1
|
Peek SI, Twele F, Meller S, Packer RMA, Volk HA. Epilepsy is more than a simple seizure disorder: Causal relationships between epilepsy and its comorbidities. Vet J 2024; 303:106061. [PMID: 38123062 DOI: 10.1016/j.tvjl.2023.106061] [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: 06/05/2021] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
This review draws connections between the pathogenesis of canine epilepsy and its most commonly recognised comorbidities: cognitive impairment (CI), attention deficit hyperactivity disorder (ADHD)-like behaviour, fear and anxiety. Uni/bidirectional causalities and the possibility of a common aetiology triggering both epilepsy and the associated diseases are considered. Research on this topic is sparse in dogs, so information has been gathered and assessed from human and laboratory animal studies. Anatomical structures, functional connections, disrupted neurotransmission and neuroinflammatory processes collectively serve as a common foundation for epilepsy and its comorbidities. Specific anatomical structures, especially parts of the limbic system, such as the amygdala and the hippocampus, are involved in generating seizures, as well as cognitive- and behavioural disorders. Furthermore, disturbances in inhibitory and excitatory neurotransmission influence neuronal excitability and networks, leading to underlying brain dysfunction. Functional magnetic resonance imaging (fMRI), interictal epileptiform discharges (IEDs), and electroencephalography (EEG) have demonstrated functional brain connections that are related to the emergence of both epilepsy and its various comorbidities. Neuroinflammatory processes can either cause or be a consequence of seizures, and inflammatory mediators, oxidative stress and mitochondrial dysfunction, can equally evoke mood disorders. The extensive relationships contributing to the development and progression of seizures and comorbid cognitive and behavioural conditions illustrate the complexity of the disease that is epilepsy.
Collapse
Affiliation(s)
- Saskia I Peek
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Friederike Twele
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany.
| |
Collapse
|
2
|
Chioma R, Sbordone A, Patti ML, Perri A, Vento G, Nobile S. Applications of Artificial Intelligence in Neonatology. APPLIED SCIENCES 2023; 13:3211. [DOI: 10.3390/app13053211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
The development of artificial intelligence methods has impacted therapeutics, personalized diagnostics, drug discovery, and medical imaging. Although, in many situations, AI clinical decision-support tools may seem superior to rule-based tools, their use may result in additional challenges. Examples include the paucity of large datasets and the presence of unbalanced data (i.e., due to the low occurrence of adverse outcomes), as often seen in neonatal medicine. The most recent and impactful applications of AI in neonatal medicine are discussed in this review, highlighting future research directions relating to the neonatal population. Current AI applications tested in neonatology include tools for vital signs monitoring, disease prediction (respiratory distress syndrome, bronchopulmonary dysplasia, apnea of prematurity) and risk stratification (retinopathy of prematurity, intestinal perforation, jaundice), neurological diagnostic and prognostic support (electroencephalograms, sleep stage classification, neuroimaging), and novel image recognition technologies, which are particularly useful for prompt recognition of infections. To have these kinds of tools helping neonatologists in daily clinical practice could be something extremely revolutionary in the next future. On the other hand, it is important to recognize the limitations of AI to ensure the proper use of this technology.
Collapse
Affiliation(s)
- Roberto Chioma
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Annamaria Sbordone
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Letizia Patti
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Alessandro Perri
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Vento
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefano Nobile
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| |
Collapse
|
3
|
Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
Collapse
Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| |
Collapse
|
4
|
Canitano R, Palumbi R, Scandurra V. Autism with Epilepsy: A Neuropsychopharmacology Update. Genes (Basel) 2022; 13:1821. [PMID: 36292706 PMCID: PMC9601574 DOI: 10.3390/genes13101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022] Open
Abstract
The association between autism spectrum disorders (ASD) and epilepsy has been extensively documented, and the estimated prevalence varies depending upon the selected population and the clinical characteristics. Currently, there are a lack of studies assessing the patient care pathways in ASD, particularly for comorbidity with epilepsy, despite its personal, familial, and economic impacts. Genetic abnormalities are likely implicated in the association of ASD and epilepsy, although they are currently detectable in only a small percentage of patients, and some known genetic and medical conditions are associated with ASD and epilepsy. There is no specificity of seizure type to be expected in children and adolescents with ASD compared with other neurodevelopmental disorders or epileptic syndromes. Treatment options include antiepileptic drugs (AED) and developmentally-based early interventions for ASD. Carbamazepine and lamotrigine are the most used AED, but further studies are needed to more precisely define the most suitable medications for this specific group of children with ASD.
Collapse
Affiliation(s)
- Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, 53100 Siena, Italy
| | - Roberto Palumbi
- Basic Medical Sciences, Neurosciences, and Sensory Organs Department, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Valeria Scandurra
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, 53100 Siena, Italy
| |
Collapse
|
5
|
Hasegawa N, Annaka H. Cognitive features of adult focal epilepsy with unknown etiology revealed by the trail making test. Epilepsy Behav 2022; 129:108625. [PMID: 35245763 DOI: 10.1016/j.yebeh.2022.108625] [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: 09/17/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether the Trail Making Test (TMT) can clarify cognitive dysfunction in focal epilepsy with unknown etiology. METHODS Trail Making Test data were obtained from patients with focal epilepsy with no structural abnormalities on magnetic resonance imaging, history or coexistence of central nerve system diseases, intellectual disability, psychiatric disorders, or medications that might interfere with cognitive function. We performed multiple regression analyses with TMT scores as dependent variables and clinical features as independent variables. RESULTS We enrolled 125 patients in the study. The statistical analyses revealed that taking fewer antiseizure medications, having a longer duration of education, exhibiting left non-temporal epileptic discharge, and exhibiting right temporal epileptic discharge were associated with shorter time to complete the TMT-A and TMT-B. Older age at the time of last seizure was associated with longer time to complete the TMT-B. In addition, a longer active seizure period was associated with longer time to complete the TMT-A subtracted from time to complete the TMT-B. CONCLUSIONS This study indicated that the TMT can be used for assessing the cumulative effects of seizures and the effects of polypharmacy on cognitive function in patients with focal epilepsy. Furthermore, our results indicated that the visuospatial cognitive ability associated with the TMT may depend on the site of epileptic focus of non-lesional focal epilepsy.
