE can provide the first preventive treatment for one of the chief comorbidities of epilepsy.
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Affiliation(s)
- Nicholas H Varvel
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Radhika Amaradhi
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Claudia Espinosa-Garcia
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Steven Duddy
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Ronald Franklin
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Avijit Banik
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Carlos Alemán-Ruiz
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Lisa Blackmer-Raynolds
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Wenyi Wang
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Tage Honore
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia
| | - Thota Ganesh
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia.
| | - Raymond Dingledine
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, Georgia.
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Bertoncello KT, Bonan CD. The Effect of Adenosine Signaling on Memory Impairment Induced by Pentylenetetrazole in Zebrafish. Neurochem Res 2023; 48:1889-1899. [PMID: 36729312 DOI: 10.1007/s11064-023-03867-2] [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: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
Epilepsy is characterized by the manifestation of spontaneous and recurrent seizures. The high prevalence of comorbidities associated with epilepsy, such as cognitive dysfunction, affects the patients quality of life. Adenosine signaling modulation might be an effective alternative to control seizures and epilepsy-associated comorbidities. This study aimed to verify the role of adenosine modulation on the seizure development and cognitive impairment induced by pentylenetetrazole (PTZ) in zebrafish. At first, animals were submitted to a training session in the inhibitory avoidance test and, after 10 min, they received an intraperitoneal injection of valproate, adenosine A1 receptor agonist cyclopentyladenosine (CPA), adenosine A1 receptor antagonist 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), adenosine A2A receptor antagonist ZM 241385, adenosine deaminase inhibitor erythro-9-(2-hydroxy-3-nony1)-adenine hydrochloride (EHNA) or the nucleoside transporter inhibitor dipyridamole. Thirty min after the intraperitoneal injection, the animals were exposed to 7.5 mM PTZ for 10 min, where they were evaluated for latency to reach the seizure stages (I, II, and III). Finally, 24 h after the training session, the animals were submitted to the inhibitory avoidance test to verify their cognitive performance during the test session. Valproate, CPA, and EHNA showed antiseizure effects and prevented the memory impairment induced by PTZ exposure. DPCPX, ZM 241385, and dipyridamole pretreatments caused no changes in seizure development; however, these drugs prevented memory impairment without altering locomotion. Our results reinforce the antiseizure effects of adenosine signaling and support the idea that the involvement of adenosine in memory processes may be a target for preventive strategies against cognitive impairment associated with epilepsy.
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Affiliation(s)
- Kanandra Taisa Bertoncello
- Laboratório de Neuroquímica e Psicofarmacologia, Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carla Denise Bonan
- Laboratório de Neuroquímica e Psicofarmacologia, Programa de Pós-Graduação em Biologia Celular e Molecular, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil. .,Programa de Pós-Graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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