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Lemoine É, Neves Briard J, Rioux B, Gharbi O, Podbielski R, Nauche B, Toffa D, Keezer M, Lesage F, Nguyen DK, Bou Assi E. Computer-assisted analysis of routine EEG to identify hidden biomarkers of epilepsy: A systematic review. Comput Struct Biotechnol J 2024; 24:66-86. [PMID: 38204455 PMCID: PMC10776381 DOI: 10.1016/j.csbj.2023.12.006] [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: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
Background Computational analysis of routine electroencephalogram (rEEG) could improve the accuracy of epilepsy diagnosis. We aim to systematically assess the diagnostic performances of computed biomarkers for epilepsy in individuals undergoing rEEG. Methods We searched MEDLINE, EMBASE, EBM reviews, IEEE Explore and the grey literature for studies published between January 1961 and December 2022. We included studies reporting a computational method to diagnose epilepsy based on rEEG without relying on the identification of interictal epileptiform discharges or seizures. Diagnosis of epilepsy as per a treating physician was the reference standard. We assessed the risk of bias using an adapted QUADAS-2 tool. Results We screened 10 166 studies, and 37 were included. The sample size ranged from 8 to 192 (mean=54). The computed biomarkers were based on linear (43%), non-linear (27%), connectivity (38%), and convolutional neural networks (10%) models. The risk of bias was high or unclear in all studies, more commonly from spectrum effect and data leakage. Diagnostic accuracy ranged between 64% and 100%. We observed high methodological heterogeneity, preventing pooling of accuracy measures. Conclusion The current literature provides insufficient evidence to reliably assess the diagnostic yield of computational analysis of rEEG. Significance We provide guidelines regarding patient selection, reference standard, algorithms, and performance validation.
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Affiliation(s)
- Émile Lemoine
- Department of Neurosciences, University of Montreal, Canada
- Institute of biomedical engineering, Polytechnique Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
| | - Joel Neves Briard
- Department of Neurosciences, University of Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
| | - Bastien Rioux
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Oumayma Gharbi
- Department of Neurosciences, University of Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
| | | | - Bénédicte Nauche
- University of Montreal Hospital Center’s Research Center, Canada
| | - Denahin Toffa
- Department of Neurosciences, University of Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
| | - Mark Keezer
- Department of Neurosciences, University of Montreal, Canada
- School of Public Health, University of Montreal, Canada
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Frédéric Lesage
- Institute of biomedical engineering, Polytechnique Montreal, Canada
| | - Dang K. Nguyen
- Department of Neurosciences, University of Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
| | - Elie Bou Assi
- Department of Neurosciences, University of Montreal, Canada
- University of Montreal Hospital Center’s Research Center, Canada
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Chen X, Yu W, Zhao Y, Ji Y, Qi Z, Guan Y, Wan J, Hao Y. Diagnosis of epilepsy by machine learning of high-performance plasma metabolic fingerprinting. Talanta 2024; 277:126328. [PMID: 38824860 DOI: 10.1016/j.talanta.2024.126328] [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: 03/16/2024] [Revised: 05/18/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024]
Abstract
Epilepsy is a chronic neurological disorder that causes a major threat to public health and the burden of disease worldwide. High-performance diagnostic tools for epilepsy need to be developed to improve diagnostic accuracy and efficiency while still missing. Herein, we utilized nanoparticle-enhanced laser desorption/ionization mass spectrometry (NELDI MS) to acquire plasma metabolic fingerprints (PMFs) from epileptic and healthy individuals for timely and accurate screening of epilepsy. The NELDI MS enabled high detection speed (∼30 s per sample), high throughput (up to 384 samples per run), and favorable reproducibility (coefficients of variation <15 %), acquiring high-performed PMFs. We next constructed an epilepsy diagnostic model by machine learning of PMFs, achieving desirable diagnostic capability with the area under the curve (AUC) value of 0.941 for the validation set. Furthermore, four metabolites were identified as a diagnostic biomarker panel for epilepsy, with an AUC value of 0.812-0.860. Our approach provides a high-performed and high-throughput platform for epileptic diagnostics, promoting the development of metabolic diagnostic tools in precision medicine.
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Affiliation(s)
- Xiaonan Chen
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200241, PR China
| | - Wendi Yu
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China
| | - Yinbing Zhao
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200241, PR China
| | - Yuxi Ji
- School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, PR China
| | - Ziheng Qi
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200241, PR China
| | - Yangtai Guan
- Department of Neurology, Punan Branch of Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200125, PR China.
| | - Jingjing Wan
- School of Chemistry and Molecular Engineering, East China Normal University, Shanghai, 200241, PR China.
| | - Yong Hao
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, PR China.
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Roghani A, Wang CP, Henion A, Amuan M, Altalib H, LaFrance WC, Baca C, Van Cott A, Towne A, Kean J, Hinds SR, Kennedy E, Panahi S, Pugh MJ. Mortality among veterans with epilepsy: Temporal significance of traumatic brain injury exposure. Epilepsia 2024; 65:2255-2269. [PMID: 39119799 DOI: 10.1111/epi.18026] [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: 12/10/2023] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Epilepsy is associated with significant mortality risk. There is limited research examining how traumatic brain injury (TBI) timing affects mortality in relation to the onset of epilepsy. We aimed to assess the temporal relationship between epilepsy and TBI regarding mortality in a cohort of post-9/11 veterans. METHODS This retrospective cohort study included veterans who received health care in the Defense Health Agency and the Veterans Health Administration between 2000 and 2019. For those diagnosed with epilepsy, the index date was the date of first antiseizure medication or first seizure; we simulated the index date for those without epilepsy. We created the study groups by the index date and first documented TBI: (1) controls (no TBI, no epilepsy), (2) TBI only, (3) epilepsy only, (4) TBI before epilepsy, (5) TBI within 6 months after epilepsy, and (6) TBI >6 months after epilepsy. Kaplan-Meier estimates of all-cause mortality were calculated, and log-rank tests were used to compare unadjusted cumulative mortality rates among groups compared to controls. Cox proportional hazard models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS Among 938 890 veterans, 27 436 (2.92%) met epilepsy criteria, and 264 890 (28.22%) had a TBI diagnosis. Mortality was higher for veterans with epilepsy than controls (6.26% vs. 1.12%; p < .01). Veterans with TBI diagnosed ≤6 months after epilepsy had the highest mortality hazard (HR = 5.02, 95% CI = 4.21-5.99) compared to controls, followed by those with TBI before epilepsy (HR = 4.25, 95% CI = 3.89-4.58), epilepsy only (HR = 4.00, 95% CI = 3.67-4.36), and TBI >6 months after epilepsy (HR = 2.49, 95% CI = 2.17-2.85). These differences were significant across groups. SIGNIFICANCE TBI timing relative to epilepsy affects time to mortality; TBI within 6 months after epilepsy or before epilepsy diagnosis was associated with earlier time to death compared to those with epilepsy only or TBI >6 months after epilepsy.