Collapse
Affiliation(s)
- Naoya Hasegawa
- Department of Psychiatry, National Hospital Organization, Nishiniigata Chuo Hospital Epilepsy Center, 1-14-1 Masago, Nishi-ku, Niigata 950-2085 Japan.
| | - Hiroki Annaka
- Department of Rehabilitation, National Hospital Organization, Nishiniigata Chuo Hospital Epilepsy Center, 1-14-1 Masago, Nishi-ku, Niigata 950-2085 Japan; Graduate School, Niigata University of Health and Welfare, 1398 Shimami-tyou, Kita-ku, Niigata, Niigata 950-3198 Japan
| |
Collapse
|
6
|
Herlopian A, Barnett JR, Nascimento FA, Lee H, Thiele EA. Electroencephalographic changes in purified pharmaceutical cannabidiol therapy. Epilepsy Behav 2022; 128:108558. [PMID: 35078115 DOI: 10.1016/j.yebeh.2022.108558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/02/2022] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Evaluate electroencephalographic changes in patients receiving purified pharmaceutical cannabidiol (CBD). METHODS A total of 104 EEG studies from 52 patients with pediatric-onset refractory epilepsy, who were enrolled in the FDA-approved expanded access investigational new drug program, were retrospectively analyzed for electroencephalographic changes in the background, interictal epileptiform discharges (IEDs), ictal findings, and sleep architecture after CBD treatment. RESULTS Patients were between 18 months and 52 years of age. After CBD treatment, 88.4% (46/52) of patients had EEG changes. Eighty-nine percent of these patients had changes in their background, 74% in IEDs, 46% in ictal findings, and 17% in sleep architecture. Seven out of 52 patients had modified hypsarrhythmia on their pre-treatment EEG. The pattern resolved in 2/7 patients (29%), diminished in prevalence in 4/7 (57%) subjects, and remained unchanged in 1/7 (14%) cases. Electrographic improvement was seen in 70% (32/46) of the patients, and worsening in 7% (3/46) of the cases. At the post-CBD EEG, 83% had a reduction in the frequency of the most predominant seizure type, and 25% reported subjective cognitive improvement. Of these patients, 88% (p = 0.09) and 92% (p = 0.45) had corresponding EEG changes, respectively. CONCLUSION Our results revealed electrographic changes in association with the CBD treatment. Despite these changes, a substantial association between specific electrographic findings and clinical outcomes was not established.
Collapse
Affiliation(s)
- Aline Herlopian
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, 15 York St, LCI-7, New Haven, CT 06510, USA
| | - James R Barnett
- Pediatric Epilepsy, Program Department of Neurology, Massachusetts General Hospital Boston, MA 02114, USA
| | - Fábio A Nascimento
- Epilepsy Program, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics, Harvard Medical School, 50 Staniford St, Boston, MA 02114, USA
| | - Elizabeth A Thiele
- Pediatric Epilepsy, Program Department of Neurology, Massachusetts General Hospital Boston, MA 02114, USA.
| |
Collapse
|
7
|
Epilepsy Surgery is a Viable Treatment for Lennox Gastaut Syndrome. Semin Pediatr Neurol 2021; 38:100894. [PMID: 34183143 DOI: 10.1016/j.spen.2021.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
Lennox Gastaut Syndrome (LGS) is a severe developmental epileptic encephalopathy with onset in childhood characterized by multiple seizure types and characteristic electroencephalogram findings. The majority of patients develop drug resistant epilepsy, defined as failure of 2 appropriate anti-seizure medications used at adequate doses. Epilepsy surgery can reduce seizure burden, in some cases leading to seizure freedom, and improve neuro-developmental outcomes and quality of life. Epilepsy surgery should be considered for all patients with drug resistant LGS. Herein, we review current surgical treatment options for patients with LGS, both definitive and palliative, including: focal cortical resection, vagus nerve stimulation and corpus callosotomy. Newer neuromodulation techniques will be explored, as well as the concept of LGS as a secondary network disorder.
