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Wang H, Tan G, Li X, Chen D, An D, Gong Q, Liu L. Aberrant functional connectivity associated with drug response in patients with newly diagnosed epilepsy. Neurol Sci 2024; 45:4973-4982. [PMID: 38653915 DOI: 10.1007/s10072-024-07529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To analyze the local functional activity and connectivity features of the brain associated with drug response inpatients newly diagnosed with epilepsy (NDE) who are naïve to anti-seizure medication (ASM). METHODS Recruited patients, underwent functional magnetic resonance imaging at baseline, and were assigned to the well-controlled (WC, n = 28) or uncontrolled (UC, n = 11) groups based on their response to ASM. Healthy participants were included in the control group (HC, n = 29). The amplitudes of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) were used to measure local functional activity, and voxel-wise degree centrality (DC) and seed-based functional connectivity (FC) were used to evaluate the connecting intensity of the brain areas. RESULTS Compared to the HC and WC groups, the UC group had higher ALFF values in the left posterior central gyrus (PoCG.L) and left inferior temporal gyrus (ITG.L) and higher DC in the bilateral PoCG (Gaussian random field correction, voxel-level P < 0.001, and cluster-level P < 0.05). Both PoCG and ITG.L in the UC group showed stronger FC with multiple brain regions, mainly located in the occipital and temporal lobes, compared to the HC or WC group, while the WC group showed decreased or similar FC compared to the HC group. INTERPRETATION Excessive enhancement of brain functional activity or connecting intensity in ASM-naïve patients with NDE may be associated with a higher risk of poor drug response.
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Affiliation(s)
- Haijiao Wang
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, 610041, Sichuan, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Yuelu District, Changsha City, China
| | - Ge Tan
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, 610041, Sichuan, China
| | - Xiuli Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan Province, China
| | - Deng Chen
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, 610041, Sichuan, China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, 610041, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan Province, China.
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Wai Nan Guo Xue Lane 37#, Chengdu, 610041, Sichuan, China.
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Zhong J, Tan G, Wang H, Chen Y. Excessively increased thalamocortical connectivity and poor initial antiseizure medication response in epilepsy patients. Front Neurol 2023; 14:1153563. [PMID: 37396772 PMCID: PMC10312096 DOI: 10.3389/fneur.2023.1153563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives The network mechanism underlying the initial response to antiseizure medication in epilepsy has not been revealed yet. Given the central role of the thalamus in the brain network, we conducted a case-control study to investigate the association between thalamic connectivity and medication response. Methods We recruited 39 patients with newly diagnosed and medication-naïve epilepsy of genetic or unknown etiology, including 26 with a good response (GR group) and 13 with a poor response (PR group), and 26 matched healthy participants (control group). We measured the gray matter density (GMD) and the amplitude of low-frequency fluctuation (ALFF) of bilateral thalami. We then set each thalamus as the seed region of interest (ROI) to calculate voxel-wise functional connectivity (FC) and assessed ROI-wise effective connectivity (EC) between the thalamus and targeted regions. Results We found no significant difference between groups in the GMD or ALFF of bilateral thalami. However, we observed that the FC values of several circuits connecting the left thalamus and the cortical areas, including the bilateral Rolandic operculum, the left insula, the left postcentral gyrus, the left supramarginal gyrus, and the left superior temporal gyrus, differed among groups (False Discovery Rate correction, P < 0.05), with a higher value in the PR group than in the GR group and/or the control group (Bonferroni correction, P < 0.05). Similarly, both the outflow and the inflow EC in each thalamocortical circuit were higher in the PR group than in the GR group and the control group, although these differences did not remain statistically significant after applying the Bonferroni correction (P < 0.05). The FC showed a positive correlation with the corresponding outflow and inflow ECs for each circuit. Conclusion Our finding suggested that patients with stronger thalamocortical connectivity, potentially driven by both thalamic outflowing and inflowing information, may be more likely to respond poorly to initial antiseizure medication.