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Affiliation(s)
- Ali Roghani
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Chen-Pin Wang
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System, Geriatric Research, Education & Clinical Center, San Antonio, Texas, USA
| | - Amy Henion
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Megan Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Hamada Altalib
- Connecticut Veteran Healthcare System, West Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry, Providence Veterans Administration Salt Lake City Health Care System Medical Center, Providence, Rhode Island, USA
| | - Christine Baca
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anne Van Cott
- Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alan Towne
- Department of Psychiatry, Providence Veterans Administration Salt Lake City Health Care System Medical Center, Providence, Rhode Island, USA
- Epilepsy Center of Excellence, Central Virginia Veterans Administration Hospital, Richmond, Virginia, USA
| | - Jacob Kean
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sidney R Hinds
- Department of Radiology/Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eamonn Kennedy
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Samin Panahi
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Mary Jo Pugh
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah, USA
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Klein P, Kaminski RM, Koepp M, Löscher W. New epilepsy therapies in development. Nat Rev Drug Discov 2024:10.1038/s41573-024-00981-w. [PMID: 39039153 DOI: 10.1038/s41573-024-00981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 07/24/2024]
Abstract
Epilepsy is a common brain disorder, characterized by spontaneous recurrent seizures, with associated neuropsychiatric and cognitive comorbidities and increased mortality. Although people at risk can often be identified, interventions to prevent the development of the disorder are not available. Moreover, in at least 30% of patients, epilepsy cannot be controlled by current antiseizure medications (ASMs). As a result of considerable progress in epilepsy genetics and the development of novel disease models, drug screening technologies and innovative therapeutic modalities over the past 10 years, more than 200 novel epilepsy therapies are currently in the preclinical or clinical pipeline, including many treatments that act by new mechanisms. Assisted by diagnostic and predictive biomarkers, the treatment of epilepsy is undergoing paradigm shifts from symptom-only ASMs to disease prevention, and from broad trial-and-error treatments for seizures in general to mechanism-based treatments for specific epilepsy syndromes. In this Review, we assess recent progress in ASM development and outline future directions for the development of new therapies for the treatment and prevention of epilepsy.
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Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
| | | | - Matthias Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Wolfgang Löscher
- Translational Neuropharmacology Lab., NIFE, Department of Experimental Otology of the ENT Clinics, Hannover Medical School, Hannover, Germany.
- Center for Systems Neuroscience, Hannover, Germany.
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Jiang Z, Fu Y, Shen H. UGT1A4*3 polymorphism influences serum concentration and therapeutic effect of lamotrigine for epilepsy treatment: A meta-analysis. PLoS One 2024; 19:e0307377. [PMID: 39024362 PMCID: PMC11257390 DOI: 10.1371/journal.pone.0307377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/04/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Lamotrigine as a broad-spectrum antiepileptic drug, is widely applied and its clinical efficacy is highly recognized. However, significant differences are observed in blood drug concentration of lamotrigine among individuals, which may have an impact on its efficacy. UGT1A4 is the main metabolic enzyme. However, it was inconsistent for the influence of UGT1A4 genetic polymorphism on concentration and efficacy of lamotrigine therapy. This study aimed to evaluate the influences of UGT1A4*3 genetic polymorphisms on lamotrigine concentration and therapeutic effect through meta-analysis. METHODS The literature search was conducted in Medline, Embase, PubMed, Web of Science, Wan Fang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database until January 2024. The primary outcome included the mean serum concentration, concentration-to-dose-ratio by body weight (CDR), or efficacy related to different UGT1A4*3 genotype for lamotrigine therapy. Data were collected to access the Mean Difference or odds ratio with 95% confidence interval. Meta-analysis was performed by RevMan 5.2. RESULTS A total of eleven studies were enrolled. The meta-analysis for mean serum concentration of lamotrigine showed no significant difference between patients carrying TT genotypes and TG and GG genotypes group (MD: 0.12, 95% [-0.35, 0.58], P = 0.62). There was significant difference in CDR (MD: 0.49, 95% [0.03, 0.94], P = 0.04) and therapeutic efficacy (OR: 7.18, 95% [4.01, 12.83], P<0.00001) of lamotrigine, however no significant difference was found in subgroup analysis of CDR of children (MD: 0.03, 95% [-0.35, 0.42], P = 0.87) between patients carrying TT genotypes and TG and GG genotypes group. CONCLUSIONS Polymorphism of UGT1A4*3 influenced the CDR and therapeutic efficacy of lamotrigine for antiepileptic therapy. Genotype analysis provided reference for personalized medication in the future. However, more high-quality evidences are necessary for precise and definitive conclusion.
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Affiliation(s)
- Zhimei Jiang
- Department of Pharmacy, West China Second University Hospital of Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Yuzhi Fu
- Department of Pharmacy, West China Second University Hospital of Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hongxin Shen
- Department of Pharmacy, West China Second University Hospital of Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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Siddiqui F, Soomro BA, Rehman EU, Numan A, Bano S, Salam JU, Brohi H, Zaheer M, Memon FH, Qureshi MW, Sheikh JA, Sunejo AL, Iqbal A, Abbass S, Zaidi S, Nawaz S, Fatima K, Altaf S, Maheshwary N, Khan MA, Ahmed A, Asif MI. A prospective, observational, multicentre study to evaluate the efficacy of brivaracetam as adjuvant therapy for epilepsy: The Bravo study. Drugs Context 2024; 13:2024-3-2. [PMID: 38989131 PMCID: PMC11235182 DOI: 10.7573/dic.2024-3-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024] Open
Abstract
Background Epilepsy is a persistent tendency to experience epileptic seizures and can lead to various neurobiological disorders, with an elevated risk of premature mortality. This study evaluates the efficacy of brivaracetam adjuvant therapy in patients with epilepsy. Methods A prospective observational multicentre study that was conducted in Pakistan from March to September 2022, by using a non-probability convenience sampling technique. The population consisted of 543 individuals with a diagnosis of epilepsy for whom adjunctive brivaracetam (Brivera; manufactured by Helix Pharma Pvt Ltd., Sindh, Pakistan) was recommended by the treating physician. The research sample was drawn from various private neurology clinics of Karachi, Lahore, Rawalpindi, Islamabad and Peshawar. Data originating from routine patient visits, and assessments at three study time points, were recorded in the study case report form. Results Across 18 clinical sites, 543 individuals participated, with a mean age of 32.9 years. The most prescribed dosages were 50 mg BD, followed by 100 mg BD. Notably, brivaracetam combined with divalproex sodium was the most prevalent treatment, followed by brivaracetam with levetiracetam. At both the 14th and 90th day assessments, a significant reduction in seizure frequency was observed, with 63.1% of individuals showing a favourable response by day 90. Treatment-naive individuals exhibited higher rates of seizure freedom and response compared with treatment-resistant individuals. Conclusions The study demonstrates the effectiveness of brivaracetam combination therapy in epilepsy management, with notable reductions in seizure frequency and favourable clinical responses observed, particularly in treatment-naive individuals.