Collapse
|
8
|
Watkins MW, Shah EG, Funke ME, Garcia-Tarodo S, Shah MN, Tandon N, Maestu F, Laohathai C, Sandberg DI, Lankford J, Thompson S, Mosher J, Von Allmen G. Indications for Inpatient Magnetoencephalography in Children - An Institution's Experience. Front Hum Neurosci 2021; 15:667777. [PMID: 34149382 PMCID: PMC8213217 DOI: 10.3389/fnhum.2021.667777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Magnetoencephalography (MEG) is recognized as a valuable non-invasive clinical method for localization of the epileptogenic zone and critical functional areas, as part of a pre-surgical evaluation for patients with pharmaco-resistant epilepsy. MEG is also useful in localizing functional areas as part of pre-surgical planning for tumor resection. MEG is usually performed in an outpatient setting, as one part of an evaluation that can include a variety of other testing modalities including 3-Tesla MRI and inpatient video-electroencephalography monitoring. In some clinical circumstances, however, completion of the MEG as an inpatient can provide crucial ictal or interictal localization data during an ongoing inpatient evaluation, in order to expedite medical or surgical planning. Despite well-established clinical indications for performing MEG in general, there are no current reports that discuss indications or considerations for completion of MEG on an inpatient basis. We conducted a retrospective institutional review of all pediatric MEGs performed between January 2012 and December 2020, and identified 34 cases where MEG was completed as an inpatient. We then reviewed all relevant medical records to determine clinical history, all associated diagnostic procedures, and subsequent treatment plans including epilepsy surgery and post-surgical outcomes. In doing so, we were able to identify five indications for completing the MEG on an inpatient basis: (1) super-refractory status epilepticus (SRSE), (2) intractable epilepsy with frequent electroclinical seizures, and/or frequent or repeated episodes of status epilepticus, (3) intractable epilepsy with infrequent epileptiform discharges on EEG or outpatient MEG, or other special circumstances necessitating inpatient monitoring for successful and safe MEG data acquisition, (4) MEG mapping of eloquent cortex or interictal spike localization in the setting of tumor resection or other urgent neurosurgical intervention, and (5) international or long-distance patients, where outpatient MEG is not possible or practical. MEG contributed to surgical decision-making in the majority of our cases (32 of 34). Our clinical experience suggests that MEG should be considered on an inpatient basis in certain clinical circumstances, where MEG data can provide essential information regarding the localization of epileptogenic activity or eloquent cortex, and be used to develop a treatment plan for surgical management of children with complicated or intractable epilepsy.
Collapse
Affiliation(s)
- Michael W Watkins
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Ekta G Shah
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Michael E Funke
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Stephanie Garcia-Tarodo
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Pediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Manish N Shah
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States
| | - Fernando Maestu
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Universidad Complutense and Universidad Politecnica de Madrid, Madrid, Spain.,Department of Experimental Psychology, Universidad Complutense de Madrid, Madrid, Spain
| | - Christopher Laohathai
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - David I Sandberg
- Department of Neurosurgery, McGovern Medical School, Houston, TX, United States.,Division of Pediatric Neurosurgery, Department of Pediatric Surgery, McGovern Medical School, Houston, TX, United States
| | - Jeremy Lankford
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States
| | - Stephen Thompson
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - John Mosher
- Department of Neurology, McGovern Medical School, Houston, TX, United States
| | - Gretchen Von Allmen
- Division of Child Neurology, Department of Pediatrics, McGovern Medical School, Houston, TX, United States.,Department of Neurology, McGovern Medical School, Houston, TX, United States
| |
Collapse
|
9
|
de Rooy RLP, Halbertsma FJ, Struijs EA, van Spronsen FJ, Lunsing RJ, Schippers HM, van Hasselt PM, Plecko B, Wohlrab G, Whalen S, Benoist JF, Valence S, Mills PB, Bok LA. Pyridoxine dependent epilepsy: Is late onset a predictor for favorable outcome? Eur J Paediatr Neurol 2018; 22:662-666. [PMID: 29661537 DOI: 10.1016/j.ejpn.2018.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/06/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
AIM In pyridoxine dependent epilepsy (PDE), patients usually present with neonatal seizures. A small subgroup is characterized by late-onset beyond 2 months of age. We aim to analyze the observation of relatively good cognitive outcome in this subgroup of late-onset PDE patients. METHODS We retrospectively analyzed data from four metabolically and genetically confirmed late-onset patients with PDE due to antiquitin (ALDH7A1) deficiency. Data were analyzed regarding ALDH7A1 mutations, alpha-Aminoadipic semialdehyde (α-AASA) and pipecolic acid (PA) levels, medication during pregnancy, delivery, treatment delay, amount of seizures, pyridoxine dose, adjuvant therapy and findings on brain MRI. RESULTS Results showed that three patients had relatively good outcome (IQ 80-97), while one patient did not undergo formal testing and was considered mildly delayed. We were unable to find a clear association between the above-mentioned variables and cognitive outcome, although a less severe genotype may be present in three patients, and maternal medication could be accountable for better outcome in two patients. INTERPRETATION We suggest that favorable outcome in late onset PDE might be explained by a combination of factors. A yet unknown protective factor, different genetic variations, functional variation and secondarily variation in treatment regimens and absence of neonatal seizure induced brain damage.
Collapse
Affiliation(s)
- R L P de Rooy
- Department of Pediatrics, Zuyderland Hospital, Heerlen, The Netherlands
| | - F J Halbertsma
- Department of Pediatrics, Màxima Medical Center, Veldhoven, The Netherlands
| | - E A Struijs
- Metabolic Unit, Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - F J van Spronsen
- Department of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R J Lunsing
- Department of Child Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H M Schippers
- Department of Neurology, Sint Antonius Ziekenhuis, Nieuwegein, Utrecht, The Netherlands
| | - P M van Hasselt
- Department of Pediatric Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - B Plecko
- Division of Neurology, Children's Hospital, University of Zurich, Zurich, Switzerland
| | - G Wohlrab
- Division of Neurology, Children's Hospital, University of Zurich, Zurich, Switzerland
| | - S Whalen
- UF de génétique clinique, APHP, Hôpital Armand Trousseau, Paris, France
| | - J F Benoist
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Biochimie-Hormonologie, Hôpital Robert Debré, Paris, France
| | - S Valence
- Department of Child Neurology, APHP, Armand Trousseau Hospital, Paris, France
| | - P B Mills
- Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London, United Kingdom
| | - L A Bok
- Department of Pediatrics, Màxima Medical Center, Veldhoven, The Netherlands.
