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Rheims S, Herbillon V, Gaillard S, Mercier C, Villeuve N, Villéga F, Cances C, Castelnau P, Napuri S, de Saint‐Martin A, Auvin S, Nguyen The Tich S, Berquin P, de Bellecize J, Milh M, Roy P, Arzimanoglou A, Bodennec J, Bezin L, Kassai B. Phosphatidylserine enriched with polyunsaturated n-3 fatty acid supplementation for attention-deficit hyperactivity disorder in children and adolescents with epilepsy: A randomized placebo-controlled trial. Epilepsia Open 2024; 9:582-591. [PMID: 38173190 PMCID: PMC10984292 DOI: 10.1002/epi4.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/24/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is a frequent comorbidity in children with epilepsy, which management mostly relies on the usual treatments of ADHD, especially methylphenidate. Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed as an alternative therapeutic approach in ADHD without epilepsy but has never been evaluated in epilepsy-associated ADHD. METHODS A multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA, in eicosapentaenoic- and docosahexaenoic-acid form, conjugated to a phospholipid vector (PS-Omega3) in children aged >6 and <16-years old, and suffering from any type of epilepsy and ADHD (inattentive or combined type) according to DSM-V. After a 4-week baseline period, patients were allocated (1:1) either to placebo group or to PS-Omega 3 group and entered a 12 week-double-blind treatment period which was followed by a 12 week-open-label treatment period. The primary outcome was the reduction of the ADHD-rating scale IV attention-deficit subscore after 12 weeks of treatment. RESULTS The study was stopped early because of lack of eligible participants and the expected sample size was not reached. Seventy-four patients were randomized, 44 in PS-Omega3, and 30 in the placebo group. The reduction after 12 weeks of treatment in the inattention subscore of the ADHD-IV scale was -1.57 in the PS-Omega3 group, and -2.90 in the placebo group (p = 0.33, α = 5%). Results were similar after 24 weeks of treatment and for all other ADHD-related secondary outcomes, with no difference between placebo and PS-Omega3. CONCLUSION Our study remaining underpowered, no formal conclusion about the effect of Ps-Omega3 could be drawn. However, our data strongly suggested that the PS-Omega 3 formulation used in the current study did not improve ADHD symptoms in children with epilepsy. PLAIN LANGUAGE SUMMARY Supplementation with polyunsaturated n-3 Fatty Acid (PUFA) has been proposed in ADHD but has never been evaluated in patients with both epilepsy and ADHD. To address this issue, we conducted a multicenter double blind randomized placebo-controlled trial evaluating supplementation with PUFA in children with epilepsy and ADHD. The study was stopped early because of lack of eligible participants, hampering formal conclusion. However, the evolution of the ADHD symptoms at 12 and 24 weeks did not differ between placebo and PUFA supplementation, strongly suggesting that PUFA did not improve ADHD symptoms in children with epilepsy.
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Affiliation(s)
- Sylvain Rheims
- Department of Functional Neurology and EpileptologyHospices Civils de Lyon and Lyon 1 UniversityLyonFrance
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Vania Herbillon
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Ségolène Gaillard
- Clinical Investigation Centre 1407, Hospices Civils de Lyon‐InsermHôpital Louis PradelBronFrance
| | | | | | | | | | | | | | | | - Stéphane Auvin
- Pediatric Neurology Department, AP‐HP, Robert‐Debré University HospitalCRMR Épilepsies Rares, EpiCARE MemberParisFrance
- INSERM NeuroDiderotUniversité Paris CitéParisFrance
- Institut Universitaire de France (IUF)ParisFrance
| | | | | | - Julitta de Bellecize
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Mathieu Milh
- Department of Pediatric NeurologyAPHMMarseilleFrance
| | - Pascal Roy
- Department of BiostatisticsHospices Civils de LyonLyonFrance
| | - Alexis Arzimanoglou
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy, Sleep and Paediatric Neurophysiology DepartmentHospices Civils de LyonLyonFrance
| | - Jacques Bodennec
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Laurent Bezin
- Lyon Neuroscience Research Center, INSERM U1028/CNRS UMR 5292Lyon 1 UniversityLyonFrance
- Epilepsy InstituteLyonFrance
| | - Behrouz Kassai
- Clinical Investigation Centre 1407, Hospices Civils de Lyon‐InsermHôpital Louis PradelBronFrance
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé, CNRS, UMR 5558Lyon 1 UniversityVilleurbanneFrance
