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Lesser RP, Webber WRS, Miglioretti DL. Pan-cortical electrophysiologic changes underlying attention. Sci Rep 2024; 14:2680. [PMID: 38302535 PMCID: PMC10834435 DOI: 10.1038/s41598-024-52717-w] [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: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
We previously reported that pan-cortical effects occur when cognitive tasks end afterdischarges. For this report, we analyzed wavelet cross-coherence changes during cognitive tasks used to terminate afterdischarges studying multiple time segments and multiple groups of inter-electrode-con distances. We studied 12 patients with intractable epilepsy, with 970 implanted electrode contacts, and 39,871 electrode contact combinations. When cognitive tasks ended afterdischarges, coherence varied similarly across the cortex throughout the tasks, but there were gradations with time, distance, and frequency: (1) They tended to progressively decrease relative to baseline with time and then to increase toward baseline when afterdischarges ended. (2) During most time segments, decreases from baseline were largest for the closest inter-contact distances, moderate for intermediate inter-contact distances, and smallest for the greatest inter-contact distances. With respect to our patients' intractable epilepsy, the changes found suggest that future therapies might treat regions beyond those closest to regions of seizure onset and treat later in a seizure's evolution. Similar considerations might apply to other disorders. Our findings also suggest that cognitive tasks can result in pan-cortical coherence changes that participate in underlying attention, perhaps complementing the better-known regional mechanisms.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, Davis, School of Medicine, University of California, Davis, CA, 95616, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
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Lesser RP, Webber WRS, Miglioretti DL. Timing of cognitive effects on afterdischarge termination. Clin Neurophysiol 2023; 153:28-32. [PMID: 37442023 DOI: 10.1016/j.clinph.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE We previously studied efficacy of cognitive tasks on afterdischarge termination in patients undergoing cortical stimulation and found that diffuse wavelet cross-coherence changes on electrocorticography were associated with termination efficacy. We now report wavelet cross-coherence findings during different time segments of trials during which afterdischarges ended. METHODS For 12 patients with implanted subdural electrodes, we compared wavelet cross-coherence findings among several 1-second portions of cognitive tasks, reflecting task presentation, patient replies, and afterdischarge termination. RESULTS Coherence decreased significantly and progressively over time for 16.89, 22.53, and 30.03 Hz frequency ranges, but increased with afterdischarge termination. Coherence first increased, and then decreased for the 7.13 Hz frequency range. CONCLUSIONS The findings suggest that cumulative but non-specific factors, likely related primarily to attention, influence the coherence results throughout the task, with a separate effect due to resolution of the afterdischarges at the end. SIGNIFICANCE Task performance is well known to localize to specific brain regions and to be restricted in timing. In contrast, attention and overall mental activation might be due to emergent properties of brain as a whole and that are less circumscribed in space or time. Cognitive tasks might modify seizures and other neurological disorders.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
| | - W R S Webber
- Department of Neurology Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, CA 95616, USA; Kaiser Permanente Washington Health Research Institute, Seattle WA 98101, USA
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Puteikis K, Mameniškienė R, Wolf P. Reading epilepsy today: A scoping review and meta-analysis of reports of the last three decades. Epilepsy Behav 2023; 145:109346. [PMID: 37437391 DOI: 10.1016/j.yebeh.2023.109346] [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: 04/21/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND AND AIM Reading-induced seizures are presumed to be rare phenomena attributed to an epilepsy syndrome not clearly belonging to either focal or generalized epilepsies. The aim of the article was to summarize knowledge and recent developments in the field of reading-induced seizures by reviewing all cases for which data were reported within the last three decades. METHODS A scoping systematic review of demographic, clinical, electroencephalography (EEG) and imaging data of cases with reading-induced seizures reported in PubMed and Web of Science between 1991-01-01 and 2022-08-21 and a meta-analysis of the findings. RESULTS The review included 101 case reports of epilepsy with reading-induced seizures (EwRIS) from 42 articles. The phenomenon was more prevalent among males (67, 66.3% vs. 34, 