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Affiliation(s)
- Jiyuan Zhong
- International Medical College of Chongqing Medical University, Chongqing, China
| | - Ge Tan
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Haijiao Wang
- Epilepsy Center, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang L, Fu LL, Deng ZR, Zhang J, Zu MD, Wu JC, Wang Y. Overexpression of BDNF in the ventrolateral periaqueductal gray regulates the behavior of epilepsy-migraine comorbid rats. Brain Behav 2022; 12:e2594. [PMID: 35557046 PMCID: PMC9226826 DOI: 10.1002/brb3.2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/15/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the effects of brain-derived neurotrophic factor (BDNF) overexpression in the ventrolateral periaqueductal gray (vlPAG) on behavioral changes in epilepsy-migraine comorbid rats. METHOD We used an adeno-associated virus (AAV)-mediated vector to supplement BDNF in the vlPAG area prior to the establishment of a pilocarpine-nitroglycerin (Pilo-NTG) combination-induced comorbid model of epilepsy and migraine. Seizure- and migraine-related behaviors were analyzed. Cell loss and apoptosis in vlPAG were detected through hematoxylin-eosin (HE) and TUNEL staining. Immunofluorescence staining analyses were employed to detect expressions of BDNF and its receptor, tyrosine kinase B (TrkB), in vlPAG. Immunohistochemical staining was conducted to detect expressions of c-Fos and calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis (TNC) and trigeminal ganglion (TG). RESULTS Comparing to control group, AAV-BDNF injected comorbid group showed lower pain sensitivity, scratching head, and spontaneous seizures accompanied by the downregulation of c-Fos labeling neurons and CGRP immunoreactivity in the TNC and TG. However, these changes were still significantly higher in the comorbid group than those in both epilepsy and migraine groups under the same intervention. CONCLUSION These data demonstrated that supplying BDNF to vlPAG may protect structural and functional abnormalities in vlPAG and provide an antiepileptic and analgesic therapy.
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Affiliation(s)
- Long Wang
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lu-Lan Fu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zi-Ru Deng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei-Dan Zu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun-Cang Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Cerulli Irelli E, Morano A, Orlando B, Salamone EM, Fanella M, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Seizure outcome trajectories in a well-defined cohort of newly diagnosed juvenile myoclonic epilepsy patients. Acta Neurol Scand 2022; 145:314-321. [PMID: 34791656 DOI: 10.1111/ane.13556] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate the temporal course of medication response and associated prognostic factors in a cohort of juvenile myoclonic epilepsy (JME) patients over a long-term follow-up. MATERIALS AND METHODS Data from 113 JME patients diagnosed according to recently proposed class II criteria were retrospectively reviewed. Early sustained remission was defined as 4-year seizure remission starting within 2 years from the first antiseizure medication (ASM) intake, as opposed to delayed sustained remission. Spontaneous relapse rate (ie, not related to ASM withdrawal) was also investigated, along with factors associated with seizure relapse. RESULTS Four-year seizure remission was obtained by 76/113 (67.3%) subjects. Early sustained remission was achieved by 45/76 (59.2%) patients. Absence seizures were significantly associated with no-remission at multivariable multinomial logistic regression analysis. Catamenial seizures and earlier age at epilepsy onset significantly predicted delayed sustained remission. Spontaneous seizure relapse after 4-year remission occurred in 15.7% of patients with early sustained remission and in 35.5% of those with delayed sustained remission (p = 0.045). The most common concomitant factors for a spontaneous relapse were irregular lifestyle habits and pregnancy-related switch from valproate to another ASM. Patients with a history of catamenial seizures were more likely to experience a spontaneous generalized tonic-clonic seizure relapse after 4-year remission at univariable analysis. SIGNIFICANCE Our data support the prognostic relevance of early medication response in JME patients. Furthermore, the prognostic significance of catamenial seizures and the impact of valproate switch on seizure relapse after a prolonged remission account for the challenging therapeutic management of women with childbearing potential.