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Affiliation(s)
| | - Bashir A Soomro
- Department of Neurology, Zia Uddin Medical College, Karachi, Pakistan
| | - Ehsan U Rehman
- Department of Neurology, Akhtar Saeed Medical College, Islamabad, Pakistan
| | - Ahsan Numan
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Safia Bano
- Department of Neurology, Mayo Hospital, Lahore, Pakistan
| | - Jawwad Us Salam
- Department of Neurology, Dow University of Health Sciences, Karachi, Pakistan
| | - Hazim Brohi
- Department of Neurology, LNH, Karachi, Pakistan
| | - Muhammad Zaheer
- Department of Neurology, Khattak Medical Center, Peshawar, Pakistan
| | - Faizan Hyder Memon
- Department of Neurology, United Medical & Dental College, Karachi, Pakistan
| | | | | | - Abdul Latif Sunejo
- Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Amjad Iqbal
- Department of Neurology, Klmc, Karachi, Pakistan
| | - Saira Abbass
- Department of Neurology, Dow University of Health Sciences, Karachi, Pakistan
| | - Saba Zaidi
- Department of Neurology, LNH, Karachi, Pakistan
| | - Sidrah Nawaz
- Department of Neurology, Wah International Hospital, Islamabad, Pakistan
| | - Kaukab Fatima
- Department of Neurology, Bashir Hospital, Sialkot, Pakistan
| | - Samar Altaf
- Department of Neurology, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Athar Khan
- Department of Community Medicine, Liaquat College of Medicine & Dentistry, Karachi, Pakistan
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Wartmann H, Effenberger T, Klähn H, Volmer T, Surges R. [Incidence of sudden death in epilepsy (SUDEP): update and limitations]. DER NERVENARZT 2024; 95:544-552. [PMID: 38252160 PMCID: PMC11178670 DOI: 10.1007/s00115-023-01595-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is in most cases probably due to a fatal complication of tonic-clonic seizures and plays a significant role in the premature mortality of individuals with epilepsy. The reported risks of SUDEP vary considerably depending on the study population, so that an up-dated systematic review of SUDEP incidence including most recent studies is required to improve the estimated SUDEP risk and the counseling of individuals with epilepsy. OBJECTIVE To provide an overview of the current research landscape concerning SUDEP incidence across different patient populations and discuss potential conclusions and existing limitations. MATERIAL AND METHODS A systematic literature review on SUDEP incidence was conducted in MEDLINE and EMBASE, supplemented by a manual search in June 2023. Out of a total of 3324 publications, 50 were reviewed for this study. RESULTS The analyzed studies showed significant heterogeneity concerning cohorts, study design and data sources. Studies conducted without specific criteria and relying on comprehensive registers indicated an incidence of 0.78-1.2 per 1000 patient-years. Research providing incidences across various age groups predominantly show an increase with age, peaking in middle age. DISCUSSION Due to varying methods of data collection and incidence calculation, comparing between studies is challenging. The association with age might be due to an underrepresentation of children, adolescents and patients over 60 years. CONCLUSION Considering all age groups and types of epilepsy it is estimated that about 1 in 1000 individuals with epilepsy dies of SUDEP annually. With an assumed epilepsy prevalence of 0.6% in Germany, this could lead to more than one SUDEP case daily. Standardization of research methods is essential to gain more profound insights.
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Affiliation(s)
| | | | | | - Timm Volmer
- SmartStep Data Institute GmbH, Hamburg, Deutschland
| | - Rainer Surges
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Tian N, Kobau R, Friedman D, Liu Y, Eke PI, Greenlund KJ. Mortality and mortality disparities among people with epilepsy in the United States, 2011-2021. Epilepsy Behav 2024; 155:109770. [PMID: 38636143 PMCID: PMC11284737 DOI: 10.1016/j.yebeh.2024.109770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
Studies on epilepsy mortality in the United States are limited. We used the National Vital Statistics System Multiple Cause of Death data to investigate mortality rates and trends during 2011-2021 for epilepsy (defined by the International Classification of Diseases, 10th Revision, codes G40.0-G40.9) as an underlying, contributing, or any cause of death (i.e., either an underlying or contributing cause) for U.S. residents. We also examined epilepsy as an underlying or contributing cause of death by selected sociodemographic characteristics to assess mortality rate changes and disparities in subpopulations. During 2011-2021, the overall age-standardized mortality rates for epilepsy as an underlying (39 % of all deaths) or contributing (61 % of all deaths) cause of death increased 83.6 % (from 2.9 per million to 6.4 per million population) as underlying cause and 144.1 % (from 3.3 per million to 11.0 per million population) as contributing cause (P < 0.001 for both based on annual percent changes). Compared to 2011-2015, in 2016-2020 mortality rates with epilepsy as an underlying or contributing cause of death were higher overall and in nearly all subgroups. Overall, mortality rates with epilepsy as an underlying or contributing cause of death were higher in older age groups, among males than females, among non-Hispanic Black or non-Hispanic American Indian/Alaska Native persons than non-Hispanic White persons, among those living in the West and Midwest than those living in the Northeast, and in nonmetro counties compared to urban regions. Results identify priority subgroups for intervention to reduce mortality in people with epilepsy and eliminate mortality disparity.
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Affiliation(s)
- Niu Tian
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Rosemarie Kobau
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Daniel Friedman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016 USA
| | - Yong Liu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Kurt J Greenlund
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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9
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Jaramillo-Jiménez E, Sandoval-Barrios J, Walsh FJ, Jaramillo-Jiménez MC, Echeverri-Sánchez JD, Rodríguez-Márquez IA, Barrientos-Montoya HD, Ascencio-Lancheros JL, Giraldo-Palacio JF, Sierra-Arrieta IM, Gómez-Duque DI, Pérez-López S, Bustamante MT. Epileptic encephalopathies secondary to hypothalamic hamartomas treated with radiosurgery: A case series. Epileptic Disord 2024. [PMID: 38804823 DOI: 10.1002/epd2.20246] [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: 05/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Hypothalamic hamartomas are congenital lesions that typically present with gelastic seizures, refractory epilepsy, neurodevelopmental delay, and severe cognitive impairment. Surgical procedures have been reported to be effective in removing the hamartomas, however, they are associated with significant morbidity. Therefore, it is not considered a safe therapeutic modality. Image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) has been shown to provide good outcomes without lasting complications. METHODS This series of cases describes the clinical, radiological, radiotherapeutic, and postsurgical outcomes of five patients with epileptic encephalopathies secondary to hypothalamic hamartomas who were treated with CyberKnife®. RESULTS All patients exhibited refractory epilepsy with gelastic seizures and were unsuitable candidates for surgical resection The prescribed dose ranged between 16 and 25 Gy, delivered in a single fraction for four patients and five fractions for one patient while adhering strictly to visual pathway constraints. After radiosurgery, four patients maintained seizure control (one with an Engel class Ia, three with an Engel class 1d), and another presented sporadic, nondisabling gelastic seizures (with an Engel class IIa). After 24-26 months of follow-up, in three patients, their intelligence quotient scores increased. No complications were reported. SIGNIFICANCE This report suggests that Cyberknife may be a good option for treating hypothalamic hamartoma, particularly in cases where other noninvasive alternatives are unavailable. Nevertheless, additional studies are essential in order to evaluate the effectiveness of the technique in these cases.