33.7%) with an average age of onset of 18.3 ± 7.9 years. When reported, 30.8% of patients had a family history of epilepsy. Orofacial reflex myocloni (ORM) were the most frequent manifestation (68, 67.3% cases), other presentations, mostly in addition to ORM, included visual, sensory or cognitive symptoms, non-orofacial myoclonic seizures, and absence seizures. Within the sample, 75 (74.3%) patients were identified as having primary reading epilepsy (PRE), 13 (12.9%) idiopathic generalised epilepsy (IGE) and 13 (12.9%) focal epilepsies. Advanced EEG and functional imaging data suggest that the basic mechanism of reading-induced seizures is probably similar despite different symptoms and consists of upregulation of the complex cerebral subsystem involved in reading. Ictogenesis and resulting symptomatology may then depend on predominant sensory or proprioceptive stimuli during reading. CONCLUSION In most cases, reading-induced seizures were confirmed to belong to a particular epilepsy syndrome of PRE. However, there were substantial subgroups with IGE and focal epilepsies. Most likely, reading-induced seizures occur as an abnormal response to extero- or proprioceptive input into an upregulated cortical network subserving reading. Most recent researchers consider EwRIS a system epilepsy.
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Affiliation(s)
| | | | - Peter Wolf
- Center for Neurology, Vilnius University, Vilnius, Lithuania; Danish Epilepsy Center Filadelfia, Dianalund, Denmark; Postgraduation Programme in Clinical Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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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
- Correspondence may also be addressed to: Guido Rubboli Danish Epilepsy Center, Filadelfia/University of Copenhagen Kolonivej 2A, Dianalund 4293, Denmark E-mail:
| | - 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
- Correspondence to: Deb K. Pal Maurice Wohl Clinical Neurosciences Institute Institute of Psychiatry, Psychology and Neuroscience, King’s College London 5 Cutcombe Road, London SE5 9RX, UK E-mail:
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Lesser RP, Webber W, Miglioretti DL. Pan-cortical coordination underlying mental effort. Clin Neurophysiol 2022; 136:130-137. [DOI: 10.1016/j.clinph.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/11/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
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Alqadi K, Alghamdi O, Babtain F, Ba'arma H, Bajammal S, Albalawi M, Alfadhel A, Jawhari M, Abu-Jabber A, Madani N, Al-Said Y, Baz S, Kayyali H. Effects of fasting during Ramadan on seizure control and quality of life in patients with epilepsy. Epilepsy Behav 2020; 112:107440. [PMID: 32906015 DOI: 10.1016/j.yebeh.2020.107440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND During Ramadan, the ninth month of the lunar Islamic calendar, adult Muslims are obliged to fast, which involves refraining from taking any food, beverages, or oral medications from dawn to sunset. Fasting's effect on seizure control is not fully understood, and a few observational studies have provided inconclusive results. This study aimed to investigate the effect of fasting during Ramadan on seizure control and quality of life in adult patients with epilepsy. METHODS This was a prospective observational study over a 3-month period (one month before fasting, the fasting month, and one month after fasting). We recruited adult patients with active epilepsy who were able to fast during the month of Ramadan. The primary outcome measures were as follows: 1) seizure control and 2) quality of life score using the Arabic version of the Ferrans and Powers Quality of Life Index (QLI). Changes in anticonvulsant medications were not allowed during the study period. We used a seizure log provided to participants to record the number of seizures during the 3-month period. Quality of life was scored at the end of each month of the study period. RESULTS Thirty-seven patients were studied (59% males). The mean age was 30 years (range, 14-51 years), and mean age at epilepsy onset was 13 years (range, 0.5-35 years). On average, patients were on three antiepileptic medications at baseline (range: 2-5). A total of 1576 seizures were reported during the 3-month follow-up, where seizures prior to fasting represented 35.5% of all seizures. Multilinear regression analysis revealed a significant decline of seizures by 21% during the fasting month compared with baseline (adjusted coefficient = 0.79, p < 0.01, 95% confidence interval (CI); 0.61-0.98, R2 = 0.81) and by 29% during post fasting compared with baseline (adjusted coefficient = 0.71, p < 0.01, 95% CI; 0.53-0.90, R2 = 0.79). No significant change was found in the QLI scores calculated during the three months of the study period. CONCLUSION Fasting during Ramadan might have a positive impact on seizure control in patients with epilepsy, which continued during the month following fasting, whereas the quality of life scores were not affected by fasting.
