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Posar A, Visconti P. Continuous Spike-Waves during Slow Sleep Today: An Update. CHILDREN (BASEL, SWITZERLAND) 2024; 11:169. [PMID: 38397281 PMCID: PMC10887038 DOI: 10.3390/children11020169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
In the context of childhood epilepsy, the concept of continuous spike-waves during slow sleep (CSWS) includes several childhood-onset heterogeneous conditions that share electroencephalograms (EEGs) characterized by a high frequency of paroxysmal abnormalities during sleep, which have negative effects on the cognitive development and behavior of the child. These negative effects may have the characteristics of a clear regression or of a slowdown in development. Seizures are very often present, but not constantly. The above makes it clear why CSWS have been included in epileptic encephalopathies, in which, by definition, frequent EEG paroxysmal abnormalities have an unfavorable impact on cognitive functions, including socio-communicative skills, causing autistic features, even regardless of the presence of clinically overt seizures. Although several decades have passed since the original descriptions of the electroclinical condition of CSWS, there are still many areas that are little-known and deserve to be further studied, including the EEG diagnostic criteria, the most effective electrophysiological parameter for monitoring the role of the thalamus in CSWS pathogenesis, its long-term evolution, the nosographic location of Landau-Kleffner syndrome, standardized neuropsychological and behavioral assessments, and pharmacological and non-pharmacological therapies.
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Affiliation(s)
- Annio Posar
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
- Department of Biomedical and Neuromotor Sciences, Bologna University, 40139 Bologna, Italy
| | - Paola Visconti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Disturbi dello Spettro Autistico, 40139 Bologna, Italy;
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Krutoshinskaya Y, Coulehan K, Pushchinska G, Spiegel R. The Reciprocal Relationship between Sleep and Epilepsy. J Pers Med 2024; 14:118. [PMID: 38276240 PMCID: PMC10817641 DOI: 10.3390/jpm14010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
The relationship between sleep and epilepsy is bidirectional. Certain epilepsy syndromes predominantly or exclusively manifest during sleep, with seizures frequently originating from non-rapid eye movement (NREM) sleep. Interictal epileptiform discharges observed on electroencephalograms are most likely to be activated during the deep NREM sleep stage known as N3. Conversely, epileptiform discharges, anti-seizure medications (ASMs), as well as other anti-seizure therapies can exert detrimental effects on sleep architecture. Moreover, the co-occurrence of sleep disorders has the potential to exacerbate seizure control. Understating the relationship between sleep and epilepsy is crucial for healthcare providers. Addressing and managing sleep-related problems in individuals with epilepsy can potentially contribute to improved seizure control and overall well-being. At the same time, improving seizure control can improve sleep quality and quantity, thus further improving the health of individuals with epilepsy.
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Affiliation(s)
- Yana Krutoshinskaya
- Department of Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, USA; (K.C.); (G.P.); (R.S.)
