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Delazer L, Bao H, Lauseker M, Stauner L, Nübling G, Conrad J, Noachtar S, Havla J, Kaufmann E. Association between retinal thickness and disease characteristics in adult epilepsy: A cross-sectional OCT evaluation. Epilepsia Open 2024; 9:236-249. [PMID: 37920967 PMCID: PMC10839337 DOI: 10.1002/epi4.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/29/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Thinning of the peripapillary retinal nerve fiber layer (p-RNFL), as measured by optical coherence tomography (OCT), was recently introduced as a promising marker for cerebral neuronal loss in people with epilepsy (PwE). However, its clinical implication remains to be elucidated. We thus aimed to (1) systematically characterize the extent of the retinal neuroaxonal loss in a broad spectrum of unselected PwE and (2) to evaluate the main clinical determinants. METHODS In this prospective study, a spectral-domain OCT evaluation was performed on 98 well-characterized PwE and 85 healthy controls (HCs) (18-55 years of age). All inner retinal layers and the total macula volume were assessed. Group comparisons and linear regression analyses with stepwise backward selection were performed to identify relevant clinical and demographic modulators of the retinal neuroaxonal integrity. RESULTS PwE (age: 33.7 ± 10.6 years; 58.2% female) revealed a significant neuroaxonal loss across all assessed retinal layers (global pRNFL, P = 0.001, Δ = 4.24 μm; macular RNFL, P < 0.001, Δ = 0.05 mm3 ; ganglion cell inner plexiform layer, P < 0.001, Δ = 0.11 mm3 ; inner nuclear layer, INL, P = 0.03, Δ = 0.02 mm3 ) as well as significantly reduced total macula volumes (TMV, P < 0.001, Δ = 0.18 mm3 ) compared to HCs (age: 31.2 ± 9.0 years; 57.6% female). The extent of retinal neuroaxonal loss was associated with the occurrence and frequency of tonic-clonic seizures and the number of antiseizure medications, and was most pronounced in male patients. SIGNIFICANCE PwE presented an extensive retinal neuroaxonal loss, affecting not only the peripapillary but also macular structures. The noninvasive and economic measurement via OCT bears the potential to establish as a practical tool to inform patient management, as the extent of the retinal neuroaxonal loss reflects aspects of disease severity and sex-specific vulnerability. PLAIN LANGUAGE SUMMARY The retina is an extension of the brain and closely connected to it. Thus, cerebral alterations like atrophy reflect also on the retinal level. This is advantageous, as the retina is easily accessible and measureable with help of the optical coherence tomography. Here we report that adults with epilepsy have a significantly thinner retina than healthy persons. Especially people with many big seizures and a lot of medications have a thinner retina. We propose that measurement of the retina can be useful as a marker of disease severity and to inform patient management.
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Affiliation(s)
- Luisa Delazer
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Han Bao
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
- Institute for StatisticsMunichGermany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and EpidemiologyLudwig Maximilians UniversityMunichGermany
| | - Livia Stauner
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Georg Nübling
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- German Center for Neurodegenerative DiseasesMunichGermany
| | - Julian Conrad
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Division for Neurodegenerative DiseasesUniversitätsmedizin Mannheim, University of HeidelbergHeidelbergGermany
| | - Soheyl Noachtar
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
| | - Joachim Havla
- Institute of Clinical NeuroimmunologyLMU HospitalLMU Hospital, Ludwig Maximilians UniversityMunichGermany
| | - Elisabeth Kaufmann
- Epilepsy Center, Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
- Department of NeurologyLMU University Hospital, LMU MunichMunichGermany
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Stelzle D, Kaducu J, Schmidt V, Welte TM, Ngowi BJ, Matuja W, Escheu G, Hauke P, Richter V, Ovuga E, Pfausler B, Schmutzhard E, Amos A, Harrison W, Keller L, Winkler AS. Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis. BMC Neurol 2022; 22:321. [PMID: 36028820 PMCID: PMC9414166 DOI: 10.1186/s12883-022-02813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. METHODS We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. RESULTS Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). CONCLUSIONS Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.
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Affiliation(s)
- Dominik Stelzle
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Joyce Kaducu
- grid.415705.2Ministry of Health, Kampala, Republic of Uganda
| | - Veronika Schmidt
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tamara M. Welte
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.411668.c0000 0000 9935 6525Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Bernard J. Ngowi
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania ,grid.8193.30000 0004 0648 0244University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - William Matuja
- grid.25867.3e0000 0001 1481 7466Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gabrielle Escheu
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Peter Hauke
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Vivien Richter
- grid.411544.10000 0001 0196 8249Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Emilio Ovuga
- grid.442626.00000 0001 0750 0866Department of Mental Health, University of Gulu, Gulu, Uganda
| | - Bettina Pfausler
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Action Amos
- National Epilepsy Association Malawi, International Bureau of Epilepsy, Lilongwe, Malawi
| | - Wendy Harrison
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Luise Keller
- grid.6936.a0000000123222966Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andrea S. Winkler
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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