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Cognitive impairments are common in children with epilepsy. They may already be present before the onset of epilepsy or occur - and even progress - during its course. Many variables contribute to cognitive dysfunction. Those that can be targeted to prevent (further) cognitive impairment will be highlighted in this review. RECENT FINDINGS Ideally, but not yet realistically, epileptogenesis is prevented to avert seizures and cognitive impairments in high-risk patients. New and targeted treatments of progressive epileptogenic disorders and precision medicine approaches in genetic epilepsies are increasingly applied. Cognitive outcome benefits from early diagnosis and treatment of epileptic encephalopathy. Ongoing seizures may cause permanent and progressive changes in brain structure and connectivity, suggesting that early seizure control optimizes eventual cognitive functioning. Frequent interictal epileptiform discharges justify treatment in children with cognitive impairments that are otherwise unexplained. Cognitive adverse effects of antiepileptic drugs should be closely monitored and balanced against potential benefits. Finally, early surgical treatment in selected candidates will improve their cognitive outcome. SUMMARY Although important determinants of intellectual functioning - including the child's genetic and environmental background and the epileptogenic pathology - may not be modifiable, several variables that contribute to cognitive impairment can be targeted to improve outcome. Early etiological diagnosis, personalized therapies, presurgical evaluation, and strict control of seizures - or in some patients interictal discharges - can prevent (further) cognitive impairments.
Collapse
|
11
|
Oates S, Tang S, Rosch R, Lear R, Hughes EF, Williams RE, Larsen LHG, Hao Q, Dahl HA, Møller RS, Pal DK. Incorporating epilepsy genetics into clinical practice: a 360°evaluation. NPJ Genom Med 2018; 3:13. [PMID: 29760947 PMCID: PMC5945675 DOI: 10.1038/s41525-018-0052-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 01/13/2023] Open
Abstract
We evaluated a new epilepsy genetic diagnostic and counseling service covering a UK population of 3.5 million. We calculated diagnostic yield, estimated clinical impact, and surveyed referring clinicians and families. We costed alternative investigational pathways for neonatal onset epilepsy. Patients with epilepsy of unknown aetiology onset < 2 years; treatment resistant epilepsy; or familial epilepsy were referred for counseling and testing. We developed NGS panels, performing clinical interpretation with a multidisciplinary team. We held an educational workshop for paediatricians and nurses. We sent questionnaires to referring paediatricians and families. We analysed investigation costs for 16 neonatal epilepsy patients. Of 96 patients, a genetic diagnosis was made in 34% of patients with seizure onset < 2 years, and 4% > 2 years, with turnaround time of 21 days. Pathogenic variants were seen in SCN8A, SCN2A, SCN1A, KCNQ2, HNRNPU, GRIN2A, SYNGAP1, STXBP1, STX1B, CDKL5, CHRNA4, PCDH19 and PIGT. Clinician prediction was poor. Clinicians and families rated the service highly. In neonates, the cost of investigations could be reduced from £9362 to £2838 by performing gene panel earlier and the median diagnostic delay of 3.43 years reduced to 21 days. Panel testing for epilepsy has a high yield among children with onset < 2 years, and an appreciable clinical and financial impact. Parallel gene testing supersedes single gene testing in most early onset cases that do not show a clear genotype-phenotype correlation. Clinical interpretation of laboratory results, and in-depth discussion of implications for patients and their families, necessitate multidisciplinary input and skilled genetic counseling. Screening for epilepsy-related gene variants can lead to effective, personalized treatment plans while reducing costs. UK and Danish scientists, led by Deb Pal, King’s College London, evaluated a new service within the UK that searches for genetic variants in patients that cause epilepsy. The authors assessed the impact of next-generation gene panel tests, as well as the necessary resources to make such a service effective. Genetic testing was most effective in patients with seizure onset under 2 years old (21% diagnosed) and yield even higher in neonatal-onset epilepsy (63% diagnosed). For many patients with pathogenic variants, the diagnoses allowed for recommendations on treatment or enrolment in clinical trials. The researchers found that diagnostic delay and financial burden in neonatal epilepsy could be drastically reduced with gene panel testing. The scheme was highly rated by users and patients alike.
Collapse
Affiliation(s)
- Stephanie Oates
- 1King's College Hospital, London, UK.,2Evelina London Children's Hospital, London, UK
| | | | | | | | - Elaine F Hughes
- 1King's College Hospital, London, UK.,2Evelina London Children's Hospital, London, UK
| | | | | | - Qin Hao
- Amplexa Genetics, Odense, Denmark
| | | | - Rikke S Møller
- Danish National Epilepsy Centre, Dianalund, Denmark.,6Institute for Regional Health research, University of Southern Denmark, Odense, Denmark
| | - Deb K Pal
- 1King's College Hospital, London, UK.,2Evelina London Children's Hospital, London, UK.,3Kings College London, London, UK
| |
Collapse
|
12
|
Vega C, Sánchez Fernández I, Peters J, Thome-Souza MS, Jackson M, Takeoka M, Wilkening GN, Pearl PL, Chapman K, Loddenkemper T. Response to clobazam in continuous spike-wave during sleep. Dev Med Child Neurol 2018; 60:283-289. [PMID: 29168169 DOI: 10.1111/dmcn.13607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the efficacy of clobazam treatment in reducing epileptiform discharges and modifying neuropsychological function in continuous spike-wave during slow wave sleep. METHOD We performed a prospective clinical trial in patients with continuous spike-wave during sleep aged 4 to 10 years. Patients underwent neuropsychological assessment and overnight electroencephalographic monitoring before treatment, and subsequent repeat assessment and overnight electroencephalographic monitoring 3 months after treatment. Treatment consisted of 1mg/kg clobazam up to a maximum dose of 30mg during the first night, followed by 0.5mg/kg nightly for 3 months. RESULTS Nine patients completed the study and had pre- and post-neuropsychological evaluation. There was a qualitative reduction in median (p25 -p75 ) spike percentage after 3 months (72.2 [68.0-75.8] vs 32.7 [4.7-81.7]). There were no marked changes in median (p25 -p75 ) IQ comparing pre- and post-clobazam treatment (80.0 [74.0-88.0] vs 80.0 [67.0-89.0]). There was a qualitative increase in Verbal IQ (83.0 [69.0-92.0] vs 95.0 [83.0-99.0]) and a qualitative decrease in Non-verbal IQ (84.0 [74.0-87.0] vs 71.0 [60.0-84.0]). INTERPRETATION Qualitative improvements in epileptiform activity and cognition occurred in patients treated with clobazam for 3 months and the relationship between epileptiform activity and cognitive outcome should be studied in larger studies. WHAT THIS PAPER ADDS Verbal IQ in patients with continuous spike-wave during sleep improved following short-term treatment with clobazam. Other neuropsychological improvements were observed, but varied by patient. Cognitive improvement was observed despite some worsening of epileptiform discharges.