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Affiliation(s)
| | | | - Fergus John Walsh
- School of Medicine, College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Liu C, Ye J, He S, Ma Z, Luo F, Miao J, Li H, Cao P, Zhu J. Causal relationship between rheumatoid arthritis and epilepsy in a European population: a univariate and multivariate Mendelian randomization study. Front Immunol 2024; 15:1389549. [PMID: 38817604 PMCID: PMC11137193 DOI: 10.3389/fimmu.2024.1389549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Background Several previous studies have reported an association between rheumatoid arthritis (RA) and epilepsy, but the causal relationship is unclear. The aim of this study was to assess the connection between RA and epilepsy in a European population using Mendelian randomization (MR). Methods Genome-wide association study summary data on RA and epilepsy from European populations were included. Univariate MR (UVMR) and multivariate MR were used to investigate the causal relationship between the two conditions. Three analysis methods were applied: inverse variance weight (IVW), MR-Egger, and weighted median, with IVW being the primary method. Cochran Q statistics, MR-PRESSO, MR-Egger intercept, leave-one-out test, and MR-Steiger test were combined for the sensitivity analysis. Results UVMR showed a positive association between RA and epilepsy risk (OR=1.038, 95% CI=1.007-1.038, p=0.017) that was supported by sensitivity analysis. Further MVMR after harmonizing the three covariates of hypertension, alcohol consumption, and smoking, confirmed the causal relationship between RA and epilepsy (OR=1.049, 95% CI=1.011-1.087, p=0.010). Conclusion This study demonstrated that RA is associated with an increased risk of epilepsy. It has emphasized that the monitoring of epilepsy risk in patients diagnosed with RA should be strengthened in clinical practice, and further studies are needed in the future to explore the potential mechanism of action connecting the two conditions.
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Affiliation(s)
- Chang Liu
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiangnan Ye
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shixiu He
- Arthrology Department, Nanchong Gaoping District People’s Hospital, Nanchong, Sichuan, China
| | - Zhijun Ma
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fang Luo
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jintao Miao
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huinan Li
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Puhua Cao
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jun Zhu
- School of Acupuncture-Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- The Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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11
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Yang JJ, Liu YX, Wang YF, Ge BY, Wang Y, Wang QS, Li S, Zhang JJ, Jin LL, Hong JS, Yin SM, Zhao J. Anti-epileptic and Neuroprotective Effects of Ultra-low Dose NADPH Oxidase Inhibitor Dextromethorphan on Kainic Acid-induced Chronic Temporal Lobe Epilepsy in Rats. Neurosci Bull 2024; 40:577-593. [PMID: 37973720 PMCID: PMC11127903 DOI: 10.1007/s12264-023-01140-8] [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: 03/15/2023] [Accepted: 06/24/2023] [Indexed: 11/19/2023] Open
Abstract
Neuroinflammation mediated by microglia and oxidative stress play pivotal roles in the development of chronic temporal lobe epilepsy (TLE). We postulated that kainic acid (KA)-Induced status epilepticus triggers microglia-dependent inflammation, leading to neuronal damage, a lowered seizure threshold, and the emergence of spontaneous recurrent seizures (SRS). Extensive evidence from our laboratory suggests that dextromethorphan (DM), even in ultra-low doses, has anti-inflammatory and neuroprotective effects in many animal models of neurodegenerative disease. Our results showed that administration of DM (10 ng/kg per day; subcutaneously via osmotic minipump for 4 weeks) significantly mitigated the residual effects of KA, including the frequency of SRS and seizure susceptibility. In addition, DM-treated rats showed improved cognitive function and reduced hippocampal neuronal loss. We found suppressed microglial activation-mediated neuroinflammation and decreased expression of hippocampal gp91phox and p47phox proteins in KA-induced chronic TLE rats. Notably, even after discontinuation of DM treatment, ultra-low doses of DM continued to confer long-term anti-seizure and neuroprotective effects, which were attributed to the inhibition of microglial NADPH oxidase 2 as revealed by mechanistic studies.
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Affiliation(s)
- Jing-Jing Yang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Ying-Xin Liu
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Yan-Fang Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Bi-Ying Ge
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Qing-Shan Wang
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
- School of Public Health, Dalian Medical University, Dalian, 116044, China
| | - Sheng Li
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Jian-Jie Zhang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, China
| | - Ling-Ling Jin
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China
| | - Jau-Shyong Hong
- Neurobiology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, Durham, NC, 27709, USA
| | - Sheng-Ming Yin
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China.
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China.
| | - Jie Zhao
- College of Basic Medical Sciences, Dalian Medical University, Dalian, 116044, China.
- National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases, Dalian, 116044, China.
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12
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Osman M, Khalil J, El-Bahri M, Swalah Mcdahrou J, Fahda R, Mustafa R, Ooi A, Attayee M, Catanzariti R, Pont L, Williams K, Yeung S, Dua K, De Rubis G, Loebenberg R. Decoding epilepsy treatment: A comparative evaluation contrasting cannabidiol pharmacokinetics in adult and paediatric populations. Chem Biol Interact 2024; 394:110988. [PMID: 38574834 DOI: 10.1016/j.cbi.2024.110988] [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: 01/25/2024] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024]
Abstract
Epilepsy is a neurological disorder characterized by overstimulation of neurotransmitters and uncontrolled seizures. Current medications for epilepsy result in adverse effects or insufficient seizure control, highlighting the necessity to develop alternative therapies. Cannabidiol (CBD), derived from cannabis plants, has been popularly explored as an alternative. CBD is shown to have anti-convulsivatng and muscle-relaxing properties, which have been used in patients with epilepsy with promising results. Current research explores varying dosages in either adult or paediatric patients, with little or no comparison between the two populations. In this review, we aim at consolidating this data and comparing the effect and pharmacokinetic properties of CBD across these two patient populations. When comparing the absorption, there was insufficient data to show differences between paediatric and adult patients. Similarly, limited information was available in comparing the distribution of CBD, but a higher volume of distribution was found in the paediatric population. From the metabolism perspective, the paediatric population had a greater success rate when treated with the drug compared to the adult population. In the elimination, there were no clear distinctions in the clearance rate between the two populations. The drug's half-life was highly variable in both populations, with paediatrics having a lower range than adults. In summary, the paediatric population had a more significant reduction in the severity of seizures compared to the adult population upon CBD treatment. The complexity in which CBD operates highlights the need for further studies of the compound to further understand why differences occur between these two populations.
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Affiliation(s)
- Mohamed Osman
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jamileh Khalil
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Mostafa El-Bahri
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Jamal Swalah Mcdahrou
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Reem Fahda
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Reymin Mustafa
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Arthur Ooi
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Marwa Attayee
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Rachelle Catanzariti
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Lisa Pont
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Kylie Williams
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Stewart Yeung
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
| | - Gabriele De Rubis
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia.