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Affiliation(s)
- Khalid Alqadi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
| | - Omar Alghamdi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Taif Children's Hospital, Taif, Saudi Arabia
| | - Fawzi Babtain
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hanan Ba'arma
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Somaya Bajammal
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Internal Medicine, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Miad Albalawi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | | | - Amal Abu-Jabber
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nadia Madani
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Youssef Al-Said
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salah Baz
- Alfaisal University, Riyadh, Saudi Arabia
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Lesser RP, Webber WRS, Miglioretti DL, Pillai JJ, Agarwal S, Mori S, Morrison PF, Castagnola S, Lawal A, Lesser HJ. Cognitive effort decreases beta, alpha, and theta coherence and ends afterdischarges in human brain. Clin Neurophysiol 2019; 130:2169-2181. [PMID: 31399356 DOI: 10.1016/j.clinph.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Mental activation has been reported to modify the occurrence of epileptiform activity. We studied its effect on afterdischarges. METHOD In 15 patients with implanted electrodes we presented cognitive tasks when afterdischarges occurred. We developed a wavelet cross-coherence function to analyze the electrocorticography before and after the tasks and compared findings when cognitive tasks did or did not result in afterdischarge termination. Six patients returned for functional MRI (fMRI) testing, using similar tasks. RESULTS Cognitive tasks often could terminate afterdischarges when direct abortive stimulation could not. Wavelet cross-coherence analysis showed that, when afterdischarges stopped, there was decreased coherence throughout the brain in the 7.13-22.53 Hz frequency ranges (p values 0.008-0.034). This occurred a) regardless of whether an area activated on fMRI and b) regardless of whether there were afterdischarges in the area. CONCLUSIONS It is known that cognitive tasks can alter localized or network synchronization. Our results show that they can change activity throughout the brain. These changes in turn can terminate localized epileptiform activity. SIGNIFICANCE Cognitive tasks result in diffuse brain changes that can modify focal brain activity. Combined with a seizure detection device, cognitive activation might provide a non-invasive method of terminating or modifying seizures.
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Affiliation(s)
- Ronald P Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - W R S Webber
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, CA 95616, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Jay J Pillai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shruti Agarwal
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Susumu Mori
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Peter F Morrison
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Stefano Castagnola
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Adeshola Lawal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Helen J Lesser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Tan ZR, Tian FF, Long XY, Zhang C, Feng YY, Zhang SY, Li GL. Successful treatment of reflex epilepsy with praxis induction by stimulus avoidance only. Epilepsy Behav 2018; 86:163-165. [PMID: 30037584 DOI: 10.1016/j.yebeh.2018.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Reflex epilepsy is a type of epilepsy with seizures that are consistently triggered by a specific stimulus. Zipai is a Chinese ancient card game which has been popular in Southern China for hundreds of years. We sought to report and characterize clinical features of patients with reflex epilepsy evoked by playing Zipai. METHODS We collected and analyzed clinical data of patients with Zipai-induced epilepsy. Patients were regarded as having Zipai-induced epilepsy if they suffered at least two seizure attack during the course of playing Zipai. Prolonged electroencephalography (EEG) and brain magnetic resonance imaging (MRI) were applied to all patients. All patients were advised to avoid watching and playing Zipai games in daily life, instead of using antiepileptic drugs. The seizure outcome was assessed during outpatient visits and by telephone contact. RESULTS Five patients were included in this study. No spontaneous seizures occurred in all five patients. No patients had experienced myoclonic and coexistent absences with generalized tonic-clonic seizures (GTCS). All patients had normal MRI and prolonged EEG findings. All patients were advised to avoid the Zipai game, and became seizure-free without medication during the follow-up period (mean 5.4 years, range 3.5-7 years). CONCLUSION Zipai-induced epilepsy may be an unreported subtype form of reflex epilepsy with praxis induction. Nonpharmacological conservative treatment plays a significant role in the treatment of reflex epilepsy.