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Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Biagio Orlando
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Enrico M. Salamone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Anna T. Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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Zafar R, Schlag A, Phillips L, Nutt DJ. Medical cannabis for severe treatment resistant epilepsy in children: a case-series of 10 patients. BMJ Paediatr Open 2021. [PMCID: PMC8689159 DOI: 10.1136/bmjpo-2021-001234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo report the findings of a case-series of 10 children suffering with intractable epilepsies in the UK to determine the feasibility for using whole-plant cannabis medicines to treat seizures in children.SettingThis study was conducted retrospectively through collecting clinical data from caretakers and clinicians on study outcome variables. Participants were recruited through the MedCann Support and End our Pain charity groups which are patient representative groups that support children who are using medical cannabis to treat their epilepsies. Medicines were prescribed to patients by clinicians in both National Health Service and private medical practices. Follow-up calls were conducted throughout the period January 2021 to May 2021 to keep data recorded up to date.ParticipantsTen children, 18 years old or under, with intractable epilepsies were recruited from two charities. There were no limitations on diagnosis, sex or ethnic origin.InterventionsParticipants were treated with a range of whole-plant medical cannabis oils. Individual dosing regimens were determined by clinicians.Primary outcome measureThe primary outcome measure was seizure frequency.ResultsSeizure frequency across all 10 participants reduced by 86% with no significant adverse events. Participants reduced use of antiepileptic drugs from an average of seven to one following treatment with medical cannabis. We also noted significant financial costs of £874 per month to obtain these medicines through private prescriptions.ConclusionsThis study establishes the feasibility of whole-plant medical cannabis as an effective and well-tolerated medicine for reducing seizure frequency in children suffering with intractable epilepsies. These findings justify the potential value of further research into the reported therapeutic benefit of whole-plant medicinal cannabis products.
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Affiliation(s)
- Rayyan Zafar
- DrugScience, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Department of Brain Sciences, Imperial College London, London, UK
| | - Anne Schlag
- DrugScience, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Department of Brain Sciences, Imperial College London, London, UK
| | - Lawrence Phillips
- DrugScience, London, UK
- The London School of Economics and Political Science, London, UK
| | - David J Nutt
- DrugScience, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Department of Brain Sciences, Imperial College London, London, UK
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Risk Factors for Drug Resistance in Epileptic Children with Age of Onset above Five Years: A Case-Control Study. Behav Neurol 2021; 2021:9092824. [PMID: 34804259 PMCID: PMC8598367 DOI: 10.1155/2021/9092824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/14/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background Children with epilepsy with onset above five years encompass distinct epidemiological and clinical characteristics that may have specific risk factors for resistance to antiseizure medications (ASMs). Studies on this age group are limited. Purpose To identify risk factors for drug resistance in children with epilepsy with the age of onset above five years. Methods A case-control study was conducted on children with epilepsy with the age of onset above five years visiting the Pediatric Neurology Clinic of Cipto Mangunkusumo and Mohammad Hoesin Hospital between September 2015 and August 2016. Cases consisted of drug-resistant children while control consisted of drug-responsive children according to 2010 ILAE classification. Risk factors studied include onset, number of seizures, illness duration before treatment, cause, seizure type, status epilepticus, initial and evolution of EEG, brain imaging, and initial treatment response. Results Thirty-two pairs of children were included in the study. After logistic regression analysis, symptomatic etiology and failure to achieve early response to treatment were found to be associated with drug resistance with adjusted OR of 84.71 (95% CI: 5.18-1359.15) and 72.55 (95% CI: 7.08-743.85), respectively. Conclusion Poor initial response to ASM and symptomatic etiology are independent risk factors for drug resistance in children with epilepsy with the age of onset above five years.
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Li Y, Xia L, Wang Y, Li R, Li J, Pan S. Long-term response and response patterns to antiepileptic drugs in patients with newly diagnosed epilepsy. Epilepsy Behav 2021; 124:108309. [PMID: 34536736 DOI: 10.1016/j.yebeh.2021.108309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study investigated the long-term response and response patterns to antiepileptic drugs (AEDs) in patients with newly diagnosed epilepsy. METHODS Patients who had been newly diagnosed with epilepsy and had at least 3-year follow-up records were enrolled. Their long-term response and response patterns to AEDs were retrospectively analyzed. Patients were divided into two groups, a controlled group and an uncontrolled group, according to whether 3-year seizure freedom (3YSF) was achieved. Multiple logistic regression analyses were used to identify risk factors associated with a poor drug response. RESULTS Of the 472 patients with epilepsy, 180 achieved immediate seizure control, 36 achieved early seizure control, 118 achieved late seizure control, and 138 did not achieve 3YSF. Patients who achieved 3YSF (334/472, 70.8%) were categorized into the controlled group. Among them, 53.9% (180/334) achieved 3YSF immediately, 10.8% (36/334) achieved 3YSF within 6 months, and 35.3% (118/334) achieved 3YSF after 6 months. Also in this group, 228 (228/472, 48.3%), 84 (84/472, 17.8%), 15 (15/472, 3.2%), and 7 (7/472, 1.5%) patients achieved 3YSF on the first, second, third, and fourth regimen, respectively. Multivariate analyses showed that multiple seizure types (odds ratio [OR] = 3.903, 95% confidence interval [CI]: 2.098-7.264; P < 0.001] and polytherapy (OR = 5.093, 95% CI: 3.183-8.149; P < 0.001) were independent risk factors for a poor drug response. CONCLUSION The 3YSF rate in this cohort was 70.8%. More than half of the patients achieved long-term remission immediately after treatment. The probability of attaining 3YSF decreased with the increase in number of drug regimens, especially in patients who experienced failure of two treatment regimens.