| | - Raimar Loebenberg
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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13
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Badger S, Watkins LV, Bassett P, Roy A, Eyeoyibo M, Sawhney I, Purandare K, Wood L, Pugh A, Hammett J, Sheehan R, Tromans S, Shankar R. The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy - national comparative cohort study. BJPsych Open 2024; 10:e94. [PMID: 38686441 PMCID: PMC11060072 DOI: 10.1192/bjo.2024.45] [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: 11/11/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND A quarter of People with Intellectual Disabilities (PwID) have epilepsy compared with 1% of the general population. Epilepsy in PwID is a bellwether for premature mortality, multimorbidity and polypharmacy. This group depends on their care provider to give relevant information for management, especially epilepsy. There is no research on care status relationship and clinical characteristics of PwID and epilepsy. AIM Explore and compare the clinical characteristics of PwID with epilepsy across different care settings. METHOD A retrospective multicentre cohort study across England and Wales collected information on seizure characteristics, intellectual disability severity, neurodevelopmental/biological/psychiatric comorbidities, medication including psychotropics/anti-seizure medication, and care status. Clinical characteristics were compared across different care settings, and those aged over and younger than 40 years. RESULTS Of 618 adult PwID across six centres (male:female = 61%:39%), 338 (55%) received professional care whereas 258 (42%) lived with family. Significant differences between the care groups existed in intellectual disability severity (P = 0.01), autism presence (P < 0.001), challenging behaviour (P < 0.001) and comorbid physical conditions (P = 0.008). The two groups did not vary in intellectual disability severity/genetic conditions/seizure type and frequency/psychiatric disorders. The professional care cohort experienced increased polypharmacy (P < 0.001) and antipsychotic/psychotropic use (P < 0.001/P = 0.008).The over-40s cohort had lower autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) comorbidity (P < 0.001/P = 0.007), increased psychiatric comorbidity and challenging behaviour (P < 0.05), physical multimorbidity (P < 0.001), polypharmacy (P < 0.001) and antipsychotic use (P < 0.001) but reduced numbers of seizures (P = 0.007). CONCLUSION PwID and epilepsy over 40 years in professional care have more complex clinical characteristics, increased polypharmacy and antipsychotic prescribing but fewer seizures.
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Affiliation(s)
- Sarah Badger
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - Lance V Watkins
- University of South Wales, Pontypridd, UK; Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK; and Swansea Bay University Health Board, Port Talbot, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Kiran Purandare
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Laurie Wood
- Swansea Bay University Health Board, Port Talbot, UK
| | - Andrea Pugh
- Swansea Bay University Health Board, Port Talbot, UK
| | | | - Rory Sheehan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuel Tromans
- SAPPHIRE Group, Department of Population Health Sciences, University of Leicester, Leicester, UK; and Adult Learning Disability Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
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14
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Kim DH, Park JO, Lee DY, Choi YS. Multiscale distribution entropy analysis of short epileptic EEG signals. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:5556-5576. [PMID: 38872548 DOI: 10.3934/mbe.2024245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
This paper proposes an information-theoretic measure for discriminating epileptic patterns in short-term electroencephalogram (EEG) recordings. Considering nonlinearity and nonstationarity in EEG signals, quantifying complexity has been preferred. To decipher abnormal epileptic EEGs, i.e., ictal and interictal EEGs, via short-term EEG recordings, a distribution entropy (DE) is used, motivated by its robustness on the signal length. In addition, to reflect the dynamic complexity inherent in EEGs, a multiscale entropy analysis is incorporated. Here, two multiscale distribution entropy (MDE) methods using the coarse-graining and moving-average procedures are presented. Using two popular epileptic EEG datasets, i.e., the Bonn and the Bern-Barcelona datasets, the performance of the proposed MDEs is verified. Experimental results show that the proposed MDEs are robust to the length of EEGs, thus reflecting complexity over multiple time scales. In addition, the proposed MDEs are consistent irrespective of the selection of short-term EEGs from the entire EEG recording. By evaluating the Man-Whitney U test and classification performance, the proposed MDEs can better discriminate epileptic EEGs than the existing methods. Moreover, the proposed MDE with the moving-average procedure performs marginally better than one with the coarse-graining. The experimental results suggest that the proposed MDEs are applicable to practical seizure detection applications.
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Affiliation(s)
- Dae Hyeon Kim
- Department of Electronics and Communications Engineering, Kwangwoon University, Seoul 01897, South Korea
| | - Jin-Oh Park
- Department of Electronics and Communications Engineering, Kwangwoon University, Seoul 01897, South Korea
| | - Dae-Young Lee
- Department of Electronics and Communications Engineering, Kwangwoon University, Seoul 01897, South Korea
| | - Young-Seok Choi
- Department of Electronics and Communications Engineering, Kwangwoon University, Seoul 01897, South Korea
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15
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Shah RA, Chahal CAA, Ranjha S, Sharaf Dabbagh G, Asatryan B, Limongelli I, Khanji M, Ricci F, De Paoli F, Zucca S, Tristani-Firouzi M, St Louis EK, So EL, Somers VK. Cardiovascular Disease Burden, Mortality, and Sudden Death Risk in Epilepsy: A UK Biobank Study. Can J Cardiol 2024; 40:688-695. [PMID: 38013064 DOI: 10.1016/j.cjca.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Sudden death is the leading cause of mortality in medically refractory epilepsy. Middle-aged persons with epilepsy (PWE) are under investigated regarding their mortality risk and burden of cardiovascular disease (CVD). METHODS Using UK Biobank, we identified 7786 (1.6%) participants with diagnoses of epilepsy and 6,171,803 person-years of follow-up (mean 12.30 years, standard deviation 1.74); 566 patients with previous histories of stroke were excluded. The 7220 PWE comprised the study cohort with the remaining 494,676 without epilepsy as the comparator group. Prevalence of CVD was determined using validated diagnostic codes. Cox proportional hazards regression was used to assess all-cause mortality and sudden death risk. RESULTS Hypertension, coronary artery disease, heart failure, valvular heart disease, and congenital heart disease were more prevalent in PWE. Arrhythmias including atrial fibrillation/flutter (12.2% vs 6.9%; P < 0.01), bradyarrhythmias (7.7% vs 3.5%; P < 0.01), conduction defects (6.1% vs 2.6%; P < 0.01), and ventricular arrhythmias (2.3% vs 1.0%; P < 0.01), as well as cardiac implantable electric devices (4.6% vs 2.0%; P < 0.01) were more prevalent in PWE. PWE had higher adjusted all-cause mortality (hazard ratio [HR], 3.9; 95% confidence interval [CI], 3.01-3.39), and sudden death-specific mortality (HR, 6.65; 95% CI, 4.53-9.77); and were almost 2 years younger at death (68.1 vs 69.8; P < 0.001). CONCLUSIONS Middle-aged PWE have increased all-cause and sudden death-specific mortality and higher burden of CVD including arrhythmias and heart failure. Further work is required to elucidate mechanisms underlying all-cause mortality and sudden death risk in PWE of middle age, to identify prognostic biomarkers and develop preventative therapies in PWE.
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Affiliation(s)
- Ravi A Shah
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - C Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA; WellSpan Center for Inherited Cardiovascular Diseases, WellSpan Health, York, Pennsylvania, USA.
| | | | - Ghaith Sharaf Dabbagh
- WellSpan Center for Inherited Cardiovascular Diseases, WellSpan Health, York, Pennsylvania, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Babken Asatryan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Mohammed Khanji
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | | | | | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Mayo Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elson L So
- Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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16
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Rybczynski S. Mortality and Autism: Suicide and Elopement. Pediatr Clin North Am 2024; 71:343-351. [PMID: 38423725 DOI: 10.1016/j.pcl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Autistic children and youth are at risk for premature mortality. Two preventable causes of that increased risk are elopement and suicide. Pediatricians should educate themselves and caregivers about strategies that could prevent tragic situations involving autistic youth.