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Affiliation(s)
- Zhe-Ren Tan
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Fa-Fa Tian
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Xiao-Yan Long
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Chen Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yan-Yan Feng
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Si-Yuan Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Guo-Liang Li
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, China.
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Gelžinienė G, Endzinienė M, Jurkevičienė G. EEG activation by neuropsychological tasks in idiopathic generalized epilepsy of adolescence. Brain Dev 2015; 37:409-17. [PMID: 25043766 DOI: 10.1016/j.braindev.2014.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/20/2014] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
Abstract
THE AIM OF THE STUDY To evaluate the effects of neuropsychological activation (NPA) tasks on epileptiform discharges in adolescents with idiopathic generalized epilepsy (IGE) and their possible relationship to clinical epilepsy-related factors, also to compare the effects of the NPA to the habitual methods of electroencephalographic (EEG) activation. METHODS/SUBJECTS Fifty-nine patients with IGE aged 14-17 years underwent baseline video-EEG recording with habitual activation procedures followed by NPA tasks, and sleep EEG after sleep deprivation on the next day. RESULTS At least one task of NPA showed provocative effect in 18.6% of cases. There was no difference between the provocative effects of action-programming and thinking NPA task groups as well as among individual NPA tasks. The provocative effects of NPA tasks were more prevalent in photosensitive cases, especially the tasks of action-programming type (p=0.04). The provocative NPA effects showed no relationship to gender, age, age at seizure onset, duration of epilepsy, treatment status, presence of myoclonias, recent generalized tonic-clonic seizures, family history of epilepsy. The provocative effects of NPA were comparable to those of hyperventilation (23.7%) and intermittent light stimulation (30.5%) (p>0.05). CONCLUSIONS Although the provocative effects NPA tasks on epileptiform discharges on EEG did not outweigh the effects of the habitual activation procedures, NPA activation might be helpful as an additional diagnostic tool in adolescents with IGE in selected cases when routine EEG is not informative enough or when sleep EEG is readily unavailable, also in photosensitive cases. It may also help in providing advice for patients on safety issues.
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Affiliation(s)
- Giedrė Gelžinienė
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Milda Endzinienė
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Giedrė Jurkevičienė
- Neurology Department, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Osorio I. Competition for neuronal processing time: a physiological seizure control mechanism? Epilepsy Behav 2014; 36:133-7. [PMID: 24915199 DOI: 10.1016/j.yebeh.2014.05.013] [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: 10/28/2013] [Revised: 05/12/2014] [Accepted: 05/18/2014] [Indexed: 11/16/2022]
Abstract
Cognitive means for seizure control remain underinvestigated in clinical epileptology. Since administration of a complex reaction time (CRT) test triggered by a seizure detection algorithm is a unique research paradigm, its effects on seizure frequency and severity were examined in 14 subjects undergoing invasive epilepsy surgery evaluation. These variables were compared with those of 37 subjects evaluated using the same surgical protocol, but to whom the CRT test was not administered. The results were analyzed for statistical significance using the t-test and the chi-squared test. Eight of fourteen subjects who took the CRT test had fewer than 5 clinical seizures, and 7 of 14 subjects had fewer than 5 clinical and subclinical seizures over 8.9 days compared with 37 subjects who did not take this test, each of whom had a minimum of 5 clinical seizures over 6.7 days (chi-square=25.08; p<0.001). The monitoring duration difference (2.2 days longer for CRT test takers) was statistically significant (p~0.04). In one subject, seizure severity was lower (p<0.001) during testing compared with nontesting periods. It is posited that seizure frequency reduction is a beneficial, unconditioned, and, probably, contingent effect of the CRT test. These and other experimental observations form the basis for a hypothetical physiological antiseizure mechanism, the "competition for neuronal processing time".
