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Zhou Z, Gong P, Jiao X, Niu Y, Xu Z, Qin J, Yang Z. A generalized seizure type: Myoclonic-to-tonic seizure. Clin Neurophysiol 2024; 164:24-29. [PMID: 38823261 DOI: 10.1016/j.clinph.2024.04.011] [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: 11/30/2023] [Revised: 03/31/2024] [Accepted: 04/13/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND PURPOSE To test the hypothesis that myoclonic seizures can evolve to tonic seizures, we documented the electroclinical features of this under-recognized seizure type. METHODS We observed a distinct seizure pattern starting with myoclonus without returning to an interictal state, which subsequently evolved into generalized tonic seizures. The detailed symptomatic and electroencephalographic characteristics of this seizure were extracted, and the clinical manifestations, drug curative responses in patients with this seizure were reviewed and analyzed. RESULTS The onset of all seizures was characterized by a preceding period of myoclonus and bursts of generalized spike or poly-spike slow wave discharges with high amplitude. This was closely followed by the occurrence of tonic seizures, which were distinguished by bursts of generalized fast activity at 10 Hz or higher frequency. This under-recognized seizure type has been designated as myoclonic-to-tonic (MT) seizure. The number of patients identified with MT seizures in this study was 34. The prevalence rate of MT seizures was found to be higher in males. While MT seizures typically included a tonic component, it should be noted that some patients experiencing this seizure type never presented with isolated tonic seizures. Generalized Epilepsy not further defined (GE) accounted for approximately one-third of the diagnosed cases, followed by Lennox-Gastaut syndrome and Epilepsy with Myoclonic-Atonic seizures. In comparison to other types of epilepsy, GE with MT seizures demonstrated a more favorable prognosis. CONCLUSIONS The classification of myoclonic-to-tonic seizure represents a novel approach in comprehending the ictogenesis of generalized seizures and can provide valuable assistance to clinicians in epilepsy diagnosis.
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Affiliation(s)
- Zongpu Zhou
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Yue Niu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Zhao Xu
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University People's Hospital, Beijing, China; Epilepsy Center, Peking University People's Hospital, Beijing, China.
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Peña-Ceballos J, Moloney PB, Kilbride RD, Naggar HE, Widdess-Walsh P, Delanty N. Oligoepilepsy and lifelong seizure susceptibility in epilepsy with generalized tonic-clonic seizures alone: Experience at an adult tertiary center. Epilepsy Res 2024; 202:107362. [PMID: 38652996 DOI: 10.1016/j.eplepsyres.2024.107362] [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: 02/23/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Epilepsy with generalized tonic-clonic seizures alone (GTCA) is the least studied syndrome within the idiopathic generalized epilepsy (IGE) spectrum. We characterize a large cohort of adult patients with GTCA to understand natural history and drug responsiveness. METHODS In this retrospective single-center study using our epilepsy electronic record, we evaluated clinical characteristics, seizure outcomes, anti-seizure medication (ASM) response including seizure recurrence after ASM withdrawal, and sex differences in a cohort of GTCA patients aged ≥17 years. RESULTS Within a cohort of 434 IGE patients, 87 patients (20 %) with GTCA were included. The mean age was 34.9 years (range 17-73 years). Forty-six patients (52.8 %) were females. Seventy-two patients (82.8 %) were seizure-free and 15 (17.2 %) had active epilepsy over the previous 12 months. Thirty-four patients (39.1 %) had ≤5 lifetime seizures, aligning with a prior definition of 'oligoepilepsy'. Sixty-five patients (74.7 %) were treated with monotherapy, 19 (21.8 %) were treated with polytherapy, and three were not taking any ASM. Levetiracetam (37.9 %) was the most commonly prescribed ASM, followed by lamotrigine (32.1 %) and valproate (31 %). Seventeen patients (19.5 %) attempted to withdraw their ASM. The rate of seizure recurrence after ASM withdrawal was 88.2 % (15/17), including two patients who relapsed more than 20 years after ASM discontinuation. Females had more seizures in their lifetime and had trialed more ASM compared to males. SIGNIFICANCE GTCA has a relatively good prognosis, with most patients becoming seizure-free on monotherapy. The high rate of seizure recurrence after ASM withdrawal supports lifetime seizure susceptibility. We found potential sex differences in seizure outcomes and ASM response, although further research is needed to validate this finding.
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Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | | | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | | | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
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Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Rosati E, Catania C, Ferlazzo E, Casciato S, Di Gennaro G, Pizzanelli C, Giuliano L, Viola V, Mostacci B, Pignatta P, Fortunato F, Pulitano P, Panzini C, Gambardella A, Atalar AÇ, Labate A, Operto FF, Giallonardo AT, Baykan BB, Beier CP, Di Bonaventura C. Predictors of Seizure Recurrence in Women With Idiopathic Generalized Epilepsy Who Switch From Valproate to Another Medication. Neurology 2024; 102:e209222. [PMID: 38569127 DOI: 10.1212/wnl.0000000000209222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the predictors of seizure recurrence in women of childbearing age with idiopathic generalized epilepsy (IGE) who switched from valproate (VPA) to alternative antiseizure medications (ASMs) and compare the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) as VPA alternatives after switch. METHODS This multicenter retrospective study included women of childbearing age diagnosed with IGE from 16 epilepsy centers. Study outcomes included worsening or recurrence of generalized tonic-clonic seizure (GTCS) at 12 months and 24 months after the switch from VPA to an alternative ASM. The comparative effectiveness of LEV and LTG as alternative ASM following VPA discontinuation was assessed through inverse probability treatment-weighted (IPTW) Cox regression analysis. RESULTS We included 426 women with IGE, with a median (interquartile range) age at VPA switch of 24 (19-30) years and a median VPA dosage of 750 (500-1,000) mg/d. The most common reason for VPA switch was teratogenicity concern in 249 women (58.6%), and the most common ASM used in place of VPA was LEV in 197 (46.2%) cases, followed by LTG in 140 (32.9%). GTCS worsening/recurrence occurred in 105 (24.6%) and 139 (32.6%) women at 12 and 24 months, respectively. Catamenial worsening of seizures, higher VPA dosage during switch, multiple seizure types, and shorter duration of GTCS freedom before switch were independent predictors of GTCS recurrence or worsening at 12 months according to mixed multivariable logistic regression analysis. After internal-external validation through 16 independent cohorts, the model showed an area under the curve of 0.71 (95% CI 0.64-0.77). In the subgroup of 337 women who switched to LEV or LTG, IPTW Cox regression analysis showed that LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG (adjusted hazard ratio 0.59, 95% CI 0.40-0.87, p = 0.008) during the 24-month follow-up. DISCUSSION Our findings can have practical implications for optimizing counselling and treatment choices in women of childbearing age with IGE and may help clinicians in making informed treatment decisions in this special population of patients. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for women with IGE switching from VPA, LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG.