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Barbour K, Tian N, Yozawitz EG, Wolf S, McGoldrick PE, Sands TT, Nelson A, Basma N, Grinspan ZM. Creating rare epilepsy cohorts using keyword search in electronic health records. Epilepsia 2023; 64:2738-2749. [PMID: 37498137 PMCID: PMC10984273 DOI: 10.1111/epi.17725] [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: 01/12/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Administrative codes to identify people with rare epilepsies in electronic health records are limited. The current study evaluated the use of keyword search as an alternative method for rare epilepsy cohort creation using electronic health records data. METHODS Data included clinical notes from encounters with International Classification of Diseases, Ninth Revision (ICD-9) codes for seizures, epilepsy, and/or convulsions during 2010-2014, across six health care systems in New York City. We identified cases with rare epilepsies by searching clinical notes for keywords associated with 33 rare epilepsies. We validated cases via manual chart review. We compared the performance of keyword search to manual chart review using positive predictive value (PPV), sensitivity, and F-score. We selected an initial combination of keywords using the highest F-scores. RESULTS Data included clinical notes from 77 924 cases with ICD-9 codes for seizures, epilepsy, and/or convulsions. The all-keyword search method identified 6095 candidates, and manual chart review confirmed that 2068 (34%) had a rare epilepsy. The initial combination method identified 1862 cases with a rare epilepsy, and this method performed as follows: PPV median = .64 (interquartile range [IQR] = .50-.81, range = .20-1.00), sensitivity median = .93 (IQR = .76-1.00, range = .10-1.00), and F-score median = .71 (IQR = .63-.85, range = .18-1.00). Using this method, we identified four cohorts of rare epilepsies with over 100 individuals, including infantile spasms, Lennox-Gastaut syndrome, Rett syndrome, and tuberous sclerosis complex. We identified over 50 individuals with two rare epilepsies that do not have specific ICD-10 codes for cohort creation (epilepsy with myoclonic atonic seizures, Sturge-Weber syndrome). SIGNIFICANCE Keyword search is an effective method for cohort creation. These findings can improve identification and surveillance of individuals with rare epilepsies and promote their referral to specialty clinics, clinical research, and support groups.
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Affiliation(s)
- Kristen Barbour
- University of California San Diego, San Diego, California, USA
| | - Niu Tian
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elissa G Yozawitz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven Wolf
- Boston Children's Health Physicians, Hawthorne, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Patricia E McGoldrick
- Boston Children's Health Physicians, Hawthorne, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Tristan T Sands
- Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Nelson
- New York University Langone Medical Center, New York, New York, USA
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Renner G, Schroeder A, Irblich D. Factorial Validity of the German KABC-II at Ages 7 to 12 in a Clinical Sample: Four Factors Fit Better than Five. J Intell 2023; 11:148. [PMID: 37504791 PMCID: PMC10381406 DOI: 10.3390/jintelligence11070148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Multidimensional intelligence test batteries such as the KABC-II are widely used in clinical practice. Although validity evidence should be provided for all intended uses of a test, data on the factorial validity of the KABC-II mostly relies on the standardization samples and raises some concerns about the adequacy of the factor structure. Confirmatory factor analyses of the KABC-II core subtests were conducted in a sample of 627 children who had been assessed in German Centers for Social Pediatrics. The standard structure of the KABC-II was superior to unidimensional models but, as in previous research, evidenced cross-loadings and a high correlation between Planning/Gf and Simultaneous/Gv. Pattern Reasoning was more closely related to Simultaneous/Gv than to Planning/Gf. A four-factorial structure combining subtests from Planning/Gf and Simultaneous/Gv to form a common factor emerged as a better representation of the data. Story Completion showed a secondary loading on Knowledge/Gc. On average, most subtest variance was accounted for by the general factor. Models with bonus points for fast responses generally fitted worse than those without. Clinicians should be aware that Planning/Gf and Simultaneous/Gv measure both visual and fluid abilities. Scales of the KABC-II should not be interpreted as dimensions independent of the general factor.
