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Sharma S, Anand A, Garg D, Batra S, Mukherjee SB, Patra B, Aneja S. Use of the International League Against Epilepsy (ILAE) 1989, 2010, and 2017 Classification of Epilepsy in children in a low-resource setting: A hospital-based cross-sectional study. Epilepsia Open 2020; 5:397-405. [PMID: 32913948 PMCID: PMC7469804 DOI: 10.1002/epi4.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/18/2020] [Accepted: 05/10/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This cross-sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource-limited setting in India. METHODS Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II-epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme. RESULTS Seven hundred and twenty-six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system (P = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes (P = .31) or the 2010 and 2017 schemes (P = .10). SIGNIFICANCE The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.
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Affiliation(s)
- Suvasini Sharma
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
| | - Aakanksha Anand
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
| | - Divyani Garg
- Department of NeurologyLady Hardinge Medical College and associated Smt. Sucheta Kriplani HospitalNew DelhiIndia
| | - Sakshi Batra
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
| | - Sharmila B. Mukherjee
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
| | - Bijoy Patra
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
| | - Satinder Aneja
- Department of PediatricsLady Hardinge Medical College and associated Kalawati Saran Children’s HospitalNew DelhiIndia
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Analysis of the aetiology of epilepsy in 3,216 adult patients attending a tertiary referral center enabled by an electronic patient record. Seizure 2020; 81:332-337. [PMID: 32883563 PMCID: PMC7442552 DOI: 10.1016/j.seizure.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/27/2023] Open
Abstract
Large scale studies examining the aetiologies of the epilepsies in existence worldwide are few. Assigning causation in epilepsy is a dynamic and evolving diagnostic process owing to continuous advances in science and technology. Electronic patient records offer immense clinical and research opportunities to clinicians. The data acquisition process used in this study utilised a bespoke extant dynamic clinically utilised electronic heath record. This is the first robust large analysis of aetiology following the publication of updated ILAE 2017 classification system.
Purpose The aim of this study was to review the causes of the epilepsies in our institution, an adult tertiary referral center for neurology and neurosurgery in Dublin, Ireland. Data was obtained from a bespoke epilepsy electronic patient record (EPR). Methods Predetermined search parameters of well-established broad categories of epilepsy aetiology were used to identify patients with a diagnosis of epilepsy attending Beaumont Hospital, Dublin. There were 3216 patients that met the inclusion criteria for this study. We included living patients with epilepsy attending our institution. We then excluded patients with a diagnosis of pure non-epileptic attack disorder and patients found to have idiopathic generalised epilepsy (IGE) (n = 382) from our final cohort. We excluded IGE due to the complex polygenic basis underlying this patient group. Results An aetiology was identified in 54.3 % (n = 1747) of the total number of patients studied. Of the symptomatic epilepsies, 41.08 % (n = 1321) were acquired and 13.3 % (n = 426) were predominantly of genetic or developmental aetiology. The most common causes of the acquired epilepsies were hippocampal sclerosis (n = 380; 28.75 %), cerebral tumor (n = 279; 21.06 %), traumatic brain injury (n = 248; 18.77 %), stroke and cerebrovascular disease (n = 151; 11.43 %) and perinatal causes (n = 138; 10.45 %). The leading causes in the genetic / developmental category included cavernous haemangiomas (n = 62, 22.22 %), arteriovenous malformations (n = 59; 21.15 %) and cortical dysplasia (n = 55; 19.71 %). The aetiology of a patient’s epilepsy was undetermined in 45.68 % (n = 1469) of individuals. Conclusion This study emphasizes the clinical utility of the ILAE’s 2017 revised classification of the epilepsies and highlights the evolving dynamic nature of attributing causality in epilepsy. This is the largest single centre analysis of the aetiology of the epilepsies described in the literature. It is also the first large scale study examining aetiology utilising a bespoke electronic patient record in epilepsy.
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Wang F, Chen Z, Davagnanam I, Hoskote C, Ding D, Wang W, Yang B, Wang Y, Wang T, Li W, Sander JW, Kwan P. Comparing two classification schemes for seizures and epilepsy in rural China. Eur J Neurol 2018; 26:422-427. [PMID: 30414301 DOI: 10.1111/ene.13857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The International League against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. The 2017 classifications were compared with the 1980s classifications in rural China. METHODS People with epilepsy receiving treatment under the National Epilepsy Control Programme were recruited from rural areas in China. Their seizures and epileptic syndrome were classified using the 1980s ILAE classification system and then re-classified according to the 2017 system. Differences in seizure, epilepsy and aetiology classifications were identified. RESULTS A total of 597 individuals (58% males, aged 6-78 years) were included. Amongst them 535 (90%) had a single seizure type, 57 (9.55%) had two types and five (0.84%) had three. There was complete agreement between the 1981 and 2017 classifications for the 525 individuals with focal seizures. Seizures originally classified as generalized in 10 of 65 individuals were re-classified as unknown in the 2017 classification. Compared to the 1980s classifications, the proportion of individuals with unknown seizures and unknown epilepsy increased from 1.2% (7/597) to 2.8% (17/597, P = 0.002), and unknown aetiology increased from 32% (189/597: 182 cryptogenic and seven unclassified) to 39% (230/597; P < 0.001) in the 2017 classifications. CONCLUSIONS The 1980s and 2017 classifications had 100% agreement in classifying focal seizures and epilepsy in rural China. A small but significant proportion of generalized seizures and epilepsy and aetiologies classified in the old classifications were re-classified to unknown in the new classifications. These results highlight the need for improvement in clinical evaluation of people with epilepsy in resource-poor settings.