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Kirkham FJ, Vigevano F, Raspall-Chaure M, Wilken B, Lee D, Le Reun C, Werner-Kiechle T, Lagae L. Health-related quality of life and the burden of prolonged seizures in noninstitutionalized children with epilepsy. Epilepsy Behav 2020; 102:106340. [PMID: 31733569 DOI: 10.1016/j.yebeh.2019.04.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/09/2019] [Accepted: 04/13/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to provide information on the burden of illness and health-related quality of life (HRQoL) in children with epilepsy who experience prolonged acute convulsive seizures (PACS) in the community setting, and to investigate factors that may predict poor HRQoL in this population. METHODS Noninstitutionalized children (aged 3-16 years) who had experienced at least one PACS within the past year and had currently prescribed PACS rescue medication were enrolled in a cross-sectional study in Germany, Italy, Spain, and the United Kingdom (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3 [PERFECT-3]). Clinicians, parents/guardians, and patients completed web-based questionnaires regarding clinical characteristics, PACS frequency, and day-to-day impairment. Patients' HRQoL was rated by clinicians, parents/guardians, and patients themselves using the 5-dimension EuroQol questionnaire (EQ-5D) and summarized as a utility score. Potential predictors of poor HRQoL were tested in individual univariate generalized linear models and a global multivariable model. RESULTS Enrolled children (N = 286) had experienced 1-400 PACS (median: 4) in the past year. Clinicians reported that 216/281 patients (76.9%) had learning disabilities of varying severity. Mean EQ-5D utility scores rated by clinicians (n = 279), parents (n = 277), and patients (n = 85) were 0.52 (standard deviation: 0.41), 0.51 (0.39), and 0.74 (0.29), respectively. Increasing PACS frequency, increasing severity of learning disability, and specialist school attendance were significantly associated with decreasing EQ-5D utility score. In the multivariable model, having learning disabilities was the best predictor of poor HRQoL. SIGNIFICANCE Health-related quality of life was very poor in many children with epilepsy whose PACS were managed with rescue medication in the community, with learning disability being the most powerful predictor of patients' HRQoL. Mean EQ-5D utility scores were lower (worse) than published values for many other chronic disorders, indicating that optimal treatment should involve helping children and their families to manage learning disabilities and day-to-day impairments, in addition to preventing seizures.
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Affiliation(s)
- Fenella J Kirkham
- Department of Child Health, University Hospital Southampton NHS Trust, Southampton, United Kingdom; Developmental Neurosciences Unit and Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Miquel Raspall-Chaure
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Bernd Wilken
- Department of Pediatric Neurology, Klinikum Kassel, Kassel, Germany
| | - Dawn Lee
- BresMed Health Solutions, Sheffield, United Kingdom
| | | | - Tamara Werner-Kiechle
- Global Medical Affairs, Shire (a member of the Takeda group of companies), Zug, Switzerland
| | - Lieven Lagae
- Department of Pediatric Neurology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
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Das A, Sarwar MS, Hossain MS, Karmakar P, Islam MS, Hussain ME, Banik S. Elevated Serum Lipid Peroxidation and Reduced Vitamin C and Trace Element Concentrations Are Correlated With Epilepsy. Clin EEG Neurosci 2019; 50:63-72. [PMID: 29788779 DOI: 10.1177/1550059418772755] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epilepsy is one of the chronic and heterogeneous epidemic neurological disorders leading to substantial mortality. The aim of the present study was to investigate the serum levels of malondialdehyde (MDA), vitamin C, and trace elements namely zinc (Zn), copper (Cu), and manganese (Mn) in epileptic patients of Bangladesh and to establish if there are any pathophysiological correlations. METHODS This was a case-control study with 40 generalized epileptic patients and 40 healthy subjects as controls. Epilepsy was determined by the presence of seizure events with an abnormal electroencephalography and magnetic resonance imaging report of brain. RESULTS Anthropometric parameters highlighted that age is a major risk factor of epilepsy and men are more prone to epilepsy than women. Blood serum analysis demonstrated significantly ( P < .001) higher values of MDA and lower level of vitamin C in the patient group (4.41 ± 0.76 μmol/mL and 18.31 ± 0.84 μmol/L, respectively) compared with control (1.81 ± 0.70 μmol/mL and 29.72 ± 1.06 μmol/L, respectively). Pearson's correlation analysis revealed a negative correlation between the serum level of MDA and vitamin C for both patient ( r = -0.023, P = .887) and control group ( r = -0.142, P = .383). This study also revealed that the trace elements (Zn, Cu) were significantly ( P < .05) lower in epileptics (68.32 ± 4.59 and 50.81 ± 2.54 μg/dL, respectively) where the level of Mn in patients (187.71 ± 9.04 μg/dL) was almost similar to that of the control group ( P > .05). The univariate analysis demonstrated that zinc <70 μg/dL (odds ratio = 3.56, P < .05) and copper <50 μg/dL were associated (odds ratio = 14.73, P < .001) with an increased risk of epilepsy. Establishment of interelement relationship strongly supported that there was a disturbance in the element homeostasis of epileptic patients. CONCLUSIONS The study results strengthen the role of lipid peroxidation, antioxidants and trace elements in the pathogenesis and warrant larger studies to investigate the association of these biochemical parameters with epilepsy.