Collapse
Affiliation(s)
- Clemente Vega
- Neurology/Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Ivan Sánchez Fernández
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA.,Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Jurriaan Peters
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Maria S Thome-Souza
- Departments of Neurology and Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Michele Jackson
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Masanori Takeoka
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Greta N Wilkening
- Pediatrics and Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Phillip L Pearl
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Kevin Chapman
- Pediatrics and Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO, USA
| | - Tobias Loddenkemper
- Neurology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Patel AD, Berg AT, Billinghurst L, Fain D, Fecske E, Feyma T, Grinspan Z, Houtrow A, Kothare S, Kumar G, Lee E, Monduy M, Morita D, Szperka CL, Victorio MC, Yeh A, Buchhalter JR. Quality improvement in neurology: Child neurology quality measure set: Executive summary. Neurology 2017; 90:67-73. [PMID: 29247076 DOI: 10.1212/wnl.0000000000004806] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023] Open
Affiliation(s)
- Anup D Patel
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Anne T Berg
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Lori Billinghurst
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Daniel Fain
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Erin Fecske
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Tim Feyma
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Zachary Grinspan
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Amy Houtrow
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Sanjeev Kothare
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Gogi Kumar
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Erin Lee
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Migvis Monduy
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Diego Morita
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Christina L Szperka
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - M Cristina Victorio
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Ann Yeh
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| | - Jeffrey R Buchhalter
- From Nationwide Children's Hospital (A.D.P.), Columbus, OH; Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Chicago, IL; Children's Hospital of Philadelphia (L.B., C.L.S.), PA; Spectrum Health Helen Devos Children's Hospital (D.F.), Grand Rapids, MI; Children's Mercy Hospital (E.F.), Mission, KS; Gillette Children's Specialty Health Care (T.F.), St. Paul, MN; Weill Cornell Medicine (Z.G.), New York, NY; University of Pittsburgh (A.H.), PA; Cohen Children's Medical Center (S.K.), New Hyde Park, NY; Dayton Children's Hospital (G.K.), OH; American Academy of Neurology (E.L.), Minneapolis, MN; Neuro Network Partners at Nicklaus Children's Hospital (M.M.), Miami, FL; Cincinnati Children's Hospital Medical Center (D.M.); Akron Children's Hospital (M.C.V.), OH; Hospital for Sick Children (A.Y.), Toronto; and University of Calgary (J.R.B.), Canada
| |
Collapse
|
14
|
Tuchman R. What is the Relationship Between Autism Spectrum Disorders and Epilepsy? Semin Pediatr Neurol 2017; 24:292-300. [PMID: 29249509 DOI: 10.1016/j.spen.2017.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The association of epilepsy and autism spectrum disorders (ASD) is best understood by examining the relationship between social cognition, nonsocial cognition, and epilepsy. The relationship between ASD and epilepsy is bidirectional and is strongly linked to intellectual disability (ID). The risk of developing ASD in children with epilepsy is highest in children with early onset seizures, with a high prevalence in children with infantile spasms. The risk of developing epilepsy in children first diagnosed with ASD is highest in those with ID. The prevalence of seizures in ASD increases with age. When epilepsy and ASD coexist, they share common pathophysiological mechanisms. In epilepsy with and without ID, social-cognitive deficits are an important determinant of neurodevelopmental outcomes. Early recognition of social deficits is an important aspect of the comprehensive management of children with epilepsy. Treating the seizures in individuals with epilepsy and ASD is crucial but interventions that address social-cognitive deficits are necessary to maximize neurodevelopmental outcomes.
Collapse
Affiliation(s)
- Roberto Tuchman
- From the Department of Neurology, Nicklaus Children's Hospital Miami Children's Health System, Miami, FL.
| |
Collapse
|
15
|
Tran LH, Zupanc ML. Neurocognitive Comorbidities in Pediatric Epilepsy: Lessons in the Laboratory and Clinical Profile. Semin Pediatr Neurol 2017; 24:276-281. [PMID: 29249507 DOI: 10.1016/j.spen.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Children with epilepsy are at risk for a variety of neurocognitive comorbidities. Animal models have increased our understanding about the neurobiological mechanisms underlying the association between seizures and these comorbidities. This article starts with an overview of the current data on animal model research, studying the influence of early-life seizures, followed by a summary of potential cellular and molecular mechanisms by which seizures can affect cognitive development. We then describe specific abnormal neuropsychological profiles that accompany specific pediatric epilepsy syndromes. Finally, we offer a potential guideline to the treatment and management of children with epilepsy and its neurocognitive comorbidities.