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Affiliation(s)
- Suzanne Rybczynski
- East Tennessee Children's Hospital, 2018 Clinch Avenue, Knoxville, TN 37916, USA; Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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17
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Donner E, Devinsky O, Friedman D. Wearable Digital Health Technology for Epilepsy. N Engl J Med 2024; 390:736-745. [PMID: 38381676 DOI: 10.1056/nejmra2301913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Elizabeth Donner
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
| | - Orrin Devinsky
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
| | - Daniel Friedman
- From the Division of Neurology, Hospital for Sick Children, and the Department of Paediatrics, University of Toronto - both in Toronto (E.D.); and the Epilepsy Center, Department of Neurology, New York University Grossman School of Medicine, New York (O.D., D.F.)
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18
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Lehnen J, Venkatesh P, Yao Z, Aziz A, Nguyen PVP, Harvey J, Alick-Lindstrom S, Doyle A, Podkorytova I, Perven G, Hays R, Zepeda R, Das RR, Ding K. Real-Time Seizure Detection Using Behind-the-Ear Wearable System. J Clin Neurophysiol 2024:00004691-990000000-00128. [PMID: 38376923 DOI: 10.1097/wnp.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION This study examines the usability and comfort of a behind-the-ear seizure detection device called brain seizure detection (BrainSD) that captures ictal electroencephalogram (EEG) data using four scalp electrodes. METHODS This is a feasibility study. Thirty-two patients admitted to a level 4 Epilepsy Monitoring Unit were enrolled. The subjects wore BrainSD and the standard 21-channel video-EEG simultaneously. Epileptologists analyzed the EEG signals collected by BrainSD and validated it using video-EEG data to confirm its accuracy. A poststudy survey was completed by each participant to evaluate the comfort and usability of the device. In addition, a focus group of UT Southwestern epileptologists was held to discuss the features they would like to see in a home EEG-based seizure detection device such as BrainSD. RESULTS In total, BrainSD captured 11 of the 14 seizures that occurred while the device was being worn. All 11 seizures captured on BrainSD had focal onset, with three becoming bilateral tonic-clonic and one seizure being of subclinical status. The device was worn for an average of 41 hours. The poststudy survey showed that most users found the device comfortable, easy-to-use, and stated they would be interested in using BrainSD. Epileptologists in the focus group expressed a similar interest in BrainSD. CONCLUSIONS Brain seizure detection is able to detect EEG signals using four behind-the-ear electrodes. Its comfort, ease-of-use, and ability to detect numerous types of seizures make BrainSD an acceptable at-home EEG detection device from both the patient and provider perspective.
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Affiliation(s)
- Jamie Lehnen
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pooja Venkatesh
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Zhuoran Yao
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Abdul Aziz
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, TX; and
| | - Phuc V P Nguyen
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, TX; and
- College of Information and Computer Science, University of Massachusets Amherst, Amherst, MA
| | - Jay Harvey
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sasha Alick-Lindstrom
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alex Doyle
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Irina Podkorytova
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ghazala Perven
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ryan Hays
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rodrigo Zepeda
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Rohit R Das
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kan Ding
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
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19
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Fayaz A, Raza M, Khan A, Mohandas P, Getnet Ayalew H, Perswani P, Wei CR, Abdelbaki MA. Comparison of Cardiovascular Outcomes and All-Cause Mortality Between Patients With and Without Epilepsy: A Systematic Review and Meta-Analysis of Observational Studies. Cureus 2024; 16:e54706. [PMID: 38523952 PMCID: PMC10960613 DOI: 10.7759/cureus.54706] [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] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
This meta-analysis aimed to assess the all-cause mortality and cardiovascular outcomes among patients diagnosed with epilepsy. The entire process of this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure transparency and reporting completeness. A comprehensive search strategy was employed to identify relevant studies in electronic databases, including PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL), from January 1, 2010, to January 15, 2024. Outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and arrhythmias. A total of 12 studies were included in this meta-analysis with a pooled sample size of 7,026,313. The majority of included studies were conducted in Taiwan (n=4). Our study revealed that individuals with epilepsy faced a higher risk of all-cause mortality, cardiovascular mortality, and stroke. Although there was a higher incidence of myocardial infarction and arrhythmias among epilepsy patients, this disparity did not reach statistical significance. There is a need for future research to explore the impact of epilepsy types, antiepileptic drugs, and lifestyle factors on cardiovascular outcomes.
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Affiliation(s)
- Azrung Fayaz
- Internal Medicine, College of Physicians and Surgeons, Peshawar, PAK
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Mehnahil Raza
- Medicine, King Edward Medical University, Lahore, PAK
| | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
| | | | | | - Prinka Perswani
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
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20
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Mameniškienė R, Puteikis K. Can family members reliably assess mood and suicidal ideation in individuals with epilepsy? Epilepsy Behav 2023; 149:109537. [PMID: 37976790 DOI: 10.1016/j.yebeh.2023.109537] [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: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Routine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms. METHODS From October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson's correlation analysis. RESULTS The study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) - spouses, 15 (10.7 %) - partners, 11 (7.9 %) - children and 6 (4.3 %) - siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = - 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE - proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen's Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation. CONCLUSION Companions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.
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Affiliation(s)
- Rūta Mameniškienė
- Center for Neurology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
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21
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Pérez-Navarro VM, Cánovas-Iniesta M, Palazón-Cabanes B, Navarro-Lozano M. [Epilepsy and inequality: demographic description and analysis of the difficulty in accessing advanced resources in a population in a small health area]. Rev Neurol 2023; 77:259-265. [PMID: 38010783 PMCID: PMC10831705 DOI: 10.33588/rn.7711.2023262] [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: 11/03/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Epilepsy is a very common neurological disease with high morbidity and mortality. Drug-resistant epilepsy (DRE) poses a major therapeutic challenge, even for experts in the field. Despite this, access to advanced resources for this type of patient remains difficult and unequal. The aim of this study is to analyse inequality in a population belonging to a first level hospital. PATIENTS AND METHODS An analytical observational cross-sectional study was conducted on epileptic patients attending neurology consultations in Area IX of the Murcian Health Service. Demographic, clinical, therapeutic, prognostic and equity variables are described, and significant differences between different subgroups are analysed. RESULTS The study included 68 patients with a mean age of 42.93 years. Focal epilepsy was the main type (64.7%), and the most commonly used drugs were levetiracetam (33.8%), valproic acid (27.9%) and lamotrigine (22.1%). DRE occurred in 18 patients (26.5% of the total) and only four were under active follow-up in an epilepsy unit, meaning that 71% did not have access to a necessary resource (advanced therapeutic gap). CONCLUSIONS This study demonstrates that epilepsy inequality continues to be a problem, especially in certain geographical areas, with a lack of access to advanced care for patients who need it most. The solution can be achieved by increasing human and material resources to improve overall patient care, thus strengthening both referral hospitals and epilepsy units.