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Affiliation(s)
- Abhijit Das
- 1 Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Shahid Sarwar
- 1 Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Md Shohel Hossain
- 2 Department of Pharmacy, School of Engineering, Science and Technology, Manarat International University, Dhaka, Bangladesh
| | - Palash Karmakar
- 1 Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Mohammad Safiqul Islam
- 1 Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
| | - Mohammad Enayet Hussain
- 3 Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Sujan Banik
- 1 Department of Pharmacy, Noakhali Science and Technology University, Noakhali, Bangladesh
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Nikolić D, Željka R. Quality of life in children with epilepsy. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Coutinho V, Câmara-Costa H, Kemlin I, Billette de Villemeur T, Rodriguez D, Dellatolas G. The Discrepancy between Performance-Based Measures and Questionnaires when Assessing Clinical Outcomes and Quality of Life in Pediatric Patients with Neurological Disorders. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:255-261. [DOI: 10.1080/21622965.2016.1146141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- V Coutinho
- a Pediatric Neurology Unit , APHP, GHUEP, Trousseau Hospital , Paris , France.,b Neurofibromatosis Referral Centre , Paris , France.,c National Institute of Health and Medical Research , INSERM CESP1018 , Villejuif , France.,d Paris Descartes University , Paris , France
| | - H Câmara-Costa
- c National Institute of Health and Medical Research , INSERM CESP1018 , Villejuif , France
| | - I Kemlin
- a Pediatric Neurology Unit , APHP, GHUEP, Trousseau Hospital , Paris , France.,b Neurofibromatosis Referral Centre , Paris , France
| | - T Billette de Villemeur
- a Pediatric Neurology Unit , APHP, GHUEP, Trousseau Hospital , Paris , France.,e Sorbonne Universities, UPMC , Paris , France.,f National Institute of Health and Medical Research , INSERM U1141 , Paris , France
| | - D Rodriguez
- a Pediatric Neurology Unit , APHP, GHUEP, Trousseau Hospital , Paris , France.,b Neurofibromatosis Referral Centre , Paris , France.,e Sorbonne Universities, UPMC , Paris , France.,f National Institute of Health and Medical Research , INSERM U1141 , Paris , France
| | - G Dellatolas
- c National Institute of Health and Medical Research , INSERM CESP1018 , Villejuif , France
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Coutinho V, Kemlin I, Dorison N, Billette de Villemeur T, Rodriguez D, Dellatolas G. Neuropsychological evaluation and parental assessment of behavioral and motor difficulties in children with neurofibromatosis type 1. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 48:220-230. [PMID: 26625207 DOI: 10.1016/j.ridd.2015.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/27/2015] [Accepted: 11/12/2015] [Indexed: 06/05/2023]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant multisystem disorder, with large inter and intrafamilial clinical variability and uncertain prognosis. In children with NF1 cognitive disorders, learning difficulties and behavioral problems are common. The present study aims to establish the neuropsychological and behavioral profiles of 78 patients with NF1, aged between 5 and 18 years, and to examine the relationship between these profiles and the transmission of NF1 (sporadic vs. familial), clinical manifestations, and environmental factors. We used several questionnaires completed by parents and neuropsychological tests. The results confirmed specific neuropsychological disabilities in children with NF1, especially involving visuospatial and fine motor skills, learning difficulties and behavioral problems. Cognitive difficulties were significantly more frequent in patients with familial than in those with sporadic NF1. All parental questionnaires were correlated with each other, but parental reports were not associated with FSIQ, SES, school status, and clinical manifestations of the disease. Neuropsychological tests were poorly related to parental reports of cognitive and behavioral difficulties.