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Affiliation(s)
- Yudan Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Xia
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuxuan Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songqing Pan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China.
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Braathen G, Zelano J. Long-term seizure and psychosocial outcome in childhood epilepsy of unknown cause. Acta Neurol Scand 2021; 143:653-660. [PMID: 33772757 DOI: 10.1111/ane.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose was to investigate long-term prognosis of epilepsy of unknown cause with onset between ages 2 and 16 in children without any major disability, by evaluation of a previously described prognostic model and long-term follow-up of a study on the impact of duration of initial antiseizure medication (ASM) treatment. METHODS Patients included in a randomized controlled trial (RCT) of either one or three years of ASM therapy prior to withdrawal (if seizure-free for at least 6 months) were contacted after 29-35 years and asked to complete a survey. Potential prognostic factors were evaluated: duration of initial ASM treatment, seizure type, seizure frequency, and score in a prognostic model developed in the initial publication. RESULTS One hundred and forty-nine subjects answered the questionnaire (response rate 65%). Seizure freedom without treatment was found in 110 responders (77%, 95%CI: 73-81). There was no significant difference in score in the prognostic model between responders with and without epilepsy at follow-up. Those with active epilepsy were unemployed significantly more often and perceived their mental health significantly more affected than those seizure-free without treatment. CONCLUSIONS Duration of initial ASM treatment was not associated with any difference in subsequent epilepsy risk. This indicates that the timing of withdrawal attempts is unlikely to alter the long-term prognosis of uncomplicated childhood epilepsy. The failure of the prognostic model from the initial study to predict long-term outcome argues that although prediction of relapse risk in the shorter term may be possible, the bearing of such models on long-term epilepsy risk is more questionable.
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Affiliation(s)
| | - Johan Zelano
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Clinical Neuroscience Sahlgrenska Academy Gothenburg Sweden
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Cerulli Irelli E, Morano A, Barone FA, Fisco G, Fanella M, Orlando B, Fattouch J, Manfredi M, Giallonardo AT, Di Bonaventura C. Persistent treatment resistance in genetic generalized epilepsy: A long‐term outcome study in a tertiary epilepsy center. Epilepsia 2020; 61:2452-2460. [DOI: 10.1111/epi.16708] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Francesca A. Barone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Giacomo Fisco
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Biagio Orlando
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Anna Teresa Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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Caprara ALF, Rissardo JP, Leite MTB, Silveira JOF, Jauris PGM, Arend J, Kegler A, Royes LFF, Fighera MR. Course and prognosis of adult-onset epilepsy in Brazil: A cohort study. Epilepsy Behav 2020; 105:106969. [PMID: 32113113 DOI: 10.1016/j.yebeh.2020.106969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most of the epilepsy longitudinal studies have analyzed children. However, in endemic regions, such as Brazil, neurocysticercosis accounts for many adult-onset epilepsy cases. So, the main objective of this study was to identify the clinical predictors associated with drug-resistant adult-onset epilepsy in Brazil during a long-term follow-up. METHODS We followed 302 individuals with adult-onset epilepsy for 9.8 years in our University Hospital. Structured questionnaires about drug-resistant epilepsy were applied. The presence of drug-resistant epilepsy was the primary outcome. We used multilevel linear modeling in our data analysis. RESULTS Overall 47 (15.6%) individuals presented drug-resistant epilepsy and the etiology was structural in 70.2% of them, while infectious etiology was present in 8.5% of this group. Infectious etiology occurred in 25.9% (n = 66) of the patients from the nondrug-resistant group. Those with developmental delay were two times more likely to present seizures. Structural epilepsy etiology was associated with an increased chance of relapsing. Poor school performance and abnormal electroencephalogram were also associated with an increased chance of seizures. CONCLUSION The course of epilepsy was favorable in the majority of our patients, and drug-resistant epilepsy rates were similar to those found in other studies, although we evaluated older individuals with higher levels of infectious etiology. Also, we found that neurocysticercosis was associated with well-controlled epilepsy, while structural epilepsy was directly related to the occurrence of seizures. We also hypothesized that the smaller size of lesions found in neurocysticercosis could contribute to better treatment response.