Collapse
Affiliation(s)
- Lily H Tran
- Department of Pediatrics, Pediatric Comprehensive Epilepsy Program, University of California, Irvine, Children's Hospital of Orange County, Orange, CA.
| | - Mary L Zupanc
- Department of Pediatrics and Neurology, University of California, Irvine, Children's Hospital of Orange County, Orange, CA
| |
Collapse
|
16
|
Nickels KC, Wirrell EC. Cognitive and Social Outcomes of Epileptic Encephalopathies. Semin Pediatr Neurol 2017; 24:264-275. [PMID: 29249506 DOI: 10.1016/j.spen.2017.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The term "epileptic encephalopathy" denotes a disorder in which seizures or frequent interictal discharges exacerbate neurocognitive dysfunction beyond what would be expected on the basis of underlying etiology. However, many underlying causes of epileptic encephalopathy also result in neurocognitive deficits, and it can be challenging to discern to what extent these deficits can be improved with better seizure control. Additionally, as seizures in these conditions are typically refractory, children are often exposed to high doses of multiple antiepileptic drugs which further exacerbate these comorbidities. This review will summarize the neurocognitive and social outcomes in children with various epileptic encephalopathies. Prompt, accurate diagnosis of epilepsy syndrome and etiology allows selection of optimal therapy to maximize seizure control, limiting the impact of ongoing seizures and frequent epileptiform abnormalities on the developing brain. Furthermore, mandatory screening for comorbidities allows early recognition and focused therapy for these commonly associated conditions to maximize neurocognitive outcome.
Collapse
Affiliation(s)
- Katherine C Nickels
- Divisions of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, Rochester, MN
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Mayo Clinic, Rochester, MN.
| |
Collapse
|
17
|
Lyu G, Han YL. [Research advances in hereditary epilepsy and precision drug therapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:1118-1123. [PMID: 29046212 PMCID: PMC7389281 DOI: 10.7499/j.issn.1008-8830.2017.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
Epilepsy is a common nervous system disease. It has been found that the pathogenesis of epilepsy is associated mutations in various genes, including genes encoding voltage-dependent ion channel, genes encoding ligand-gated ion channel, and solute carrier family genes. Different types of epilepsy caused by different mutations have different responses to drugs, and therefore, diagnosis and medication guidance based on genes are new thoughts for developing therapies. With the application of next-generation sequencing technology, more and more genes will be determined, which helps to further study the pathogenic mechanism of mutant genes and provides a basis for precision drug therapy for epilepsy.
Collapse
Affiliation(s)
- Ge Lyu
- Department of Pediatrics, First Affiliated Hospital of Guangxi Medical University, Nanning 530000, China.
| | | |
Collapse
|
18
|
Bonanni P, Negrin S, Antoniazzi L, Da Rold M, Fabbro F, Serafini A. Clinical implications of interictal epileptiform discharges in cognitive functioning in CEC syndrome with evolution into epileptic encephalopathy. Neurocase 2017; 23:230-238. [PMID: 28929921 DOI: 10.1080/13554794.2017.1380202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In epileptic encephalopathies (EE), interictal epileptiform discharges (IEDs) contribute to cognitive impairment. The EE process has been studied in a patient affected by epilepsy with occipital calcification and celiac disease (CEC syndrome) by combining the administration of brain area stimulus specific (visual and auditory) reaction times (RT) during continuous EEG monitoring with the off-line reconstruction of auditory and visual evoked potentials (EP). Visual RT and VEP were abnormal only if recorded concomitantly to the IEDs. Auditory RT and EP were normal. When the EE process is going on, IEDs transiently disrupt aspects of cortical functioning, contributing to the cognitive impairment.
Collapse
Affiliation(s)
- Paolo Bonanni
- a Epilepsy and Neurophysiology Unit , Scientific Institute, IRCCS Eugenio Medea , Treviso , Italy
| | - Susanna Negrin
- a Epilepsy and Neurophysiology Unit , Scientific Institute, IRCCS Eugenio Medea , Treviso , Italy
| | - Lisa Antoniazzi
- a Epilepsy and Neurophysiology Unit , Scientific Institute, IRCCS Eugenio Medea , Treviso , Italy
| | - Martina Da Rold
- a Epilepsy and Neurophysiology Unit , Scientific Institute, IRCCS Eugenio Medea , Treviso , Italy
| | - Franco Fabbro
- a Epilepsy and Neurophysiology Unit , Scientific Institute, IRCCS Eugenio Medea , Treviso , Italy
| | - Anna Serafini
- b Department of Medical and Biological Sciences , University of Udine , Udine , Italy
| |
Collapse
|
19
|
Melatonin Alleviates the Epilepsy-Associated Impairments in Hippocampal LTP and Spatial Learning Through Rescue of Surface GluR2 Expression at Hippocampal CA1 Synapses. Neurochem Res 2017; 42:1438-1448. [PMID: 28214985 DOI: 10.1007/s11064-017-2200-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/20/2017] [Accepted: 02/02/2017] [Indexed: 12/23/2022]
Abstract
Epilepsy-associated cognitive impairment is common, and negatively impacts patients' quality of life. However, most antiepileptic drugs focus on the suppression of seizures, and fewer emphasize treatment of cognitive dysfunction. Melatonin, an indolamine synthesized primarily in the pineal grand, is reported to be neuroprotective against several central nervous system disorders. In this study, we investigated whether melatonin could reverse cognitive dysfunction in lithium-pilocarpine treated rats. Chronic treatment with melatonin (8 mg/kg daily for 15 days) after induction of status epilepticus significantly alleviated seizure severity, reduced neuronal death in the CA1 region of the hippocampus, improved spatial learning (as measured by the Morris water maze test), and reversed LTP impairments, compared to vehicle treatment. Furthermore, we found that melatonin rescued the decreased surface levels of GluR2 in the CA1 region observed in epilepsy, which might be the underlying mechanism of the neuroprotective and synapse-modulating function of melatonin. Our study provides experimental evidence for the possible clinical utility of melatonin as an adjunctive therapy to prevent epilepsy-associated cognitive impairments.