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Affiliation(s)
- V Coutinho
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France; INSERM U1178, 16, avenue Paul Vaillant Couturier, 94807 Villejuif, France; Université Paris Descartes, France.
| | - I Kemlin
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France.
| | - N Dorison
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France.
| | - T Billette de Villemeur
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France; Inserm U1141, Paris, France.
| | - D Rodriguez
- APHP, GHUEP, Hôpital Trousseau, Service de Neuropédiatrie, 26, avenue Dr. Netter, 75012 Paris, France; Centre de Référence des Neurofibromatoses, 75012 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, 75012 Paris, France; Inserm U1141, Paris, France.
| | - G Dellatolas
- INSERM U1178, 16, avenue Paul Vaillant Couturier, 94807 Villejuif, France.
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Ait Khelifa-Gallois N, Laroussinie F, Puget S, Sainte- Rose C, Dellatolas G. Long-term functional outcome of patients with cerebellar pilocytic astrocytoma surgically treated in childhood. Brain Inj 2014; 29:366-73. [DOI: 10.3109/02699052.2014.975281] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soria C, Escolano S, El Sabbagh S, Chmura S, Bulteau C, Chiron C, Dellatolas G. Behavioral problems, cognitive difficulties and quality of life in children with epilepsy: An analysis of parental concerns. Child Neuropsychol 2012; 18:209-27. [DOI: 10.1080/09297049.2011.602012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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A comparison of quality of life in adolescents with epilepsy or asthma using the Short-Form Health Survey (SF-36). Epilepsy Res 2012; 101:157-65. [PMID: 22512895 DOI: 10.1016/j.eplepsyres.2012.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 02/06/2012] [Accepted: 03/21/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the quality of life (QOL) in adolescents with epilepsy or asthma. METHODS Eighty-five epileptic adolescents, 81 adolescents with asthma and 71 normal controls were recruited from the Affiliated Children's Hospital of FuDan University from June, 2007 to December, 2007. These adolescents received the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS F-36) in order to evaluate QOL. RESULTS Although the onset age for adolescents with asthma was younger (P=0.032), there were no significant differences in clinical characteristics between adolescents with epilepsy and asthma. The results of MOS SF-36 demonstrated the following: (1) For the adolescents with epilepsy, the total QOL score and sub-scores for 8 items were significantly different between epilepsy patients and healthy controls, and the total QOL score and sub-scores for 4 items were significantly different between controlled and uncontrolled epilepsy groups; (2) for the adolescents with asthma, the total QOL score and sub-scores for 4 items were significantly different between asthma patients and healthy controls, and the total QOL score and sub-scores for 4 items were significantly different between controlled and uncontrolled asthma groups; (3) the QOL of adolescents with epilepsy was poorer than that of the adolescents with asthma regardless of the remission stage and disease stage; (4) the emotional and mental health of adolescents with epilepsy was inferior to that of adolescents with asthma. CONCLUSIONS The QOL of adolescents with chronic paroxysmal diseases including epilepsy and asthma deserves close attention and should be included as a key parameter when evaluating disease status.