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Affiliation(s)
- F Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Z Chen
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Davagnanam
- Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - C Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Ding
- Fudan University, Shanghai, China
| | - W Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - B Yang
- Jiaozuo People's Hospital, Henan, China
| | - Y Wang
- Ningxia Medical University, Ningxia, China
| | - T Wang
- Jincheng Emergency Medical Rescue Center, Jincheng, China
| | - W Li
- Affiliated Second Hospital, Hebei Medical University, Hebei, China
| | - J W Sander
- NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - P Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Al-Qudah AA, Albsoul-Younes A, Masri AT, AbuRahmah SK, Alabadi IA, Nafi OA, Gharaibeh LF, Murtaja AA, Al-Sakran LH, Arabiat HA, Al-Shorman AA. Type and etiology of pediatric epilepsy in Jordan. A multi-center study. ACTA ACUST UNITED AC 2017; 22:267-273. [PMID: 29057851 PMCID: PMC5946375 DOI: 10.17712/nsj.2017.4.20170164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To study types and etiologies of epilepsy in Jordanian pediatric epileptic patients maintained on antiepileptic drugs using customized classification scheme of International League Against Epilepsy (ILAE) (2010) report. METHODS This is a cross-sectional, multi-centre study on pediatric epileptic patients on antiepileptic drugs, who were managed in the pediatric neurology clinics at 6 teaching public hospitals in Jordan. RESULTS Out of the 663 patients included in the study, (90.2%) had one seizure type, (53%) of this type were focal seizures followed by generalized seizures (41.5%) and spasms (5.5%). Distinctive constellations were found in 11/663 (1.7%) patients. Benign epilepsies with centrotemporal spikes were the most common electro clinical syndromes 60/221 (27.1%). Epilepsies attributed to structural-metabolic causes were documented in 278/663 (41.9%) patients, unknown causes 268/663(40.4%) and genetic causes in 117/663(17.7%). Most common causes of structural-metabolic group were due to perinatal insults (32%) and most common causes of the genetic group were the presumed genetic electro clinical syndromes (93.1%). CONCLUSION Our study is on pediatric epilepsy, using customized classification scheme from the ILAE 2010 report which showed interesting results about type and etiology of epileptic seizures from developing country with potential impact on the international level.
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Affiliation(s)
- Abdelkarim A Al-Qudah
- Department of Pediatrics, Faculty of Medicine, University of Jordan, Amman, Jordan. E-mail:
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Verma M, Arora A, Malviya S, Nehra A, Sagar R, Tripathi M. Do expressed emotions result in stigma? A potentially modifiable factor in persons with epilepsy in India. Epilepsy Behav 2015; 52:205-11. [PMID: 26453891 DOI: 10.1016/j.yebeh.2015.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/23/2015] [Accepted: 08/05/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Feeling stigmatized or having comorbid depression in a PWE may significantly influence epilepsy care and treatment. An important contributory factor to this can be the expressed emotions (EEs) from family, friends, or society. The present study aimed at understanding the influence of EEs, as exhibited by close relatives, on the perception of stigma and comorbid depression experienced by PWEs. METHOD Eighty PWEs aged 18 years and above, both genders, visiting neurology OPD in AIIMS Hospital, were recruited. Using the PHQ-09, we subdivided them into Group I (PWEs with comorbid depression) and Group II (PWEs without comorbid depression), followed by administration of Levels of Expressed Emotions Scale and Stigma Scale for Epilepsy, respectively. RESULTS The comparative analysis, using independent t-test (for categorical data), Pearson's correlation (for continuous data), and multivariate regression analysis, reflected significant influence of EEs on depression and stigma, with more than 20% of the participants reporting comorbid depression, out of which more than 50% further expressed feelings of inferiority or disgrace due to the ways in which family or society discriminated them from healthy persons, thereby highlighting a greater associations of high EEs as opposed to low EEs from key individuals on patients' perception of stigma or feeling of depression. CONCLUSION The result suggested that EEs from a relative might go unnoticed but may significantly overwhelm the patient, thereby making him succumb to depression or feeling stigmatized. The analysis of such a clinical profile and relationship between EEs and perceived stigma/depression may help us understand the pattern of attribution styles adopted by PWEs, thereby utilizing it further for enhancing the efficacy of cognitive-behavioral therapy for facilitating sustained recovery and improved quality of life for PWEs.
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Affiliation(s)
- Mansi Verma
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Amit Arora
- Department of Neurology, AIIMS, Delhi, India.
| | | | - Ashima Nehra
- Department of Neuropsychology, AIIMS, Delhi, India.
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