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Affiliation(s)
- Gerolf Renner
- Faculty of Special Education, Ludwigsburg University of Education, 71634 Ludwigsburg, Germany
| | | | - Dieter Irblich
- Social Pediatric Center Kreuznacher Diakonie, 55469 Simmern, Germany
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Liu M, Ding J, Wang X. The interaction between circadian rhythm and epilepsy. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractEvidence about the interaction between circadian rhythms (CR) and epilepsy has been expanded with the application of advanced detection technology. An adequate understanding of how circadian system and epilepsy interact with each other could contribute to more accurate seizure prediction as well as rapid development of potential treatment timed to specific phases of CR. In this review, we present the reciprocal relationship between CR and epileptic activities from aspects of sleep effect, genetic modulation and brain biochemistry. It has been found that sleep-wake patterns, circadian timing systems and multidien rhythms have essential roles in seizure activities and interictal epileptiform discharge (IED). For instance, specific distribution patterns of seizures and IED have been reported, i.e., lighter non-rapid eye movement (NREM) sleep stage (stage 2) induces seizures while deeper NREM sleep stage (stage 3) activates IEDs. Furthermore, the epilepsy type, seizure type and seizure onset zone can significantly affect the rhythms of seizure occurrence. Apart from the common seizure types, several specific epilepsy syndromes also have a close correlation with sleep-wakefulness patterns. Sleep influences the epilepsy rhythm, and conversely, epilepsy alters the sleep rhythm through multiple pathways. Clock genes accompanied by two feedback loops of regulation have an important role in cortical excitability and seizure occurrence, which may be involved in the mTORopathy. The suprachiasmatic nuclei (SCN) has a rhythm of melatonin and cortisol secretion under the circadian pattern, and then these hormones can feed back into a central oscillator to affect the SCN-dependent rhythms, leading to variable but prominent influence on epilepsy. Furthermore, we discuss the precise predictive algorithms and chronotherapy strategies based on different temporal patterns of seizure occurrence for patients with epilepsy, which may offer a valuable indication for non-invasive closed-loop treatment system. Optimization of the time and dose of antiseizure medications, and resynchronization of disturbed CR (by hormone therapy, light exposure, ketogenic diet, novel small molecules) would be beneficial for epileptic patients in the future. Before formal clinical practice, future large-scale studies are urgently needed to assist prediction and treatment of circadian seizure activities and address unsolved restrictions.
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Behavioral health screening in pediatric epilepsy: Which measures commonly used in the United States are 'good enough'? Epilepsy Behav 2022; 134:108818. [PMID: 35841809 DOI: 10.1016/j.yebeh.2022.108818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To improve evidence-based implementation of behavioral health screening measures in pediatric epilepsy care, guidance is needed in the selection and interpretation of evidence-based screening measures. Therefore, the goals of this project were to (1) evaluate the clinical utility and psychometric properties of screening instruments frequently used in the United States (US) for anxiety, depression, and behavior problems in youth with epilepsy (YWE), and (2) provide guidance around selection and interpretation of these behavioral health screening measures. METHOD The critique was conducted in three phases: (1) identification of articles based on search criteria; (2) full review of articles for eligibility assessment; (3) evaluation of screening measures and organization into Tiers. Nine behavioral health measures frequently used to screen for anxiety, depression, and disruptive behaviors in the US were selected for evaluation. PubMed, CINAHL, Medline, and APA databases were searched using the following search terms: [target area] + [screening measure] + epilepsy + children [youth], [adolescents]. Inclusion/exclusion criteria for articles were as follows: (1) focused on YWE, (2) written in English, and (3) conducted in the US. Once articles were selected, Hunsley and Mash's criteria were used to evaluate and categorize the screening measures' psychometric properties, which have clear relevance to clinical practice. Measures were also classified into three tiers by the level of validation according to established evidence-based criteria. RESULTS Forty-one unique papers were identified through the literature search and assessed as eligible. Evaluation of screening measures revealed only two psychometrically sound measures that met criteria for Tier 1, the NDDI-E-Y and the Pediatric NeuroQoL-Depression, both depression screening measures. Several additional depression screening measures met criteria for Tier 2 (CDI-2, BASC-2-Depression Scale, and CBCL Withdrawn/Depressed Scale). Anxiety screening measures have not been validated in pediatric epilepsy and thus only met the criteria for Tier 2 (BASC-2 Anxiety Scale, CBCL DSM-IV Oriented Anxiety Problems Scale, MASC). Similarly for disruptive behaviors, two measures met Tier 2 criteria (BASC-2 Externalizing Problems Index, CBCL Externalizing Problems Index). CONCLUSION Strides have been made in the validation of behavioral health screening measures for YWE; however, continued research in this area is necessary to validate existing psychometrically sound measures and to develop and evaluate epilepsy-specific measures in the pediatric epilepsy population.