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Affiliation(s)
- Emanuele Cerulli Irelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Enrico Cocchi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Alessandra Morano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Joanna Gesche
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Roberto H Caraballo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Simona Lattanzi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Gionata Strigaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Eleonora Rosati
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Cecilia Catania
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Edoardo Ferlazzo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Sara Casciato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Giancarlo Di Gennaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Pizzanelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Loretta Giuliano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Veronica Viola
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Barbara Mostacci
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Pietro Pignatta
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesco Fortunato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Patrizia Pulitano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Panzini
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Antonio Gambardella
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Arife Çimen Atalar
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Angelo Labate
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesca Felicia Operto
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Anna T Giallonardo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Betül B Baykan
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Christoph P Beier
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Carlo Di Bonaventura
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
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Fayad C, Saad K, Kahwagi GJ, Hallit S, Griffin D, Abou-Khalil R, El-Hayek E. A systematic review and meta-analysis of factors related to first line drugs refractoriness in patients with juvenile myoclonic epilepsy (JME). PLoS One 2024; 19:e0300930. [PMID: 38593118 PMCID: PMC11003615 DOI: 10.1371/journal.pone.0300930] [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: 10/24/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Juvenile Myoclonic Epilepsy (JME) is a prevalent form of epileptic disorder, specifically categorized within the realm of Genetic Generalized Epilepsy (GGE). Its hallmark features encompass unprovoked bilateral myoclonus and tonic-clonic seizures that manifest during adolescence. While most JME patients respond favorably to anti-seizure medication (ASM), a subset experiences refractory JME, a condition where seizures persist despite rigorous ASM treatment, often termed "Drug-Resistant Epilepsy" (DRE). This systematic review and meta-analysis aims to determine the prevalence of refractory JME, and further to identify socio-demographic, electrophysiological and clinical risk factors associated with its occurrence. Pinpointing these factors is crucial as it offers the potential to predict ASM responsiveness, enabling early interventions and tailored care strategies for patients. MATERIAL AND METHODS The systematic review and meta-analysis followed the Cochrane Handbook and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study evaluated outcomes post ASM treatment in JME cohorts by searching papers published up to September 2023 in PubMed/MEDLINE, Scopus, and Google Scholar databases. Predefined inclusion criteria were met by 25 eligible studies, forming the basis for analysis. RESULTS A total of 22 potential risk factors for refractory JME were documented. Notably, robust risk factors for treatment resistance included Psychiatric Disorder (Odds Ratio (OR), 3.42 [2.54, 4.61] (95% Confidence Inverval (Cl)), Febrile Seizures (OR, 1.83 [1.14, 2.96] (95% Cl)), Alcohol Consumption (OR, 16.86 [1.94, 146.88] (95%Cl)), Aura (OR, 2.15 [1.04, 4.47] (95%Cl)), childhood absence epilepsy (CAE) evolving into JME (OR, 4.54 [1.61, 12.78] (95%CI)), occurrence of three seizure types (OR, 2.96 [1.96, 4.46] (95%CI)), and Focal EEG abnormalities (OR, 1.85 [1.13, 3.01] (95%Cl)). In addition, there were some non-significant risk factors for DRE because of noticeable heterogeneity. CONCLUSION In aggregate, over 36% of JME patients demonstrated drug resistance, with seven significant risk factors closely linked to this refractoriness. The interplay between these factors and whether they denote treatment non-response or heightened disease burden remains an open question and more studies would be required to fully examine their influence.
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Affiliation(s)
- Claire Fayad
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Kely Saad
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Georges-Junior Kahwagi
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Darren Griffin
- School of Biosciences, University of Kent, Canterbury, United Kingdom
| | - Rony Abou-Khalil
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
| | - Elissar El-Hayek
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kaslik-Jounieh, Lebanon
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Nica A. Drug-resistant juvenile myoclonic epilepsy: A literature review. Rev Neurol (Paris) 2024; 180:271-289. [PMID: 38461125 DOI: 10.1016/j.neurol.2024.02.385] [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: 11/18/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 03/11/2024]
Abstract
The ILAE's Task Force on Nosology and Definitions revised in 2022 its definition of juvenile myoclonic epilepsy (JME), the most common idiopathic generalized epilepsy disorder, but this definition may well change again in the future. Although good drug response could almost be a diagnostic criterion for JME, drug resistance (DR) is observed in up to a third of patients. It is important to distinguish this from pseudoresistance, which is often linked to psychosocial problems or psychiatric comorbidities. After summarizing these aspects and the various definitions applied to JME, the present review lists the risk factors for DR-JME that have been identified in numerous studies and meta-analyses. The factors most often cited are absence seizures, young age at onset, and catamenial seizures. By contrast, photosensitivity seems to favor good treatment response, at least in female patients. Current hypotheses on DR mechanisms in JME are based on studies of either simple (e.g., cortical excitability) or more complex (e.g., anatomical and functional connectivity) neurophysiological markers, bearing in mind that JME is regarded as a neural network disease. This research has revealed correlations between the intensity of some markers and DR, and above all shed light on the role of these markers in associated neurocognitive and neuropsychiatric disorders in both patients and their siblings. Studies of neurotransmission have mainly pointed to impaired GABAergic inhibition. Genetic studies have generally been inconclusive. Increasing restrictions have been placed on the use of valproate, the standard antiseizure medication for this syndrome, owing to its teratogenic and developmental risks. Levetiracetam and lamotrigine are prescribed as alternatives, as is vagal nerve stimulation, and there are several other promising antiseizure drugs and neuromodulation methods. The development of better alternative treatments is continuing to take place alongside advances in our knowledge of JME, as we still have much to learn and understand.