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Affiliation(s)
- Ana Letícia F Caprara
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil.
| | - Jamir P Rissardo
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Martim T B Leite
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Juliana O F Silveira
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Paulo G M Jauris
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Josi Arend
- Health Sciences Center, Postgraduate Program in Pharmacology, Federal University of Santa Maria, RS, Brazil
| | - Aline Kegler
- Center for Natural and Exact Sciences, Postgraduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, RS, Brazil
| | - Luiz Fernando Freire Royes
- Physical Education and Sports Center, Exercise Biochemistry Laboratory (BIOEX), Federal University of Santa Maria, RS, Brazil
| | - Michele Rechia Fighera
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
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Ekanem EE, Fajola AO, Usman R, Ogbimi RN, Ikeagwu GO, Anidima TE, Etieh MN, Umejiego CN. Management of Epilepsies at the Community Cottage Hospital Level in a Developing Environment. Niger Med J 2019; 60:186-189. [PMID: 31831937 PMCID: PMC6892329 DOI: 10.4103/nmj.nmj_6_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/23/2019] [Accepted: 09/05/2019] [Indexed: 11/04/2022] Open
Abstract
Background The epilepsy problem in much of Africa is characterized by stigmatization and neglect. This article describes the efforts at a cottage hospital level to ameliorate the epilepsy problem in a resource-limited environment. Methods A seizure clinic was started in a cottage hospital after targeted health talks. The International League against Epilepsy (ILEA)/World Health Organization (WHO)/International Bureau for Epilepsy (IBE) manual was adopted for the training of staff and to guide management. Patients were followed up in the clinic and with the use of simple information communication technology. Results Forty-five patients with ages ranging from 3 months to 42 years (who had lived with epilepsy for periods ranging from 3 weeks to 32 years) were registered over 12 months period. The most common seizure type was generalized tonic clonic (21 or 46.67%) followed by generalized clonic (8 or 17.78%). Ten (22.22%) had comorbidities mainly cerebral palsy (4 or 8.89%) and attention-deficit hyperactivity disorder (3 or 6.67%). Most (98.15%) were placed on carbamazepine. Twenty-three (51.11%) had complete control of seizures, 21 (46.67%) had reduced frequencies of attacks, and all 8 children who had dropped out of school resumed schooling. Conclusion The epilepsy challenge in the developing world can be demystified and effectively managed at the cottage hospital level. Targeted health education, affordable management regimes, and committed follow-up are keys. A training manual based on the ILEA/WHO/IBE document should be developed for Africa.