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Affiliation(s)
- Ivan Osorio
- University of Kansas Medical Center, Kansas City, KS, USA.
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Novakova B, Harris PR, Ponnusamy A, Reuber M. The role of stress as a trigger for epileptic seizures: a narrative review of evidence from human and animal studies. Epilepsia 2013; 54:1866-76. [PMID: 24117321 DOI: 10.1111/epi.12377] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 12/24/2022]
Abstract
Stress is one of the most frequently self-identified seizure triggers in patients with epilepsy; however, most previous publications on stress and epilepsy have focused on the role of stress in the initial development of epilepsy. This narrative review explores the causal role of stress in triggering seizures in patients with existing epilepsy. Findings from human studies of psychological stress, as well as of physiologic stress responses in humans and animals, and evidence from nonpharmacologic interventions for epilepsy are considered. The evidence from human studies for stress as a trigger of epileptic seizures is inconclusive. Although retrospective self-report studies show that stress is the most common patient-perceived seizure precipitant, prospective studies have yielded mixed results and studies of life events suggest that stressful experiences only trigger seizures in certain individuals. There is limited evidence suggesting that autonomic arousal can precede seizures. Interventions designed to improve coping with stress reduce seizures in some individuals. Studies of physiologic stress using animal epilepsy models provide more convincing evidence. Exposure to exogenous and endogenous stress mediators has been found to increase epileptic activity in the brain and trigger overt seizures, especially after repeated exposure. In conclusion, stress is likely to exacerbate the susceptibility to epileptic seizures in a subgroup of individuals with epilepsy and may play a role in triggering "spontaneous" seizures. However, there is currently no strong evidence for a close link between stress and seizures in the majority of people with epilepsy, although animal research suggests that such links are likely. Further research is needed into the relationship between stress and seizures and into interventions designed to reduce perceived stress and improve quality of life with epilepsy.
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Affiliation(s)
- Barbora Novakova
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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Illingworth JL, Ring H. Conceptual distinctions between reflex and nonreflex precipitated seizures in the epilepsies: a systematic review of definitions employed in the research literature. Epilepsia 2013; 54:2036-47. [PMID: 24032405 DOI: 10.1111/epi.12340] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 11/29/2022]
Abstract
Seizure precipitation is a defining characteristic of reflex seizures and epilepsies, but seizure precipitants are also commonly reported for patients with epilepsies not considered to be reflex in nature. This raises the questions of exactly how reflex and nonreflex epilepsies with seizure precipitants are defined, and how these concepts are differentiated from one another in current practice. In this systematic literature review, definitions of reflex seizures, reflex epilepsies, and precipitation in a nonreflex context were extracted from published primary research papers. Content analysis was applied to these definitions to identify their main features, allowing comparisons to be made between definitions of the different concepts. Results indicated that there was little consistency within definitions of a given term, and that although some differences in definition content were found between terms, it was evident that clear defining characteristics to differentiate them from one another were lacking. These findings are discussed in the context of current debates regarding classification of the reflex epilepsies and the extent to which the distinction between reflex and nonreflex epilepsies is a meaningful one. Suggestions are made for how clarity might be increased in ongoing research in this area.