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Holmes GL, Milh MM, Dulac O. Maturation of the human brain and epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:135-43. [DOI: 10.1016/b978-0-444-52898-8.00007-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Affiliation(s)
- Gregory L. Holmes
- Department of Neurology, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Edefonti V, Bravi F, Turner K, Beghi E, Canevini MP, Ferraroni M, Piazzini A. Health-related quality of life in adults with epilepsy: the effect of age, age at onset and duration of epilepsy in a multicentre Italian study. BMC Neurol 2011; 11:33. [PMID: 21392391 PMCID: PMC3062600 DOI: 10.1186/1471-2377-11-33] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 03/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The potential effect of age-related factors on health-related quality of life (HRQOL) of patients with epilepsy has rarely been analyzed in the literature. METHODS We examined this association in a selected population of 815 adults with epilepsy recruited in the context of a multicentre study for the evaluation of Epi-QoL, one of the first Italian epilepsy-specific measures of HRQOL for adults with epilepsy. The Epi-QoL is a 46-item self-administered questionnaire focusing on six domains, which was successfully tested for reproducibility and validity. Ordinary least-squares regression models were used to assess the relationships between age-related factors (patient's age, age at seizure onset, and duration of epilepsy) and overall Epi-QoL score, controlling for the effect of potential confounders. We fitted simple regression models including each age-related factor alone to assess the independent role of each factor on the overall Epi-QoL score. We also fitted multiple regression models including pairs of age-related factors solely, as well as one or two age-related factors together with the same set of confounders. RESULTS Simple regression models showed that age and duration of epilepsy were significant negative predictors of the overall Epi-QoL score: the higher was each age-related factor, the lower was the overall Epi-QoL score; age at onset alone was a nonsignificant predictor of the overall Epi-QoL score. Multiple regression models including two age-related factors solely showed that duration of epilepsy was still a significant negative predictor of the overall Epi-QoL score in both pairwise models, whereas age was a significant negative predictor only in the model including age at onset. Age at onset emerged as a significant positive predictor of the overall Epi-QoL score only in the model including age: the higher was age at onset, the higher was the overall Epi-QoL score. Adjusted regression models including either one or two age-related factors and controlling for the selected confounding variables showed that the age-related factors had no significant effect on the overall Epi-QoL score anymore. CONCLUSIONS If no other known correlates of the overall Epi-QoL score are considered, age and duration of epilepsy can be expected to have a significant negative association with HRQOL in epilepsy (with the effect of duration being stronger and more consistent across models than the one of age), whereas age at onset is a positive predictor of the overall HRQOL of limited significance. However, demographic and clinical factors, such as seizure frequency in the preceding 12 months, may provide a better explanation of HRQOL in epilepsy.
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Affiliation(s)
- Valeria Edefonti
- Sezione di Statistica Medica e Biometria Giulio A. Maccacaro, Dipartimento di Medicina del Lavoro Clinica del Lavoro L. Devoto, Università degli Studi di Milano, Milan, Italy.
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Rakhade SN, Klein PM, Huynh T, Hilario-Gomez C, Kosaras B, Rotenberg A, Jensen FE. Development of later life spontaneous seizures in a rodent model of hypoxia-induced neonatal seizures. Epilepsia 2011; 52:753-65. [PMID: 21366558 DOI: 10.1111/j.1528-1167.2011.02992.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the development of epilepsy following hypoxia-induced neonatal seizures in Long-Evans rats and to establish the presence of spontaneous seizures in this model of early life seizures. METHODS Long-Evans rat pups were subjected to hypoxia-induced neonatal seizures at postnatal day 10 (P10). Epidural cortical electroencephalography (EEG) and hippocampal depth electrodes were used to detect the presence of seizures in later adulthood (> P60). In addition, subdermal wire electrode recordings were used to monitor age at onset and progression of seizures in the juvenile period, at intervals between P10 and P60. Timm staining was performed to evaluate mossy fiber sprouting in the hippocampi of P100 adult rats that had experienced neonatal seizures. KEY FINDINGS In recordings made from adult rats (P60-180), the prevalence of epilepsy in cortical and hippocampal EEG recordings was 94.4% following early life hypoxic seizures. These spontaneous seizures were identified by characteristic spike and wave activity on EEG accompanied by behavioral arrest and facial automatisms (electroclinical seizures). Phenobarbital injection transiently abolished spontaneous seizures. EEG in the juvenile period (P10-60) showed that spontaneous seizures first occurred approximately 2 weeks after the initial episode of hypoxic seizures. Following this period, spontaneous seizure frequency and duration increased progressively with time. Furthermore, significantly increased sprouting of mossy fibers was observed in the CA3 pyramidal cell layer of the hippocampus in adult animals following hypoxia-induced neonatal seizures. Notably, Fluoro-Jade B staining confirmed that hypoxic seizures at P10 did not induce acute neuronal death. SIGNIFICANCE The rodent model of hypoxia-induced neonatal seizures leads to the development of epilepsy in later life, accompanied by increased mossy fiber sprouting. In addition, this model appears to exhibit a seizure-free latent period, following which there is a progressive increase in the frequency of electroclinical seizures.