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22
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Faizo NL, Alrehaili AA. Differentiation of Epileptic Brain Abnormalities among Neurological Patients at Taif Region Using MRI. Int J Clin Pract 2023; 2023:8783446. [PMID: 38020535 PMCID: PMC10657246 DOI: 10.1155/2023/8783446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/29/2022] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
This study was conducted to assess the prevalence of epilepsy among different age groups and gender of neurological patients in the Taif region and define the most common brain lesion, affecting epileptic patients living in the Taif city using MRI. Data from 150 patients who were clinically diagnosed with epilepsy and had brain MRIs were analyzed using SPSS. Statistical significance was considered when the p value is 0.05. The percentage of epilepsy was generally higher in males than in females in the Taif city, and seizures were different between the studied age groups. However, epilepsy was more pronounced in females than in males at certain age groups. Moreover, white matter lesions were most commonly found in the studied group (27.7%), followed by focal lesions, edema, and stroke with equal percentages (16.9%) and less commonly with congenital diseases (12%) and atrophic changes (9.6%). Epilepsy was more pronounced in females than in males at certain age groups. White matter lesions were identified as the most common lesion, presenting in epilepsy patients in the Taif city.
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Affiliation(s)
- Nahla L. Faizo
- Department of Radiological Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amani A. Alrehaili
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
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23
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Sandouka S, Singh PK, Saadi A, Taiwo RO, Sheeni Y, Zhang T, Deeb L, Guignet M, White SH, Shekh-Ahmad T. Repurposing dimethyl fumarate as an antiepileptogenic and disease-modifying treatment for drug-resistant epilepsy. J Transl Med 2023; 21:796. [PMID: 37940957 PMCID: PMC10634153 DOI: 10.1186/s12967-023-04695-2] [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: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Epilepsy affects over 65 million people worldwide and significantly burdens patients, caregivers, and society. Drug-resistant epilepsy occurs in approximately 30% of patients and growing evidence indicates that oxidative stress contributes to the development of such epilepsies. Activation of the Nrf2 pathway, which is involved in cellular defense, offers a potential strategy for reducing oxidative stress and epilepsy treatment. Dimethyl fumarate (DMF), an Nrf2 activator, exhibits antioxidant and anti-inflammatory effects and is used to treat multiple sclerosis. METHODS The expression of Nrf2 and its related genes in vehicle or DMF treated rats were determined via RT-PCR and Western blot analysis. Neuronal cell death was evaluated by immunohistochemical staining. The effects of DMF in preventing the onset of epilepsy and modifying the disease were investigated in the kainic acid-induced status epilepticus model of temporal lobe epilepsy in rats. The open field, elevated plus maze and T-Maze spontaneous alteration tests were used for behavioral assessments. RESULTS We demonstrate that administration of DMF following status epilepticus increased Nrf2 activity, attenuated status epilepticus-induced neuronal cell death, and decreased seizure frequency and the total number of seizures compared to vehicle-treated animals. Moreover, DMF treatment reversed epilepsy-induced behavioral deficits in the treated rats. Moreover, DMF treatment even when initiated well after the diagnosis of epilepsy, reduced symptomatic seizures long after the drug was eliminated from the body. CONCLUSIONS Taken together, these findings suggest that DMF, through the activation of Nrf2, has the potential to serve as a therapeutic target for preventing epileptogenesis and modifying epilepsy.
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Affiliation(s)
- Sereen Sandouka
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Prince Kumar Singh
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aseel Saadi
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rhoda Olowe Taiwo
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yara Sheeni
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Taige Zhang
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Larin Deeb
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michelle Guignet
- Department of Pharmacy, Center for Epilepsy Drug Discovery, University of Washington, Seattle, WA, USA
| | - Steve H White
- Department of Pharmacy, Center for Epilepsy Drug Discovery, University of Washington, Seattle, WA, USA
| | - Tawfeeq Shekh-Ahmad
- Faculty of Medicine, The School of Pharmacy, The Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel.
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24
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Ben-Menachem E, Schmitz B, Kälviäinen R, Thomas RH, Klein P. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behav 2023; 148:109435. [PMID: 37748414 DOI: 10.1016/j.yebeh.2023.109435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
Despite the many therapeutic options for epilepsy available today, a third of patients still have poorly controlled epilepsy. Over the years, their transition through lines of treatment exposes them to increased risk of disease progression, mortality, morbidity, mental distress, and not least significantly impaired quality of life (QoL). The present review explores the multiple factors contributing to the impairment of health-related QoL in PWE-including both seizure-related and non seizure-related. The analysis aims to identify potential areas of intervention and strategies for a more holistic approach to epilepsy care and inform policy-makers and healthcare providers in their approach to this condition.
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Affiliation(s)
| | - Bettina Schmitz
- Neurology/Center for Epilepsy, Stroke Unit and Neurological Rehabilitation, Vivantes Humboldt Hospital, Berlin, Germany.
| | | | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
| | - Pavel Klein
- Department of Neurology, George Washington University, Boston, United States.
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25
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Hakami F, Hakami KM, Zaalah SA, Alamer AA, Alharbi GH, Awaf M, Hamdi S, Ahmed AE, Mohamed AH, Alhazmi A, Hakami T. Awareness of Seizure First Aid among the population in Jazan, Saudi Arabia: A survey Study. Heliyon 2023; 9:e22197. [PMID: 38045149 PMCID: PMC10692802 DOI: 10.1016/j.heliyon.2023.e22197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/24/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background First aid during a seizure is critical, but many people in Jazan, Saudi Arabia may not know what to do. This is because epilepsy is often stigmatized in the region and regarded as a spiritual or mental disorder. This study investigated the awareness of seizure first aid among the population living in Jazan. Methods An online survey was conducted. Healthcare workers and people who had never heard of epilepsy were excluded. Participants were asked to identify correct measures of seizure first aid from a list of 20 statements [9 correct and 11 incorrect]. A composite awareness score was calculated by subtracting the number of incorrect statements from the number of correct statements. Participants were classified into three groups: high, intermediate, and low awareness. Logistic regression was used to identify factors associated with high awareness. Results Of the 1215 participants, 80.5 % had low awareness of seizure first aid. The most common correct responses were clearing the area of dangerous objects (91.3 %), putting a pillow under the neck (69.3 %), and timing the seizure (68.5 %). However, only 32.2 % knew to tell the person what happened after the seizure. The most common misconception was that an ambulance should be called immediately, regardless of the details (88.3 %). Other common misconceptions included putting something in the person's mouth (87.5 %), holding them down (83.0 %), taking out their contact lenses (79.9 %), and giving antiseizure medications orally (73.2 %). People who previously watched an educational video on seizure first aid (OR = 4.27, 95 % CI = 1.48-12.34, p = .007) or who knew someone with epilepsy (OR = 9.01, 95 % CI = 2.82-28.83, p < .001) were more likely to have a high awareness of seizure first aid. Conclusion The study found that most people in Jazan, Saudi Arabia do not know how to provide first aid for seizures. The findings inform future research and highlight the need for increased education and training on seizure first aid in this region.