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Affiliation(s)
- A Nica
- Epilepsy Unit, Reference Center for Rare Epilepsies, Neurology Department, Clinical Investigation Center 1414, Rennes University Hospital, Rennes, France; Signal and Image Processing Laboratory (LTSI), INSERM, Rennes University, Rennes, France.
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6
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [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: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Acar D, Ozcelik EU, Baykan B, Bebek N, Demiralp T, Bayram A. Diffusion tensor imaging in photosensitive and nonphotosensitive juvenile myoclonic epilepsy. Seizure 2024; 115:36-43. [PMID: 38183826 DOI: 10.1016/j.seizure.2023.12.015] [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: 05/22/2023] [Revised: 11/27/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION/BACKGROUND Juvenile myoclonic epilepsy (JME) syndrome is known to cause alterations in brain structure and white matter integrity. The study aimed to determine structural white matter changes in patients with JME and to reveal the differences between the photosensitive (PS) and nonphotosensitive (NPS) subgroups by diffusion tensor imaging (DTI) using the tract-based spatial statistics (TBSS) method. METHODS This study included data from 16 PS, 15 NPS patients with JME, and 41 healthy participants. The mean fractional anisotropy (FA) values of these groups were calculated, and comparisons were made via the TBSS method over FA values in the whole-brain and 81 regions of interest (ROI) obtained from the John Hopkins University White Matter Atlas. RESULTS In the whole-brain TBSS analysis, no significant differences in FA values were observed in pairwise comparisons of JME patient group and subgroups with healthy controls (HCs) and in comparison between JME subgroups. In ROI-based TBSS analysis, an increase in FA values of right anterior corona radiata and left corticospinal pathways was found in JME patient group compared with HC group. When comparing JME-PS patients with HCs, an FA increase was observed in the bilateral anterior corona radiata region, whereas when comparing JME-NPS patients with HCs, an FA increase was observed in bilateral corticospinal pathway. Moreover, in subgroup comparison, an increase in FA values was noted in corpus callosum genu region in JME-PS compared with JME-NPS. CONCLUSIONS Our results support the disruption in thalamofrontal white matter integrity in JME, and subgroups and highlight the importance of using different analysis methods to show the underlying microstructural changes.
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Affiliation(s)
- Dilan Acar
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye; Hulusi Behçet Life Sciences Research Laboratory, Istanbul University, Istanbul, Türkiye
| | - Emel Ur Ozcelik
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye; Department of Neurology, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye.
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye; Department of Neurology, Istanbul EMAR Medical Center, Istanbul, Türkiye
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Tamer Demiralp
- Department of Physiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ali Bayram
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye; Hulusi Behçet Life Sciences Research Laboratory, Istanbul University, Istanbul, Türkiye
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El-Sharkawy OS, El-Rashidy OF, Elagouza IAA, Nassar BA, Taha SI. The beneficial effect of probiotics as an adjuvant treatment in childhood drug resistant epilepsy: A prospective pilot study. Int J Immunopathol Pharmacol 2024; 38:3946320241291276. [PMID: 39370908 DOI: 10.1177/03946320241291276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND One of the most common long-term neurological disorders affecting children is epilepsy. Even with effective antiseizure medications, one-third of epileptic patients develop drug-resistant epilepsy (DRE). Numerous treatments have been offered to these DRE patients, though with varying degrees of effectiveness. OBJECTIVES This study aimed to evaluate the effectiveness of probiotics in improving the quality of life (QoL) and lowering the severity and frequency of epileptic episodes in DRE patients. As well as to assess the anti-inflammatory effects of probiotics. METHODS DRE patients were daily supplemented with one probiotic for 4 months. During these 4 months, patients continued their routine anti-epileptics with no change in the doses. Before and following the 4-month trial, patients had their QoL evaluated using the validated Arabic version of QoL in epilepsy-31 inventory (QoLIE-31) questionnaire, an electroencephalogram (EEG) examination, and serum soluble CD14 (sCD14) evaluation by ELISA. RESULTS Of the 21 DRE patients who completed the study, 42.9% achieved the therapeutic goal, which was a ≥50% reduction in seizures. After probiotic, there was a significant increase in time elapsed since the last seizure (p = 0.001) and a decrease in seizure duration (p = 0.038), frequency (p = 0.002), and severity by Chalfont Seizure Severity Score (p < 0.001), as compared to pre-probiotic data. Moreover, there was a significant decrease in serum levels of sCD14 (p < 0.001) and a significant improvement in QoL (p < 0.05). CONCLUSION Probiotics may be used as a DRE adjuvant treatment. They can lessen the number and severity of seizures, alleviate the associated inflammation, and enhance the QoL for DRE patients.