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Affiliation(s)
- Sanjay N Rakhade
- Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA
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Effect of age on cognitive sequelae following early life seizures in rats. Epilepsy Res 2009; 85:221-30. [PMID: 19395239 DOI: 10.1016/j.eplepsyres.2009.03.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 02/07/2009] [Accepted: 03/12/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE Clinical studies have suggested that seizures in newborns are more damaging than seizures occurring in older children. However, these studies are difficult to interpret for a variety of factors including differing etiologies of seizures across ages. Animal studies can provide insights into the question of whether age of seizure onset in children is a factor in cognitive outcome. METHODS To evaluate the effect of age on seizure-induced cognitive impairment we subjected rats to 50 seizures from postnatal days P0-P10 or P15-P25. As adults the rats were studied in the Morris water maze, radial-arm water maze, open field, and active avoidance. To assess synaptic strength and network excitatory and inhibitory function animals were evaluated with long-term potentiation (LTP) and paired-pulse facilitation/inhibition. RESULTS Compared to controls, both groups of rats with recurrent seizures were impaired in spatial memory in both water maze tests, had altered activity in the open field, and did not differ from controls in active avoidance. Rats with recurrent seizures had impaired LTP but showed no deficits in paired-pulse facilitation or inhibition. While rats with later onset showed a trend to worse performance than rats with earlier seizures, the differences were not substantial. CONCLUSIONS Recurrent seizures during development are associated with long-term behavioral deficits in learning, memory and activity level as well as impaired synaptic efficiency. Age of seizure onset was not a strong predictor of outcome.
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Soria C, Callu D, Viguier D, El Sabbagh S, Bulteau C, Laroussinie F, Dellatolas G. Parental report of cognitive difficulties, quality of life and rehabilitation in children with epilepsy or treated for brain tumour. Dev Neurorehabil 2008; 11:268-75. [PMID: 19031199 DOI: 10.1080/17518420802551498] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Paediatric neurological chronic conditions are often associated with physical, cognitive, psychological and behavioural difficulties that may affect quality of life (QOL) of children and their families. In this study, we compare parental report of difficulties and rehabilitation in children with various epileptic syndromes or treated for a benign or malignant brain tumour. METHOD One hundred fifty-three children aged between 6 and 12 years were included, 119 with epilepsy (non-idiopathic generalized 31, non-idiopathic partial 62, idiopathic 26) and 34 treated for a brain tumour. Parents answered a multidimensional questionnaire on child's autonomy and cognitive or behavioural difficulties, impact of the illness on their own everyday life, and rehabilitation. RESULTS Learning difficulties were reported by a majority of parents in all groups. Behavioural and autonomy problems were more often reported in the non-idiopathic generalized epilepsy group. Report of tiredness was more frequent and of disrupting behaviour less frequent in the tumour group than in epilepsy. Impact of the child's illness on parents' QOL was strong in all groups, and stronger in case of severe forms of epilepsy. CONCLUSIONS Parental concerns are important to consider for rehabilitation programmes adapted to each child with these neurological conditions.
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Affiliation(s)
- Carmen Soria
- Institut de Psychologie, Laboratoire de Psychologie et de Neurosciences cognitives-CNRS UMR 8189, Universite Paris Descartes, Boulogne Billancourt, France
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Soria C, Bulteau C, El Sabbagh S, Jambaqué I, Bobet R, Dellatolas G. La qualité de vie chez l’enfant avec épilepsie : revue de la littérature. Arch Pediatr 2008; 15:1474-85. [DOI: 10.1016/j.arcped.2008.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 04/14/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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