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre; Dianalund Denmark
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15
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Seizure precipitants and inhibiting factors in mesial temporal lobe epilepsy. J Neurol Sci 2011; 308:21-4. [DOI: 10.1016/j.jns.2011.06.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/17/2011] [Accepted: 06/21/2011] [Indexed: 11/19/2022]
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A randomized trial of a group based cognitive behavior therapy program for older adults with epilepsy: the impact on seizure frequency, depression and psychosocial well-being. J Behav Med 2010; 34:201-7. [DOI: 10.1007/s10865-010-9299-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 09/13/2010] [Indexed: 11/26/2022]
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18
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Abstract
This article reviews the epilepsy cycle, distinguishing the interictal, preictal, ictal, and postictal phases. Evidence suggesting that the preictal phase can sometimes be identified based on neurophysiologic signals, premonitory features, the presence of trigger factors, or self-report is also reviewed. Diary studies have shown that seizures are not randomly distributed in time and that a subgroup of persons with epilepsy can predict an impending seizure. Paper diary data and preliminary analysis of electronic diary data suggest that seizure prediction is feasible. Whereas all of this evidence sets the stage for seizure prediction and preemptive therapy, several questions remain unanswered. First, what proportion of persons with epilepsy can predict their seizures? Second, within and among individuals, how accurate is prediction? Third, can prediction be improved through education about group level or individual predictors? And finally, in a group that can make robust predictions what are the most effective interventions for reducing seizure probability at times of high risk? The answers to these questions could reduce the burden of epilepsy by making seizures predictable and setting the stage for preemptive therapy. This work could improve the understanding of epilepsy by providing a context for studying the transitions from the interictal to preictal and ictal states. More prospective studies are needed; challenges certainly exist, but as the studies discussed here demonstrate, the field is rich with promise for improving the lives of patients with epilepsy.
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Affiliation(s)
- Sheryl R Haut
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, NY 10467, USA.
| | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, NY 10467, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA
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Guaranha MSB, da Silva Sousa P, de Araújo-Filho GM, Lin K, Guilhoto LMFF, Caboclo LOSF, Yacubian EMT. Provocative and inhibitory effects of a video-EEG neuropsychologic protocol in juvenile myoclonic epilepsy. Epilepsia 2009; 50:2446-55. [DOI: 10.1111/j.1528-1167.2009.02126.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rajna P, Sólyom A, Mezőfi L, Vargyai É. Are there real unprovoked/unprecipitated seizures? Med Hypotheses 2008; 71:851-7. [DOI: 10.1016/j.mehy.2008.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 05/13/2008] [Accepted: 05/28/2008] [Indexed: 11/27/2022]
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Abstract
BACKGROUND The decision on whether or not to treat a first seizure is dependent on several medical and non-medical factors. AIMS In this review, we have summarised the important aspects that determine the advantages and disadvantages of treating a first seizure. We have looked at evidence from randomised controlled trials and key observational studies. CONCLUSIONS There is no randomised controlled evidence that treating the aetiology of a first acute symptomatic seizure reduces the risk of relapse, although there are good biological arguments for this. For first unprovoked seizures, immediate treatment reduces the risk of seizure recurrence in the short term, but does not change the long-term prognosis for epilepsy. Other important considerations include the potential adverse events of antiepileptic drugs and socioeconomic factor such as lifestyle changes, driving, employment, financial implications and relationships. Treatment decisions can be made only on an individual patient basis after weighing the pros and cons of each case separately.