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Affiliation(s)
| | | | | | | | - Sara I Taha
- Department of Clinical Pathology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Peña-Ceballos J, Moloney PB, Valentin A, O'Donnell C, Colleran N, Liggan B, Staunton-Grufferty B, Ennis P, Grogan R, Mullins G, Costello DJ, Doherty CP, Sweeney KJ, El Naggar H, Kilbride RD, Widdess-Walsh P, O'Brien D, Delanty N. Vagus nerve stimulation in refractory idiopathic generalised epilepsy: An Irish retrospective observational study. Seizure 2023; 112:98-105. [PMID: 37778300 DOI: 10.1016/j.seizure.2023.09.019] [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: 06/09/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE Refractory idiopathic generalised epilepsy (IGE; also known as genetic generalised epilepsy) is a clinical challenge due to limited available therapeutic options. While vagus nerve stimulation (VNS) is approved as an adjunctive treatment for drug-resistant focal epilepsy, there is limited evidence supporting its efficacy for refractory IGE. METHODS We conducted a single-centre retrospective analysis of adult IGE patients treated with VNS between January 2003 and January 2022. We analysed the efficacy, safety, tolerability, stimulation parameters and potential clinical features of VNS response in this IGE cohort. RESULTS Twenty-three IGE patients were implanted with VNS between January 2003 and January 2022. Twenty-two patients (95.65%) were female. The median baseline seizure frequency was 30 per month (interquartile range [IQR]= 140), including generalised tonic-clonic seizures (GTCS), absences, myoclonus, and eyelid myoclonia with/without absences. The median number of baseline anti-seizure medications (ASM) was three (IQR= 2). Patients had previously failed a median of six ASM (IQR= 5). At the end of the study period, VNS therapy remained active in 17 patients (73.9%). amongst patients who continued VNS, thirteen (56.5% of the overall cohort) were considered responders (≥50% seizure frequency reduction). Amongst the clinical variables analysed, only psychiatric comorbidity correlated with poorer seizure outcomes, but was non-significant after applying the Bonferroni correction. Although 16 patients reported side-effects, none resulted in the discontinuation of VNS therapy. SIGNIFICANCE Over half of the patients with refractory IGE experienced a positive response to VNS therapy. VNS represents a viable treatment option for patients with refractory IGE, particularly for females, when other therapeutic options have been exhausted.
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Affiliation(s)
| | - Patrick B Moloney
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Cara O'Donnell
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Niamh Colleran
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Brenda Liggan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | | | - Patricia Ennis
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Roger Grogan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Gerard Mullins
- Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Daniel J Costello
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, Cork University Hospital, Cork, Ireland
| | - Colin P Doherty
- FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland; Department of Neurology, St. James's Hospital, Dublin, Ireland; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Hany El Naggar
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland
| | - Ronan D Kilbride
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Peter Widdess-Walsh
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland
| | - Donncha O'Brien
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Norman Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland; FutureNeuro, the Science Foundation Ireland Research Centre for Chronic and Rare Neurological Diseases, Dublin, Ireland.
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10
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Roshandel D, Sanders EJ, Shakeshaft A, Panjwani N, Lin F, Collingwood A, Hall A, Keenan K, Deneubourg C, Mirabella F, Topp S, Zarubova J, Thomas RH, Talvik I, Syvertsen M, Striano P, Smith AB, Selmer KK, Rubboli G, Orsini A, Ng CC, Møller RS, Lim KS, Hamandi K, Greenberg DA, Gesche J, Gardella E, Fong CY, Beier CP, Andrade DM, Jungbluth H, Richardson MP, Pastore A, Fanto M, Pal DK, Strug LJ. SLCO5A1 and synaptic assembly genes contribute to impulsivity in juvenile myoclonic epilepsy. NPJ Genom Med 2023; 8:28. [PMID: 37770509 PMCID: PMC10539321 DOI: 10.1038/s41525-023-00370-z] [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: 03/27/2023] [Accepted: 08/29/2023] [Indexed: 09/30/2023] Open
Abstract
Elevated impulsivity is a key component of attention-deficit hyperactivity disorder (ADHD), bipolar disorder and juvenile myoclonic epilepsy (JME). We performed a genome-wide association, colocalization, polygenic risk score, and pathway analysis of impulsivity in JME (n = 381). Results were followed up with functional characterisation using a drosophila model. We identified genome-wide associated SNPs at 8q13.3 (P = 7.5 × 10-9) and 10p11.21 (P = 3.6 × 10-8). The 8q13.3 locus colocalizes with SLCO5A1 expression quantitative trait loci in cerebral cortex (P = 9.5 × 10-3). SLCO5A1 codes for an organic anion transporter and upregulates synapse assembly/organisation genes. Pathway analysis demonstrates 12.7-fold enrichment for presynaptic membrane assembly genes (P = 0.0005) and 14.3-fold enrichment for presynaptic organisation genes (P = 0.0005) including NLGN1 and PTPRD. RNAi knockdown of Oatp30B, the Drosophila polypeptide with the highest homology to SLCO5A1, causes over-reactive startling behaviour (P = 8.7 × 10-3) and increased seizure-like events (P = 6.8 × 10-7). Polygenic risk score for ADHD genetically correlates with impulsivity scores in JME (P = 1.60 × 10-3). SLCO5A1 loss-of-function represents an impulsivity and seizure mechanism. Synaptic assembly genes may inform the aetiology of impulsivity in health and disease.
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Affiliation(s)
- Delnaz Roshandel
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Eric J Sanders
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Amy Shakeshaft
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Naim Panjwani
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Fan Lin
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Amber Collingwood
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anna Hall
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Keenan
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
| | - Celine Deneubourg
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Filippo Mirabella
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Topp
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | | | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo, Norway
| | - Pasquale Striano
- IRCCS Istituto 'G. Gaslini', Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Anna B Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Alessandro Orsini
- Pediatric Neurology, Azienda Ospedaliero-Universitaria Pisana, Pisa University Hospital, Pisa, Italy
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Rikke S Møller
- Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khalid Hamandi
- The Welsh Epilepsy Unit, Department of Neurology Cardiff & Vale University Health Board, Cardiff, UK
- Department of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | | | - Elena Gardella
- Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto, Canada
| | - Heinz Jungbluth
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Mark P Richardson
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's College Hospital, London, UK
| | - Annalisa Pastore
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Manolis Fanto
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deb K Pal
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
- King's College Hospital, London, UK.
| | - Lisa J Strug
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada.
- Division of Biostatistics, Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada.
- Departments of Statistical Sciences and Computer Science, The University of Toronto, Toronto, Canada.