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Affiliation(s)
| | - Akinwunmi O Fajola
- Department of Community Health, Shell Petroleum and Development Company, Rivers State, Nigeria
| | - Rakiya Usman
- Department of Paediatrics, Obio Cottage Hospital, Obio/Akpor LGA, Rivers State, Nigeria
| | - Rebecca N Ogbimi
- Department of Community Health, Shell Petroleum and Development Company, Rivers State, Nigeria
| | - Gloria O Ikeagwu
- Department of Paediatrics, Obio Cottage Hospital, Obio/Akpor LGA, Rivers State, Nigeria
| | - Tamunoibim E Anidima
- Department of Paediatrics, Obio Cottage Hospital, Obio/Akpor LGA, Rivers State, Nigeria
| | - Michael N Etieh
- Department of Paediatrics, Obio Cottage Hospital, Obio/Akpor LGA, Rivers State, Nigeria
| | - Chidozie N Umejiego
- Department of Paediatrics, Obio Cottage Hospital, Obio/Akpor LGA, Rivers State, Nigeria
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12
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Wang L, Shen J, Cai XT, Tao WW, Wan YD, Li DL, Tan XX, Wang Y. Ventrolateral Periaqueductal Gray Matter Neurochemical Lesion Facilitates Epileptogenesis and Enhances Pain Sensitivity in Epileptic Rats. Neuroscience 2019; 411:105-118. [PMID: 31158436 DOI: 10.1016/j.neuroscience.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022]
Abstract
The ventrolateral periaqueductal gray matter (vlPAG) plays a critical role in the pathogenesis of migraine and few studies have shown that vlPAG might be involved in the pathophysiology of epilepsy. But its roles in epileptogenesis and comorbid relationship between migraine and epilepsy have never been reported. In this study, the impairments of vlPAG neuronal network during spontaneous recurrent seizure (SRS) development after status epilepticus (SE) were investigated, and the pain sensitivity as well as the SRS investigated after neurochemical lesion to vlPAG to determine the role of vlPAG in epileptogenesis and in migraine comorbidity with epilepsy. Neuronal loss and alterations of excitatory and inhibitory neural transmission within vlPAG accompanied the development of epileptogenesis induced by SE. On the other hand, neurochemical lesion to vlPAG enhanced frequency and duration of spontaneous seizure event and frequency of epileptiform inter-ictal spike discharges in electroencephalography (EEG), but decreased pain threshold in epileptic rats. This indicates an involvement of the pain regulating structure, vlPAG, in the pathogenesis of epilepsy. This may imply that vlPAG network alterations could be a possible underlying mechanism of the interactive comorbid relationship between epilepsy and migraine.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Jie Shen
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xin-Ting Cai
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Wei-Wei Tao
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Ya-Di Wan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Dong-Lin Li
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xiu-Xiu Tan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China; Department of Neurology, the Fourth Affiliated Hospital of Anhui Medical University, Huaihai Avenue 100, Hefei 230000, China.
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13
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Chegondi M, Garland MM, Sendi P, Jayakar AR, Totapally BR. Course and Outcome of Children with Convulsive Status Epilepticus Admitted to a Pediatric Intensive Care Unit. Cureus 2019; 11:e4471. [PMID: 31249749 PMCID: PMC6579347 DOI: 10.7759/cureus.4471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction The objective of this study was to describe the course and the outcomes of children with convulsive status epilepticus and to evaluate the differences between two groups of children with new-onset seizures and known seizure disorders. Methods This is a retrospective, single-center study. Children with convulsive status epilepticus admitted to our tertiary care pediatric intensive care unit were included in the study. Medical records were reviewed to obtain the demographic- and seizure-related variables. Results Among 139 children with status epilepticus, 69.7% (n = 99) had a known seizure disorder. Focal seizures were present in 23.9% of children, and 34.6% required intubation; there was an overall mortality rate of 1.2%. The children with new-onset seizures were younger and received electroencephalography (EEG) and neuroimaging more often compared to children with known seizure disorders (p < 0.05). However, an abnormal EEG was more common among children with known seizure disorders (p < 0.001). Conclusions Sub-therapeutic anti-epileptic drugs levels were common among children with known seizure disorders presenting with status epilepticus. Gender, race, insurance status, type of seizures, intubation requirement, lengths of stay, and mortality were not significantly different between the two groups.