Collapse
|
20
|
Mintz M. Evolution in the Understanding of Autism Spectrum Disorder: Historical Perspective. Indian J Pediatr 2017; 84:44-52. [PMID: 27053182 DOI: 10.1007/s12098-016-2080-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/24/2016] [Indexed: 01/19/2023]
Abstract
The study of the evolution in the diagnosis and treatment of autism is a lesson in the dangers of medical beliefs or doctrines that are not grounded in medical science. The early descriptions of autism suggested that it was the result of childhood psychoses or psychodynamic disturbances of parent-child relationships. This flawed conceptualization of autism spectrum disorders (ASD) gave way to advances in medical science, which have established ASD as a neurobiological disorder of early brain development. There are many genetic, epigenetic, metabolic, hormonal, immunological, neuroanatomical and neurophysiological etiologies of ASD, as well as an array of gastrointestinal and other systemic co-morbid disorders. Thus, ASD are a biologically heterogeneous population with extensive neurodiversity. Early identification and understanding of ASD is crucial; interventions at younger ages are associated with improved outcomes. The advent of understanding the biological sub-phenotypes of ASD, along with targeted medical therapies, coupled with a multimodal therapeutic approach that encompasses behavioral, educational, social, speech, occupational, creative arts, and other forms of therapies has created a new and exciting era for individuals with ASD and their families: "personalized" and "precision" medical care based upon underlying biological sub-phenotypes and clinical profiles. For many individuals and their families dealing with the scourge of autism, their long and frustrating diagnostic journey is beginning to come to an end, with a hope for improved outcomes and quality of life.
Collapse
Affiliation(s)
- Mark Mintz
- The Center for Neurological and Neurodevelopmental Health, Voorhees, NJ, USA.
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Self-reported bodily symptoms are of primary importance in healthcare and in health-related research. Typically, they are assessed in clinical interviews or by means of traditional questionnaire formats that require the respondent to provide retrospective symptom estimates rated along intuitive frequency and/or intensity standards and aggregated across varying or unspecified time windows. RECENT FINDINGS Retrospective symptom assessments are often biased when compared to (averaged) momentary assessments of symptoms. A variety of factors and conditions have been identified to influence the amount of bias in symptom reporting. Recent research has focused on the underlying mechanisms for the discrepancy between memory and experience. It is suggested that different types of questions and formats assess different types of information, and each may be relevant for different purposes. Knowledge of these underlying mechanisms also provides a relevant framework to better understand individual differences in symptom reporting, including somatoform and somatic symptom disorder. SUMMARY Accuracy of self-reported bodily symptoms is important for the clinician and the researcher. Understanding the mechanisms underlying bias may provide an interesting window to understand how symptom episodes are processed, encoded, and consolidated in memory and may also provide clues to modify symptom experiences.
Collapse
|
22
|
Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol 2016; 12:465-76. [PMID: 27448186 DOI: 10.1038/nrneurol.2016.98] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cognitive and behavioural comorbidities are often seen in children with epilepsy, and are more common and severe in refractory epilepsy. These comorbidities are associated with worse quality of life, increased behavioural and language problems and worse social skills, all of which adversely affect long-term psychosocial functioning. To enable early intervention and therapy, children and teens with epilepsy should be periodically screened for cognitive comorbidities. The location of the epileptic focus can, to a certain degree, predict the type(s) of comorbidity; however, the spectrum of disability is often broad, presumably because focal perturbations can cause network dysfunction. Comorbidities often result from underlying structural or functional pathology that has led to seizures. In selected cases, therapy targeting the underlying cause, such as the ketogenic diet for GLUT1 deficiency syndromes, may be remarkably effective in ameliorating both seizures and cognitive concerns. In many cases, however, cognitive impairment persists despite seizure control. In epileptic encephalopathies, frequent seizures and/or interictal epileptiform abnormalities exacerbate neurocognitive dysfunction, owing to synaptic reorganization or impaired neurogenesis, or to other effects on developing neural circuits, and prompt initiation of effective antiepileptic therapy is essential to limit cognitive comorbidities.
Collapse
Affiliation(s)
- Katherine C Nickels
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Michael J Zaccariello
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Lorie D Hamiwka
- Seattle Children's Hospital, MB.7.420 - Neurology, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Elaine C Wirrell
- Child and Adolescent Neurology and Epilepsy, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| |
Collapse
|
23
|
Howell KB, Harvey AS, Archer JS. Epileptic encephalopathy: Use and misuse of a clinically and conceptually important concept. Epilepsia 2016; 57:343-7. [DOI: 10.1111/epi.13306] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Katherine B. Howell
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - A. Simon Harvey
- Department of Neurology; The Royal Children's Hospital; Parkville Victoria Australia
- Department of Paediatrics; The University of Melbourne; Melbourne Victoria Australia
- Murdoch Children Research Institute; Parkville Victoria Australia
| | - John S. Archer
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- The Florey Institute of Neuroscience and Mental Health; Parkville Victoria Australia
- Austin Health; Melbourne Victoria Australia
| |
Collapse
|
24
|
O'Leary H, Bernard PB, Castano AM, Benke TA. Enhanced long term potentiation and decreased AMPA receptor desensitization in the acute period following a single kainate induced early life seizure. Neurobiol Dis 2015; 87:134-44. [PMID: 26706598 DOI: 10.1016/j.nbd.2015.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/17/2015] [Accepted: 12/14/2015] [Indexed: 02/04/2023] Open
Abstract
Neonatal seizures are associated with long term disabilities including epilepsy and cognitive deficits. Using a neonatal seizure rat model that does not develop epilepsy, but develops a phenotype consistent with other models of intellectual disability (ID) and autism spectrum disorders (ASD), we sought to isolate the acute effects of a single episode of early life seizure on hippocampal CA1 synaptic development and plasticity. We have previously shown chronic changes in glutamatergic synapses, loss of long term potentiation (LTP) and enhanced long term depression (LTD), in the adult male rat ~50days following kainic acid (KA) induced early life seizure (KA-ELS) in post-natal (P) 7day old male Sprague-Dawley rats. In the present work, we examined the electrophysiological properties and expression levels of glutamate receptors in the acute period, 2 and 7days, post KA-ELS. Our results show for the first time enhanced LTP 7days after KA-ELS, but no change 2days post KA-ELS. Additionally, we report that ionotropic α-amino-3-hydroxy-5-methyl-isoxazole-propionic acid type glutamate receptor (AMPAR) desensitization is decreased in the same time frame, with no changes in AMPAR expression, phosphorylation, or membrane insertion. Inappropriate enhancement of the synaptic connections in the acute period after the seizure could alter the normal patterning of synaptic development in the hippocampus during this critical period and contribute to learning deficits. Thus, this study demonstrates a novel mechanism by which KA-ELS alters early network properties that potentially lead to adverse outcomes.