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Canada.
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11
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Nakamura Y, Sakurai K, Ishikawa S, Horinouchi T, Hashimoto N, Kusumi I. Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy. Epilepsy Behav 2023; 145:109345. [PMID: 37441983 DOI: 10.1016/j.yebeh.2023.109345] [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: 04/11/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with epilepsy (PWE), especially those with Idiopathic Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. METHODS This was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as "not showing up for the day of an appointment without prior notice." Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. RESULTS Of the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17-3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22-3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43-0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13-0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04-0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14-0.72; p = 0.006). CONCLUSIONS GE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.
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Affiliation(s)
- Yuichi Nakamura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan.
| | - Kotaro Sakurai
- Department of Neuropsychiatry, Aichi Medical University, 1-1, Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Toru Horinouchi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
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12
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Laskar S, Chaudhry N, Choudhury C, Garg D. Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study. J Neurosci Rural Pract 2023; 14:482-487. [PMID: 37692809 PMCID: PMC10483207 DOI: 10.25259/jnrp_34_2023] [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: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. Materials and Methods This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. Results We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Conclusion Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.
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Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neera Chaudhry
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Cankatika Choudhury
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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13
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Rubboli G, Beier CP, Selmer KK, Syvertsen M, Shakeshaft A, Collingwood A, Hall A, Andrade DM, Fong CY, Gesche J, Greenberg DA, Hamandi K, Lim KS, Ng CC, Orsini A, Striano P, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Variation in prognosis and treatment outcome in juvenile myoclonic epilepsy: a Biology of Juvenile Myoclonic Epilepsy Consortium proposal for a practical definition and stratified medicine classifications. Brain Commun 2023; 5:fcad182. [PMID: 37361715 PMCID: PMC10288558 DOI: 10.1093/braincomms/fcad182] [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: 10/01/2022] [Revised: 03/21/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Reliable definitions, classifications and prognostic models are the cornerstones of stratified medicine, but none of the current classifications systems in epilepsy address prognostic or outcome issues. Although heterogeneity is widely acknowledged within epilepsy syndromes, the significance of variation in electroclinical features, comorbidities and treatment response, as they relate to diagnostic and prognostic purposes, has not been explored. In this paper, we aim to provide an evidence-based definition of juvenile myoclonic epilepsy showing that with a predefined and limited set of mandatory features, variation in juvenile myoclonic epilepsy phenotype can be exploited for prognostic purposes. Our study is based on clinical data collected by the Biology of Juvenile Myoclonic Epilepsy Consortium augmented by literature data. We review prognosis research on mortality and seizure remission, predictors of antiseizure medication resistance and selected adverse drug events to valproate, levetiracetam and lamotrigine. Based on our analysis, a simplified set of diagnostic criteria for juvenile myoclonic epilepsy includes the following: (i) myoclonic jerks as mandatory seizure type; (ii) a circadian timing for myoclonia not mandatory for the diagnosis of juvenile myoclonic epilepsy; (iii) age of onset ranging from 6 to 40 years; (iv) generalized EEG abnormalities; and (v) intelligence conforming to population distribution. We find sufficient evidence to propose a predictive model of antiseizure medication resistance that emphasises (i) absence seizures as the strongest stratifying factor with regard to antiseizure medication resistance or seizure freedom for both sexes and (ii) sex as a major stratifying factor, revealing elevated odds of antiseizure medication resistance that correlates to self-report of catamenial and stress-related factors including sleep deprivation. In women, there are reduced odds of antiseizure medication resistance associated with EEG-measured or self-reported photosensitivity. In conclusion, by applying a simplified set of criteria to define phenotypic variations of juvenile myoclonic epilepsy, our paper proposes an evidence-based definition and prognostic stratification of juvenile myoclonic epilepsy. Further studies in existing data sets of individual patient data would be helpful to replicate our findings, and prospective studies in inception cohorts will contribute to validate them in real-world practice for juvenile myoclonic epilepsy management.
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Affiliation(s)
- Guido Rubboli
- Danish Epilepsy Centre, Filadelfia, Dianalund 4293, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo 0372, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo 1337, Norway
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo 3004, Norway
| | - Amy Shakeshaft
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
| | - Amber Collingwood
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Anna Hall
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Danielle M Andrade
- Adult Epilepsy Genetics Program, Krembil Research Institute, University of Toronto, Toronto M5T 0S8, Canada
| | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense 5000, Denmark
| | - David A Greenberg
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus 43215, USA
| | - Khalid Hamandi
- Department of Neurology, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Ching Ching Ng
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pisa University Hospital, Pisa 56126, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto ‘G. Gaslini’, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova 16132, Italy
| | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Jana Zarubova
- Department of Neurology, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
- Motol University Hospital, Prague 150 06, Czech Republic
| | - Mark P Richardson
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Lisa J Strug
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto M5G 1X8, Canada
- Departments of Statistical Sciences and Computer Science and Division of Biostatistics, The University of Toronto, Toronto M5G 1Z5, Canada
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London SW1H 9NA, UK
- School of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
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14
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Jeppesen JM, Sandvei CM, Beier CP, Gesche J. Neuropsychological profile and drug treatment response in Idiopathic Generalized Epilepsy. Seizure 2023; 109:12-17. [PMID: 37178660 DOI: 10.1016/j.seizure.2023.04.021] [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: 03/03/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The endophenotype of Idiopathic Generalized Epilepsies (IGE) comprises distinct neuropsychological deficits compared to normal controls. It is unknown if the severity of features of the endophenotype correlates with resistance to anti-seizure medication. Therefore, we here studied the association of neuropsychological profiles with treatment response. METHODS We evaluated 106 Danish patients aged ≥18 and diagnosed with IGE using a neuropsychological test battery comprising tests for executive dysfunction, visual attention, episodic memory, and verbal comprehension. Tests were complemented by the Purdue Pegboard test. Patients with suspected ongoing psychogenic non-epileptic seizures were excluded. RESULTS At testing, 72 patients were seizure free, and 34 patients had recent seizures despite anti-seizure medication. As compared to age corrected Danish normative values, IGE patients showed significant impairments in semantic fluency and performed significantly worse in the Purdue Pegboard test. The vocabulary subtest of the WAIS-IV suggested lower verbal comprehension in IGE patients. We found no signs of memory impairment. Comparisons between results of the test battery, drug resistance, and the different IGE subsyndromes revealed consistent null-associations in various predefined and exploratory univariate and multivariate analyses. CONCLUSION We here found and confirmed the distinct neuropsychological profile comprising impaired executive functions, reduced psychomotor speed, and normal memory previously described in juvenile myoclonic epilepsy. This profile was, however, not restricted to juvenile myoclonic epilepsy but equally affected all IGE patients. The neuropsychological deficits were not significantly associated with drug treatment outcome.