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Affiliation(s)
- S Sathasivam
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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Scientific basis behind traditional practice of application of "shoe-smell" in controlling epileptic seizures in the eastern countries. Clin Neurol Neurosurg 2008; 110:535-8. [PMID: 18353533 DOI: 10.1016/j.clineuro.2008.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 12/28/2007] [Accepted: 02/06/2008] [Indexed: 02/05/2023]
Abstract
Epilepsy has been known for thousands of years and has been subjected to various forms of conventional and non-conventional therapies including a non-pharmacological conservative treatment known as aromatherapy, ever since. One commonly practiced form of aromatherapy that persists as an immediate first-aid measure even today in some parts of developing countries in the East is the application of "shoe-smell" during an epileptic attack. The questionable remedial role has intrigued neuro-scientists at least in these parts of the world. This brief paper attempts to provide an insight to the basis of persistence of this practice and to explore a possible scientific logic behind its unscientifically reported remedial effectiveness. The neurophysiology of olfactory stimulation from "shoe-smell" reveals a sound and scientific reasoning for its remedial efficacy in epilepsy; olfactory stimuli in this study have been found to possess significantly effective anti-epileptic influence which could have formed the basis for the use of application of "shoe-smell" in earlier times and also for its persistence even today in those parts of developing regions.
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Gomceli YB, Kutlu G, Cavdar L, Inan LE. Does the seizure frequency increase in Ramadan? Seizure 2008; 17:671-6. [PMID: 18468459 DOI: 10.1016/j.seizure.2008.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Revised: 09/09/2007] [Accepted: 03/28/2008] [Indexed: 11/18/2022] Open
Abstract
During Ramadan, the ninth month of the Islamic lunar calendar, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse between dawn and sunset. In this study, we aimed at discovering alterations in drug regimens and the seizure frequency of epileptic patients during Ramadan (15 October 2004-13 November 2004). In the 3 months following Ramadan in the year 2004, 114 patients with epilepsy who were fasting during Ramadan were examined at our Epilepsy Department. Of the 114 patients who were included in the study, 38 patients had seizures and one of these patients developed status epilepticus during Ramadan. When the seizure frequency of these patients during Ramadan was compared to that in the last 1 year and last 3 months period just prior to Ramadan, a statistically significant increase was observed (p<0.001). Moreover, there was an important increase in the risk of having seizures in the patients who changed their drug regimens compared with those who did not (p<0.05). In the patients who received monotherapy or polytherapy, no difference in the frequency of seizures during Ramadan was seen (p>0.05). During Ramadan, an increase in the seizure frequency of patients with epilepsy was observed. The most important reason for this situation was the alteration in the pharmacokinetics and pharmacodynamics of drugs, and consequently, in their efficacy. We believe that in the patients who received monotherapy and who did not change their drug regimes, the increase in seizure frequency may have been related to the changes in their daily rhythms, emotional stress, tiredness and their day-long fasting.
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Affiliation(s)
- Yasemin B Gomceli
- Ministry of Health Ankara Training and Research Hospital, Department of Neurology, Ankara, Turkey.
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Handoko KB, Zwart-van Rijkom JEF, Hermens WAJJ, Souverein PC, Egberts TCG. Changes in medication associated with epilepsy-related hospitalisation: a case-crossover study. Pharmacoepidemiol Drug Saf 2007; 16:189-96. [PMID: 17036373 DOI: 10.1002/pds.1333] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To assess the association between changes in medication and epilepsy-related hospitalisation. METHODS Data were obtained from the PHARMO Record Linkage System (Jan 1998 to Dec 2002). We conducted a case-crossover study among patients with a first epilepsy-related hospital admission who had continuously used at least one antiepileptic drug (AED) during a 28-week period before admission. For each patient, changes in medication in a 28-day window before hospitalisation were compared with changes in four earlier 28-day windows. Evaluated changes were: changes in AEDs (pattern and dosage), changes in interacting co-medication and changes in non-interacting co-medication (i.e. introduction of non-interacting drugs). The strength of the association between changes in medication and epilepsy-related hospitalisation was estimated using conditional logistic regression analysis and expressed as odds ratios (ORs) with 95% confidence intervals (CI). RESULTS Out of 1185 patients with a first epilepsy-related hospitalisation, 217 patients met the inclusion criteria. Of the changes in antiepileptic therapy, discontinuation showed a trend towards an increased risk of hospitalisation (OR: 2.57; 95%CI: 0.81-8.17). Drug interactions influencing antiepileptic therapy rarely occurred. Introduction of three or more non-interacting drugs was significantly associated with epilepsy-related hospitalisation (OR: 4.80; 95%CI: 2.12-10.87). Of individual drugs, addition of antimicrobial agents was significantly associated with epilepsy-related hospitalisation (OR: 1.99; 95%CI: 1.06-3.75). CONCLUSIONS Changes in AED therapy were not significantly associated with epilepsy-related hospitalisation and few drug interactions influencing antiepileptic therapy occurred. However, patients starting three or more new non-AEDs had a nearly five times increased risk of epilepsy-related hospital admission.