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Affiliation(s)
| | - Mary M Garland
- Surgery, Herbert Wertheim College of Medicine, Miami, USA
| | - Prithvi Sendi
- Pediatrics, Nicklaus Children's Hospital, Miami, USA
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14
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Ullah S, Ali N, Khan A, Ali S, Nazish HR. The Epidemiological Characteristics of Epilepsy in the Province of Khyber Pakhtunkhwa, Pakistan. Front Neurol 2018; 9:845. [PMID: 30459698 PMCID: PMC6232227 DOI: 10.3389/fneur.2018.00845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
Previous studies have shown that Khyber Pakhtunkhwa, Pakistan has a high incidence of epilepsy and a high proportion of low socioeconomic background and high treatment gap. Considering the changes over the past 20 years little is known about the current epidemiological characteristics of epilepsy in Khyber Pakhtunkhwa, Pakistan. The current study was focused to find the impact of various contributing factors on the clinical response to anti-epileptic drugs in the KP population, Pakistan. A total of 315 participants aged 19.1 ± 8.6 years were examined. Mean age of the patients was 18 ± 8.1 year. Epilepsy was high in male patients (64.39%) and urban areas (60.1%). Mostly, 88.6% of patients were belonging to low socioeconomic status background. 42.4% patients have positive family history for epilepsy and 42.8% patients had consanguineous marriages. Middle SES class patients (OR, 2.22 [CI, 0.54-9.1]) were slightly associated with controlled response to CBZ and VPA therapy. Absence seizure (OR, 1.16 [CI, 0.59-2.3]), and Complex partial seizure (OR, 1.29 [CI, 0.58-6.3]) showed good response to CBZ therapy while, Myoclonic seizure (OR, 2.23 [CI, 0.05-8.8]) was responsive to VPA therapy. However, non-compliance (R 2 0.82, P < 0.0001) and nature of seizures (R 2 0.83, P < 0.0001) were associated with the high risk for poor response to both CBZ and VPA therapy. Epilepsy was high in male patients and in urban areas. Most patients were belonging to low socioeconomic status. Non-compliance, low socioeconomic and nature of seizures strongly predict poor clinical response of anti-epileptic drugs therapy.
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Affiliation(s)
- Shakir Ullah
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Center for Neuroscience, Shantou University Medical College, Shantou, China
| | - Niaz Ali
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Adnan Khan
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Saad Ali
- Neurology Departments, Lady Reading Hospital Peshawar, Peshawar, Pakistan
| | - Haleema Rehana Nazish
- Pharmacology/Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
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15
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Zhang L, Zhu X, Qiu X, Li Y, Chen Y, Wang H, He S, Lai W, Peng A, Ning M, Chen L. Relationship between right-to-left shunt and migraine in patients with epilepsy: a single-centre, cross-sectional study in China. BMJ Open 2018; 8:e024144. [PMID: 30297353 PMCID: PMC6194457 DOI: 10.1136/bmjopen-2018-024144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To investigate the relationship between right-to-left shunt and migraine to account for the unexplained high prevalence of migraine in patients with epilepsy. DESIGN This is a cross-sectional study. The diagnosis and interview process of patients with migraine was based on the International Classification of Headache Disorders-3 beta in patients with epilepsy. Participants underwent transthoracic echocardiography (TTE) with contrast medium to identify right-to-left shunt. The highest number of microbubbles were recorded in the left atrium before the complete microbubble outflow of the right atrium. A moderate-to-large shunt was defined as the presence of 10 or more microbubbles. SETTING A single-centre, cross-sectional study in China, 2015-2017. PARTICIPANTS Patients with epilepsy. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were the prevalence of migraine, the prevalence of right-to-left shunt in patients with migraine and those without migraine, and the prevalence of migraine in different degrees of shunting. RESULTS Three hundred thirty-nine participants with epilepsy who completed TTE were included in the analysis. The overall prevalence of migraine was 23.0%. One-third of the migraineurs had mild right-to-left shunt and one-fifth of the migraineurs had moderate-to-large right-to-left shunt. Patients with mild shunt did not have a higher prevalence of migraine than those without shunt (26.3% vs 18.1%, p=0.102); however, a higher prevalence of migraine was found in patients with moderate-to-large shunt (39.0% vs 18.1%, OR=2.90, 95% CI=1.41 to 5.98, p=0.003). Patients with migraine and patients without migraine had similar prevalence of mild shunt; however, patients with migraine had more moderate-to-large shunt (20.5% vs 9.6%, p=0.002). Right-to-left shunt and female were factors predicting migraine prevalence. CONCLUSIONS One-fifth of migraineurs were correlated with moderate-to-large right-to-left shunt which could be an underlying cause of migraine in epilepsy.