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Affiliation(s)
| | | | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN - Open Patient Data Explorative Network, Odense, Denmark.
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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15
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Lim SN, Wu T, Tseng WEJ, Chang CW, Hsieh HY, Cheng MY, Chiang HI, Lee CH, Lin WR, Liu CJ. Juvenile Myoclonic Epilepsy: Seizure and Social Outcomes in Taiwan. Healthcare (Basel) 2023; 11:healthcare11081197. [PMID: 37108031 PMCID: PMC10138449 DOI: 10.3390/healthcare11081197] [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: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME.
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Affiliation(s)
- Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Hong Lee
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wey-Ran Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
| | - Chun-Jing Liu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
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Marques VD, Hackbart BA, Guilhoto LM, Duarte JTC, Peixoto-Santos JE, Yacubian EMT, Bittar Guaranha MS. Minimum effective sodium valproate dose in genetic generalized epilepsies. Seizure 2023; 108:53-59. [PMID: 37088055 DOI: 10.1016/j.seizure.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Sodium valproate (VPA) is the most effective antiseizure medication (ASM) in genetic generalized epilepsies (GGEs). However, the frequent adverse effects and the high risk inflicted on the exposed offspring make it imperative to search for the lowest daily VPA dose able to control seizures for most patients. In the current published series, the VPA value of <1000 mg was the most adopted. OBJECTIVE This study aims to provide a cutoff VPA value below which a given daily dose can be considered a low dose in patients with GGEs. METHODS This retrospective, observational cohort study included patients with clinical and electroencephalographic diagnoses of GGEs based on the ILAE criteria. Patients were followed up for at least two years using VPA in mono- or polytherapy. Clinical data, VPA dose, and associated ASMs were analyzed. Adverse effects were also evaluated. We related seizure control to VPA doses through uni- and multivariate statistical analyses. RESULTS From 225 patients, 169 (75%) had good seizure control, with most (60%) receiving monotherapy. The cutoff daily VPA dose capable of distinguishing these patients from those without seizure control was up to 1000 mg (p = 0.006) in univariate analyses and up to 700 mg in multivariate analyses. For patients in polytherapy, the cutoff was up to 1750 mg and 1800 mg in uni- and multivariate analyses, respectively. CONCLUSIONS The lowest daily VPA dose in monotherapy able to control seizures for most GGE patients was up to 700 mg, a value that can be used as a low dose criterion in studies assessing the therapeutic VPA ranges. Patients using higher VPA doses or in polytherapy present a lower probability of seizure control.
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Affiliation(s)
- Vanessa Dinis Marques
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Bárbara Amorim Hackbart
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura Maria Guilhoto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Della Peruta C, Lozanoska-Ochser B, Renzini A, Moresi V, Sanchez Riera C, Bouché M, Coletti D. Sex Differences in Inflammation and Muscle Wasting in Aging and Disease. Int J Mol Sci 2023; 24:ijms24054651. [PMID: 36902081 PMCID: PMC10003083 DOI: 10.3390/ijms24054651] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Only in recent years, thanks to a precision medicine-based approach, have treatments tailored to the sex of each patient emerged in clinical trials. In this regard, both striated muscle tissues present significant differences between the two sexes, which may have important consequences for diagnosis and therapy in aging and chronic illness. In fact, preservation of muscle mass in disease conditions correlates with survival; however, sex should be considered when protocols for the maintenance of muscle mass are designed. One obvious difference is that men have more muscle than women. Moreover, the two sexes differ in inflammation parameters, particularly in response to infection and disease. Therefore, unsurprisingly, men and women respond differently to therapies. In this review, we present an up-to-date overview on what is known about sex differences in skeletal muscle physiology and disfunction, such as disuse atrophy, age-related sarcopenia, and cachexia. In addition, we summarize sex differences in inflammation which may underly the aforementioned conditions because pro-inflammatory cytokines deeply affect muscle homeostasis. The comparison of these three conditions and their sex-related bases is interesting because different forms of muscle atrophy share common mechanisms; for instance, those responsible for protein dismantling are similar although differing in terms of kinetics, severity, and regulatory mechanisms. In pre-clinical research, exploring sexual dimorphism in disease conditions could highlight new efficacious treatments or recommend implementation of an existing one. Any protective factors discovered in one sex could be exploited to achieve lower morbidity, reduce the severity of the disease, or avoid mortality in the opposite sex. Thus, the understanding of sex-dependent responses to different forms of muscle atrophy and inflammation is of pivotal importance to design innovative, tailored, and efficient interventions.