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Affiliation(s)
- Kim B Handoko
- Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
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Abstract
Epileptic seizures can be triggered by both nonspecific facilitating factors such as sleep withdrawal, fever, or excessive alcohol intake, and specific reflex epileptic mechanisms. These consist of sensory or cognitive inputs activating circumscribed cortical areas or functional anatomic systems that, due to some functional instability, respond with an epileptic discharge. Interruption of seizure activity at the stage of the aura (i.e., locally restricted discharge) also can be achieved by nonspecific (e.g., relaxation or concentration techniques or vagal nerve stimulation) or by specific focus-targeted sensory or cognitive inputs. The latter, again, activate circumscribed cortical areas. Intriguingly, in some patients, the same stimulus can either precipitate or abort a seizure. The response depends on the state of cortical activation: seizure precipitation occurs in the resting condition, and seizure interruption occurs when the epileptic discharge has begun close to the activated area. These relations can be understood on the background of experimental data showing that an intermediate state of neuronal activation is a precondition for the generation of paroxysmal depolarization shifts, whereas a hyperpolarized neuron will remain subthreshold, and a depolarized neuron that already produces action potentials is not recruitable for other activity. Sensory input meeting an intermediately activated pool of potentially epileptic neurons is adequate to produce a seizure. In another condition, the same stimulus can depolarize a neuron pool in the same area sufficiently to block the further propagation of nearby epileptic activity. Understanding these interactions facilitates the development of successful nonpharmaceutical therapeutic interventions for epilepsy.
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Affiliation(s)
- Peter Wolf
- Epilepsie-Zentrum Bethel, Klinik Mara I, Germany.
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Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, Corey LA. Which seizure-precipitating factors do patients with epilepsy most frequently report? Epilepsy Behav 2005; 6:85-9. [PMID: 15652738 DOI: 10.1016/j.yebeh.2004.11.003] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Revised: 11/01/2004] [Accepted: 11/01/2004] [Indexed: 11/24/2022]
Abstract
When treating patients with epilepsy, dealing with seizure-precipitating factors is a partly neglected and underestimated supplement to more traditional therapies. The aim of this study was to investigate the incidence of seizure precipitants in a large epilepsy population and to determine which precipitants patients most often reported. Study participants included twins and their family members ascertained from the Norwegian Twin Panel (NTP), the Danish Twin Registry (DTR), and the Mid-Atlantic Twin Registry (MATR). One thousand six hundred seventy-seven patients with epilepsy were identified and were asked about seizure precipitants using a closed-ended questionnaire. Fifty-three percent reported at least one seizure-precipitating factor, while 30% claimed to have experienced two or more such factors. Emotional stress, sleep deprivation, and tiredness were the three most frequently reported precipitants. Patients with generalized seizures seemed to be more sensitive to sleep deprivation and flickering light than those with partial seizures, while women with partial seizures appeared to be more prone to seizures during menstruation than women with generalized seizures. Knowledge of seizure precipitants has practical implications, not only in patient treatment and counseling, but also for diagnosis, in that it may be helpful in facilitating the appearance of interictal epileptiform discharges in EEG and ictal EEG recordings.
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