Collapse
Affiliation(s)
- Heather O'Leary
- Department of Pediatrics, University of Colorado, School of Medicine, 80045, USA
| | - Paul B Bernard
- Department of Pediatrics, University of Colorado, School of Medicine, 80045, USA
| | - Anna M Castano
- Department of Pediatrics, University of Colorado, School of Medicine, 80045, USA
| | - Tim A Benke
- Department of Pediatrics, University of Colorado, School of Medicine, 80045, USA; Department of Neurology, University of Colorado, School of Medicine, 80045, USA; Department of Pharmacology, University of Colorado, School of Medicine, 80045, USA; Department of Otolaryngology, University of Colorado, School of Medicine, 80045, USA; Neuroscience Graduate Program, University of Colorado, School of Medicine, 80045, USA.
| |
Collapse
|
25
|
Sánchez Fernández I, Loddenkemper T, Galanopoulou AS, Moshé SL. Should epileptiform discharges be treated? Epilepsia 2015; 56:1492-504. [PMID: 26293670 DOI: 10.1111/epi.13108] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/09/2023]
Abstract
To evaluate the impact of epileptiform discharges (EDs) that do not occur within seizure patterns--such as spikes, sharp waves or spike waves--on cognitive function and to discuss the circumstances under which treatment of EDs might be considered. Methods used in this article is "Review of the literature". EDs may disrupt short-term cognition in humans. Frequent EDs for a prolonged period can potentially impair long-term cognitive function in humans. However, there is conflicting evidence on the impact of EDs on long-term cognitive outcome because this relationship may be confounded by multiple factors such as underlying etiology, seizures, and medication effects. Limitations of existing studies include the lack of standardized ED quantification methods and of widely accepted automated spike quantification methods. Although there is no solid evidence for or against treatment of EDs, a non-evidence-based practical approach is suggested. EDs in otherwise asymptomatic individuals should not be treated because the risks of treatment probably outweigh its dubious benefits. A treatment trial for EDs may be considered when there is cognitive dysfunction or regression or neurologic symptoms that are unexplained by the underlying etiology, comorbid conditions, or seizure severity. In patients with cognitive or neurologic dysfunction with epilepsy or EDs, treatment may be warranted to control the underlying epileptic syndrome. EDs may cause cognitive or neurologic dysfunction in humans in the short term. There is conflicting evidence on the impact of EDs on long-term cognitive outcome. There is no evidence for or against treatment of asymptomatic ED.
Collapse
Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Tobias Loddenkemper
- Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Laboratory of Developmental Medicine, Montefiore/Einstein Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Laboratory of Developmental Medicine, Montefiore/Einstein Epilepsy Management Center, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| |
Collapse
|
26
|
Kang SK, Kadam SD. Neonatal Seizures: Impact on Neurodevelopmental Outcomes. Front Pediatr 2015; 3:101. [PMID: 26636052 PMCID: PMC4655485 DOI: 10.3389/fped.2015.00101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022] Open
Abstract
Neonatal period is the most vulnerable time for the occurrence of seizures, and neonatal seizures often pose a clinical challenge both for their acute management and frequency of associated long-term co-morbidities. Etiologies of neonatal seizures are known to play a primary role in the anti-epileptic drug responsiveness and the long-term sequelae. Recent studies have suggested that burden of acute recurrent seizures in neonates may also impact chronic outcomes independent of the etiology. However, not many studies, either clinical or pre-clinical, have addressed the long-term outcomes of neonatal seizures in an etiology-specific manner. In this review, we briefly review the available clinical and pre-clinical research for long-term outcomes following neonatal seizures. As the most frequent cause of acquired neonatal seizures, we focus on the studies evaluating long-term effects of HIE-seizures with the goal to evaluate (1) what parameters evaluated during acute stages of neonatal seizures can reliably be used to predict long-term outcomes? and (2) what available clinical and pre-clinical data are available help determine importance of etiology vs. seizure burdens in long-term sequelae.
Collapse
Affiliation(s)
- Seok Kyu Kang
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger , Baltimore, MD , USA
| | - Shilpa D Kadam
- Neuroscience Laboratory, Hugo Moser Research Institute at Kennedy Krieger , Baltimore, MD , USA ; Department of Neurology, Johns Hopkins University School of Medicine , Baltimore, MD , USA
| |
Collapse
|