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Affiliation(s)
- Chiara Della Peruta
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
| | - Biliana Lozanoska-Ochser
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
- Department of Medicine and Surgery, LUM University, 70010 Bari, Italy
| | - Alessandra Renzini
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
| | - Viviana Moresi
- Institute of Nanotechnology (Nanotec), National Research Council (CNR), c/o Sapienza University of Rome, 00185 Roma, Italy
| | - Carles Sanchez Riera
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
| | - Marina Bouché
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
- Correspondence:
| | - Dario Coletti
- Unit of Histology and Medical Embryology, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, 00161 Roma, Italy
- Biological Adaptation and Ageing (B2A), Institut de Biologie Paris-Seine, Sorbonne Université, CNRS UMR 8256, Inserm U1164, 75005 Paris, France
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Zhang B, Chen T, Hao X, Xin M, Liang J. Electroclinical characteristics of photosensitive epilepsy: A retrospective study of 31 Chinese children and literature review. Front Pediatr 2023; 11:994817. [PMID: 36969295 PMCID: PMC10034115 DOI: 10.3389/fped.2023.994817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023] Open
Abstract
Objective The objective of this study was to better understand the clinical features of photosensitive epilepsy (PSE) in Chinese children. Methods Thirty-one children with PSE were screened out of 398 children with epilepsy who were consecutively diagnosed by the video-electroencephalogram (VEEG) monitoring method and by using an intermittent photic stimulation (IPS) test. Their EEGs and clinical features were retrospectively analyzed, and their treatment outcomes were followed up. Results PSE accounted for 7.79% (31/398) of children with epilepsy during the observation period in our single epilepsy center. The male to female ratio of PSE was 1:3.43, and the average seizure onset age was 7.8 ± 3.28 years. The highest range of frequency sensitivity of the IPS test for the induction of EEG epileptic discharge or electroclinical seizures was within 10-20 Hz. Electroclinical seizures were induced in 41.94% (13/31) of PSE patients by using the IPS test, while EEG discharge without clinical seizures was induced in 58.06% (18/31) of PSE patients. Among all PSE patients, an IPS-positive reaction in the eye-closure state was induced in 83.87% of patients, and this rate was significantly higher than that in the eye-opened state (41.94%) or eye-closed state (35.48%). (Eye-closure IPS stimulation means: make the subjects close their eyes at the beginning of each stimulation, open their eyes at the end of the stimulation, and close their eyes again at the beginning of the next stimulation, and so on. While Eye-closed IPS stimulation means the stimulation is started after 5 s of eye closure, and the subjects are kept closed throughout the whole process.) The common and effective drugs used for single or combined therapy in PSE children were valproic acid and levetiracetam. Conclusion This study provides some useful information about electroclinical characteristics in a cohort of 31 PSE children. It may be beneficial for pediatric neurologists in terms of paying more attention to PSE and correctly dealing with it.
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Affiliation(s)
- Bo Zhang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Tianyu Chen
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Department of Pediatrics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xiaosheng Hao
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Meiying Xin
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
| | - Jianmin Liang
- Department of Pediatric Neurology, First Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, China
- Correspondence: Jianmin Liang
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19
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Gesche J, Beier CP. Drug resistance in idiopathic generalized epilepsies: Evidence and concepts. Epilepsia 2022; 63:3007-3019. [PMID: 36102351 PMCID: PMC10092586 DOI: 10.1111/epi.17410] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 01/11/2023]
Abstract
Although approximately 10%-15% of patients with idiopathic generalized epilepsy (IGE)/genetic generalized epilepsy remain drug-resistant, there is no consensus or established concept regarding the underlying mechanisms and prevalence. This review summarizes the recent data and the current hypotheses on mechanisms that may contribute to drug-resistant IGE. A literature search was conducted in PubMed and Embase for studies on mechanisms of drug resistance published since 1980. The literature shows neither consensus on the definition nor a widely accepted model to explain drug resistance in IGE or one of its subsyndromes. Large-scale genetic studies have failed to identify distinct genetic causes or affected genes involved in pharmacokinetics. We found clinical and experimental evidence in support of four hypotheses: (1) "network hypothesis"-the degree of drug resistance in IGE reflects the severity of cortical network alterations, (2) "minor focal lesion in a predisposed brain hypothesis"-minor cortical lesions are important for drug resistance, (3) "interneuron hypothesis"-impaired functioning of γ-aminobutyric acidergic interneurons contributes to drug resistance, and (4) "changes in drug kinetics"-genetically impaired kinetics of antiseizure medication (ASM) reduce the effectiveness of available ASMs. In summary, the exact definition and cause of drug resistance in IGE is unknown. However, published evidence suggests four different mechanisms that may warrant further investigation.
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Affiliation(s)
- Joanna Gesche
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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20
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Cervenka MC. Let’s Talk About Sex and Juvenile Myoclonic Epilepsy. Epilepsy Curr 2022; 22:356-358. [DOI: 10.1177/15357597221120487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
[Box: see text]
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21
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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22
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Demographic reporting across a decade of neuroimaging: a systematic review. Brain Imaging Behav 2022; 16:2785-2796. [DOI: 10.1007/s11682-022-00724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
Abstract
Diversity of participants in biomedical research with respect to race, ethnicity, and biological sex is crucial, particularly given differences in disease prevalence, recovery, and survival rates between demographic groups. The objective of this systematic review was to report on the demographics of neuroimaging studies using magnetic resonance imaging (MRI). The Web of Science database was used and data collection was performed between June 2021 to November 2021; all articles were reviewed independently by at least two researchers. Articles utilizing MR data acquired in the United States, with n ≥ 10 human subjects, and published between 2010–2020 were included. Non-primary research articles and those published in journals that did not meet a quality control check were excluded. Of the 408 studies meeting inclusion criteria, approximately 77% report sex, 10% report race, and 4% report ethnicity. Demographic reporting also varied as function of disease studied, participant age range, funding, and publisher. We anticipate quantitative data on the extent, or lack, of reporting will be necessary to ensure inclusion of diverse populations in biomedical research.