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Pangalila R, van der Meulen I. What is the effect of pharmacological treatment for continuous spike-wave during slow wave sleep syndrome and Landau-Kleffner syndrome? A Cochrane Review summary with commentary. Dev Med Child Neurol 2022; 64:411-412. [PMID: 35064927 DOI: 10.1111/dmcn.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Pangalila
- Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Ineke van der Meulen
- Erasmus University Medical Center, Department of Rehabilitation Medicine, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
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Docking KM, Knijnik SR. Prospective longitudinal decline in cognitive-communication skills following treatment for childhood brain tumor. Brain Inj 2021; 35:1472-1479. [PMID: 34495783 DOI: 10.1080/02699052.2021.1970806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The effect of childhood brain tumor and its treatments on the developing brain are recognized to cause late-occurring structural and functional changes, inclusive of neurocognitive and communication disturbances. AIMS The aim of the present study was to investigate changes in function in the prospective cognitive-communication and language abilities of two children surviving childhood brain tumor (CBT) over a 12-month period post-treatment. METHODS The comprehensive language and cognitive-communication abilities of two cases (male aged 7;8-8;8, female aged 10;9-11;9) were assessed at two timepoints over a 12-month period: six months and 18 months following completion of CBT cancer treatment. RESULTS Findings revealed a sharp decline in problem solving abilities over a 12-month period in the early stages of recovery from CBT in both cases examined, despite no or mild-moderate deficits in cognitive-communication or language function at initial assessment. Pre-literacy skills were noted to deteriorate on one task for one child, despite intact abilities at first assessment. CONCLUSIONS The findings of progressive deterioration of cognitive-communication skills in both children treated for CBT highlights a clear need for ongoing surveillance and full comprehensive assessment across development. The critical need for ongoing management after discharge and implementation of early intervention throughout development is highlighted.
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Affiliation(s)
- Kimberley M Docking
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stefani R Knijnik
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Sigafoos J, O’Reilly MF, Ledbetter-Cho K, Lim N, Lancioni GE, Marschik PB. Addressing sequelae of developmental regression associated with developmental disabilities: A systematic review of behavioral and educational intervention studies. Neurosci Biobehav Rev 2019; 96:56-71. [DOI: 10.1016/j.neubiorev.2018.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/06/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
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Lee YJ, Hwang SK, Kwon S. The Clinical Spectrum of Benign Epilepsy with Centro-Temporal Spikes: a Challenge in Categorization and Predictability. J Epilepsy Res 2017; 7:1-6. [PMID: 28775948 PMCID: PMC5540684 DOI: 10.14581/jer.17001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/17/2017] [Indexed: 02/06/2023] Open
Abstract
Benign epilepsy with centro-temporal spikes (BECTS) is the most common type of focal epilepsy in children; it is age-dependent and presumably genetic. Traditionally, children with BECTS have a very good prognosis, even without medical treatment, and are thought to show no neurological symptoms or cognitive deficits. However, many previous studies have shown that BECTS can present with various clinical and electroencephalographic characteristics that are commonly associated with neuropsychological deficits, including linguistic, cognitive, and behavioral impairment. The degree of the neuropsychological deficits appears to depend on the sleep cycle and the localization of epileptiform discharges. Furthermore, based on neurobiological studies, a complex interplay between the processes of brain maturation and the involvement of genes that confer susceptibility may contribute to a variety of different childhood epileptic syndromes with various neuropsychological deficits. Thus, BECTS, atypical benign focal epilepsy during childhood, status epilepticus of BECTS, Landau-Kleffner syndrome, and epileptic encephalopathy with continuous spike-and-wave during sleep are all considered different entities, but are part of a single spectrum of disorders. In clinical practice, we have to consider BECTS as benign only when there are no or only mild neuropsychological deficits before medical treatment.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Su Kyeong Hwang
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soonhak Kwon
- Department of Pediatric Neurology, Kyungpook National University Children's Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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