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Affiliation(s)
- Lin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xi Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangmiao Qiu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shixu He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wanlin Lai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingming Ning
- Department of Neurology, Cardio-Neurology Clinic, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Franz DN, Capal JK. mTOR inhibitors in the pharmacologic management of tuberous sclerosis complex and their potential role in other rare neurodevelopmental disorders. Orphanet J Rare Dis 2017; 12:51. [PMID: 28288694 PMCID: PMC5348752 DOI: 10.1186/s13023-017-0596-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/14/2017] [Indexed: 11/21/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder that affects multiple organ systems throughout the body. Dysregulation of the mammalian target of rapamycin (mTOR) pathway is implicated in the disease pathology, and evidence exists to support the use of mTOR inhibitors in treatment. The mTOR pathway has also been investigated as a potential treatment target for several other rare diseases. TSC research has highlighted the value of pursuing targeted therapies based on underlying molecular pathophysiology. One goal of current research is to identify the role of mTOR inhibition in neurologic and developmental disorders apart from TSC. There is also particular interest in the potential role of mTOR inhibitors in preventing seizures, neurodevelopmental disabilities, renal tumors, cutaneous tumors, and other manifestations typically seen in TSC. It is foreseeable that use of mTOR inhibition to prevent long-term morbidity in TSC will become mainstream therapeutic practice. This review will provide an overview of the relationship between the mTOR pathway and TSC disease pathology, summarize the clinical evidence supporting the use of mTOR inhibitors for treatment of the various manifestations of TSC, and discuss the potential therapeutic role of mTOR inhibitors in several rare diseases.
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Affiliation(s)
- David N Franz
- Department of Pediatrics, Tuberous Sclerosis Clinic, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Jamie K Capal
- Department of Neurology, Tuberous Sclerosis Clinic, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, Chen Q, Chen L, Cheng H, Gao L, Chen Z, Zhang H, Tian M. Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy. J Nucl Med 2017; 58:1293-1299. [PMID: 28104740 DOI: 10.2967/jnumed.116.187492] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
PET with 18F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (|AI|) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The |AI| significantly positively correlated with seizure frequency (P < 0.01) but negatively correlated with the time since last seizure (P < 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the |AI| was the time since last seizure, in patients both with hypometabolism (P = 0.001) and with hypermetabolism (P = 0.005). For patients with either hypometabolism (P < 0.01) or hypermetabolism (P = 0.209), higher |AI| values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of |AI| (%) was found in patients with clinical improvement compared with those with persistence or progression (P < 0.01). Conclusion:18F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. |AI| might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.
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Affiliation(s)
- Yuankai Zhu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Shuang Wu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haifeng Hou
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianfeng Ji
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lin Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haiying Cheng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Liuyan Gao
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Mei Tian
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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Chipaux M, Szurhaj W, Vercueil L, Milh M, Villeneuve N, Cances C, Auvin S, Chassagnon S, Napuri S, Allaire C, Derambure P, Marchal C, Caubel I, Ricard-Mousnier B, N'Guyen the Tich S, Pinard JM, Bahi-Buisson N, de Baracé C, Kahane P, Gautier A, Hamelin S, Coste-Zeitoun D, Rosenberg SD, Clerson P, Nabbout R, Kuchenbuch M, Picot MC, Kaminska A. Epilepsy diagnostic and treatment needs identified with a collaborative database involving tertiary centers in France. Epilepsia 2016; 57:757-69. [DOI: 10.1111/epi.13368] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2016] [Indexed: 01/17/2023]
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19
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Factors predictive of late remission in a cohort of Chinese patients with newly diagnosed epilepsy. Seizure 2016; 37:20-4. [PMID: 26921482 DOI: 10.1016/j.seizure.2016.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/05/2016] [Accepted: 02/12/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Limited data have focused on predictive factors of late remission in patients with newly diagnosed epilepsy. We are aiming to identify prognostic predictors of late remission in a prospective cohort of Chinese patients. METHODS Patients with newly diagnosed epilepsy were included from 2009 to September 2012 at a tertiary hospital, with follow-up of at least two years. Early remission was defined by seizure free either immediately or within six months of treatment initiation, late remission was defined by seizure free achieved after more than six months. All analyses were performed with SPSS 13.0 software. RESULTS A total of 223 patients were included, and followed for an average of 43 months. 115 patients (51.6%) achieved early remission and 39 patients (17.5%) achieved late remission. Multivariable logistic regression analysis demonstrated more than 3 seizures prior to treatment (OR=3.12, 95% CI 1.39-7.04, p=0.006) and multiple seizure types (OR=2.49, 95% CI 1.02-6.11, p=0.046) may predict late remission. However, nonadherence was not significantly associated with late remission. CONCLUSION Patients with a high frequency of seizures prior to treatment or multiple seizure types may achieve late remission. Particular consideration should be given to these patients.
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