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23
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Shakeshaft A, Laiou P, Abela E, Stavropoulos I, Richardson MP, Pal DK, Howell A, Hyde A, McQueen A, Duran A, Gaurav A, Collingwood A, Kitching A, Shakeshaft A, Papathanasiou A, Clough A, Gribbin A, Swain A, Needle A, Hall A, Smith A, Macleod A, Chhibda A, Fonferko-Shadrach B, Camara B, Petrova B, Stuart C, Hamilton C, Peacey C, Campbell C, Cotter C, Edwards C, Picton C, Busby C, Quamina C, Waite C, West C, Ng CC, Giavasi C, Backhouse C, Holliday C, Mewies C, Thow C, Egginton D, Dickerson D, Rice D, Mullan D, Daly D, Mcaleer D, Gardella E, Stephen E, Irvine E, Sacre E, Lin F, Castle G, Mackay G, Salim H, Cock H, Collier H, Cockerill H, Navarra H, Mhandu H, Crudgington H, Hayes I, Stavropoulos I, Daglish J, Smith J, Bartholomew J, Cotta J, Ceballos JP, Natarajan J, Crooks J, Quirk J, Bland J, Sidebottom J, Gesche J, Glenton J, Henry J, Davis J, Ball J, Selmer KK, Rhodes K, Holroyd K, Lim KS, O’Brien K, Thrasyvoulou L, Makawa L, Charles L, Richardson L, Nelson L, Walding L, Woodhead L, Ehiorobo L, Hawkins L, Adams L, Connon M, Home M, Baker M, Mencias M, Richardson MP, Sargent M, Syvertsen M, Milner M, Recto M, Chang M, O'Donoghue M, Young M, Ray M, Panjwani N, Ghaus N, Sudarsan N, Said N, Pickrell O, Easton P, Frattaroli P, McAlinden P, Harrison R, Swingler R, Wane R, Ramsay R, Møller RS, McDowall R, Clegg R, Uka S, White S, Truscott S, Francis S, Tittensor S, Sharman SJ, Chung SK, Patel S, Ellawela S, Begum S, Kempson S, Raj S, Bayley S, Warriner S, Kilroy S, MacFarlane S, Brown T, Samakomva T, Nortcliffe T, Calder V, Collins V, Parker V, Richmond V, Stern W, Haslam Z, Šobíšková Z, Agrawal A, Whiting A, Pratico A, Desurkar A, Saraswatula A, MacDonald B, Fong CY, Beier CP, Andrade D, Pauldhas D, Greenberg DA, Deekollu D, Pal DK, Jayachandran D, Lozsadi D, Galizia E, Scott F, Rubboli G, Angus-Leppan H, Talvik I, Takon I, Zarubova J, Koht J, Aram J, Lanyon K, Irwin K, Hamandi K, Yeung L, Strug LJ, Rees M, Reuber M, Kirkpatrick M, Taylor M, Maguire M, Koutroumanidis M, Khan M, Moran N, Striano P, Bala P, Bharat R, Pandey R, Mohanraj R, Thomas R, Belderbos R, Slaght SJ, Delamont S, Sastry S, Mariguddi S, Kumar S, Kumar S, Majeed T, Jegathasan U, Whitehouse W. Heterogeneity of resting-state EEG features in juvenile myoclonic epilepsy and controls. Brain Commun 2022; 4:fcac180. [PMID: 35873918 PMCID: PMC9301584 DOI: 10.1093/braincomms/fcac180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Abnormal EEG features are a hallmark of epilepsy, and abnormal frequency and network features are apparent in EEGs from people with idiopathic generalized epilepsy in both ictal and interictal states. Here, we characterize differences in the resting-state EEG of individuals with juvenile myoclonic epilepsy and assess factors influencing the heterogeneity of EEG features. We collected EEG data from 147 participants with juvenile myoclonic epilepsy through the Biology of Juvenile Myoclonic Epilepsy study. Ninety-five control EEGs were acquired from two independent studies [Chowdhury et al. (2014) and EU-AIMS Longitudinal European Autism Project]. We extracted frequency and functional network-based features from 10 to 20 s epochs of resting-state EEG, including relative power spectral density, peak alpha frequency, network topology measures and brain network ictogenicity: a computational measure of the propensity of networks to generate seizure dynamics. We tested for differences between epilepsy and control EEGs using univariate, multivariable and receiver operating curve analysis. In addition, we explored the heterogeneity of EEG features within and between cohorts by testing for associations with potentially influential factors such as age, sex, epoch length and time, as well as testing for associations with clinical phenotypes including anti-seizure medication, and seizure characteristics in the epilepsy cohort. P-values were corrected for multiple comparisons. Univariate analysis showed significant differences in power spectral density in delta (2-5 Hz) (P = 0.0007, hedges' g = 0.55) and low-alpha (6-9 Hz) (P = 2.9 × 10-8, g = 0.80) frequency bands, peak alpha frequency (P = 0.000007, g = 0.66), functional network mean degree (P = 0.0006, g = 0.48) and brain network ictogenicity (P = 0.00006, g = 0.56) between epilepsy and controls. Since age (P = 0.009) and epoch length (P = 1.7 × 10-8) differed between the two groups and were potential confounders, we controlled for these covariates in multivariable analysis where disparities in EEG features between epilepsy and controls remained. Receiver operating curve analysis showed low-alpha power spectral density was optimal at distinguishing epilepsy from controls, with an area under the curve of 0.72. Lower average normalized clustering coefficient and shorter average normalized path length were associated with poorer seizure control in epilepsy patients. To conclude, individuals with juvenile myoclonic epilepsy have increased power of neural oscillatory activity at low-alpha frequencies, and increased brain network ictogenicity compared with controls, supporting evidence from studies in other epilepsies with considerable external validity. In addition, the impact of confounders on different frequency-based and network-based EEG features observed in this study highlights the need for careful consideration and control of these factors in future EEG research in idiopathic generalized epilepsy particularly for their use as biomarkers.
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Affiliation(s)
- Amy Shakeshaft
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Petroula Laiou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Eugenio Abela
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Mark P Richardson
- Correspondence may also be addressed to: Professor Mark P Richardson Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London, 5 Cutcombe Road, London SE5 9RX, UK E-mail:
| | - Deb K Pal
- Correspondence to: Professor Deb K Pal Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology & Neuroscience King’s College London 5 Cutcombe Road, London SE5 9RX, UK E-mail:
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