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Affiliation(s)
- Faisal Hakami
- The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | | | - Afnan A. Alamer
- The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Mohammed Awaf
- The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sulaiman Hamdi
- The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Anas E. Ahmed
- The Department of Family and Community Medicine, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Amal H. Mohamed
- The Department of Internal Medicine, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Abdulaziz Alhazmi
- The Department of Microbiology and Parasitology, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Tahir Hakami
- The Department of Clinical Pharmacology, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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26
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Liu Q, Tan B, Zhang J, Jin Y, Lei P, Wang X, Li M, Jia X, Zhang Q. Premature mortality risk in individuals with convulsive epilepsy: Results from a longitudinal, prospective, population-based study. Epilepsy Res 2023; 197:107243. [PMID: 37839339 DOI: 10.1016/j.eplepsyres.2023.107243] [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: 04/03/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess premature mortality and identify associated risk factors among individuals with convulsive epilepsy in resource-poor settings using a longitudinal, prospective, population-based approach. METHOD The study recruited people with convulsive epilepsy who underwent assessment and management of epilepsy at primary healthcare centers in rural Northwest China, including newly diagnosed individuals and previously identified prevalent cases. All participants were confirmed to have epilepsy by neurologists according to strict criteria and were followed up monthly by primary care physicians. Demographic data and cause of death (COD) were obtained from death certificates or verbal autopsies conducted by neurologists, following the International Classification of Diseases, 10th Edition. The standardized mortality ratio (SMR) and proportionate mortality ratio (PMR) for each cause of death were estimated using the Cause-Of-Death Surveillance Dataset of China (2020). Survival analysis was used to identify risk factors associated with all-cause mortality and death directly due to epilepsy. RESULTS During 5.9 years of follow-up with 40,947 person-years, there were 781 (11.2%) deaths among 6967 participants. The risk of premature death in people with convulsive epilepsy was 2.7-fold higher than that in the general population. Young participants had a significantly higher risk (standardized mortality ratio 26.5-52.5) of premature death. The proportionate mortality ratio was higher for cerebrovascular disease (15%), sudden unexpected death in epilepsy (SUDEP) (13.4%), cardiovascular disease (11.7%), status epilepsy (SE) (11.3%), and epilepsy-related accidents (14.0%) than other premature mortality cause of deaths. Additionally, the highest standardized proportional mortality ratio (SPMR) was observed from drowning in all cause of death (10.4, 95% confidence interval [CI]: 7.6-13.8), followed by burning (9.0, 95% CI: 3.7-18.9). Factors that increased the risk of all-cause mortality included male sex, late age of onset, short disease duration, high body mass index, monotherapy, and the frequency of generalized tonic-clonic seizures (GTCS). High frequency of generalized tonic-clonic seizures (> 3 attacks in the last year) was an independent risk factor for premature death directly due to epilepsy (including sudden unexpected death in epilepsy, status epilepsy, and epilepsy-related accidents), while early age of onset (≤ 14 years) and long duration of epilepsy (> 20 years) were independent risk factors for sudden unexpected death in epilepsy. In addition, short duration of epilepsy (≤ 20 years) was an independent risk factor for status epilepsy. CONCLUSIONS This study demonstrated that individuals with poorly controlled seizures are more likely to experience premature death, with most deaths being epilepsy-related and preventable. These findings underline the importance of effective seizure treatment and the potential impact on reducing premature mortality among people with convulsive epilepsy.
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Affiliation(s)
- Qiang Liu
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China; Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Bofei Tan
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Jie Zhang
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Yanzi Jin
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Pingping Lei
- Ningxia Center for Disease Prevention and Control, Yinchuan 750004, Ningxia Province, China
| | - Xu Wang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China
| | - Mengyun Li
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Xiaodan Jia
- Graduate College of Ningxia Medical University, Yinchuan 750004, Ningxia Province, China
| | - Qing Zhang
- Department of Neurology, General Hospital of Ningxia Medical University, Ningxia Key Laboratory of Cerebrocranial Diseases, Incubation Base of National Key Laboratory, Yinchuan 750004, Ningxia Province, China.
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27
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Esmaeili B, Hakimian S, Ko AL, Hauptman JS, Ojemann JG, Miller JW, Tobochnik S. Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy. Neurology 2023; 101:e1359-e1363. [PMID: 37202163 PMCID: PMC10558163 DOI: 10.1212/wnl.0000000000207405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/28/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES The purpose of this report was to study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE). METHODS A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The primary outcome was the occurrence of SUDEP during postoperative follow-up. Surgical outcome was classified according to the Engel scale. RESULTS There were 5 deaths, including 4 SUDEPs, among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1,000 person-years. Three SUDEPs occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared with pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and at a rate similar to nonsurgical controls. DISCUSSION SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable with rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.
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Affiliation(s)
- Behnaz Esmaeili
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA.
| | - Shahin Hakimian
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
| | - Andrew L Ko
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
| | - Jason Scott Hauptman
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
| | - Jeffrey G Ojemann
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
| | - John W Miller
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
| | - Steven Tobochnik
- From the Department of Neurology (B.E., S.H., J.W.M.), and Department of Neurosurgery (A.L.K., J.S.H., J.G.O.), University of Washington, Seattle; Department of Neurology (S.T.), Brigham and Women's Hospital, Boston; and Department of Neurology (S.T.), VA Boston Healthcare System, MA
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28
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Perrott SL, Macleod AD. Associations between Antiepileptic Use and Hypogammaglobulinaemia: Findings from a Population-Based Case-Control Study Using Data Linkage. Neuroepidemiology 2023; 57:355-366. [PMID: 37734327 DOI: 10.1159/000533699] [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: 04/17/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Increased mortality in epilepsy due to infections (other than pneumonia) has been demonstrated. Small case series of people on antiepileptic drugs (AEDs) have described hypogammaglobulinaemia, which may predispose to infections. It is unclear whether hypogammaglobulinaemia is more frequent in people on AEDs, what AEDs it is associated with, or what clinical impact it has. In this population-based study, we aimed to determine whether AEDs were associated with hypogammaglobulinaemia, which AEDs were associated, and whether the associations may be causal. METHODS We conducted an unmatched case-control study using data linkage of routinely collected biochemistry, prescribing, and morbidity datasets in North-East Scotland from 2009-2021. Cases were participants with immunoglobulin levels less than the reference range. Controls were those with normal/high immunoglobulin levels. Logistic regression was used to investigate associations between AED exposure and any hypogammaglobulinaemia, adjusting for age, sex, and comorbidity. We also analysed low IgA, IgM, and IgG separately. We analysed "any AED" exposure and common individual drugs separately. Cumulative exposure data were used to determine whether an exposure-response relationship was present. RESULTS 18,666 cases and 127,157 controls were identified. Use of any AED was associated with increased risk of hypogammaglobulinaemia (adjusted odds ratio [aOR] 1.20 [95% CI: 1.15-1.25]). Phenytoin use was strongly associated with low IgA (aOR 5.90 [95% CI: 3.04, 10.43]). Carbamazepine and lamotrigine were also associated with low IgA. Apart from topiramate, which was associated with a non-significant decrease in odds of hypogammaglobulinaemia, there was a consistent increase in odds of hypogammaglobulinaemia across most AEDs studied. Panhypogammaglobulinaemia was associated with any AED use, carbamazepine, lamotrigine, gabapentin, and multiple AED use. There was evidence of an exposure-response relationship between any AED use and any hypogammaglobulinaemia, low IgA, and low IgG. Carbamazepine and probably lamotrigine also had an exposure-response relationship with any hypogammaglobulinaemia. DISCUSSION AEDs may increase hypogammaglobulinaemia risk. Specific classes of immunoglobulins are differentially affected, and the exposure-response analysis suggests this may be causal. Further work should investigate the clinical impact of these findings. Clinicians should check immunoglobulin levels if unusual or recurrent infections occur in patients treated with AEDs.
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Affiliation(s)
- Sarah L Perrott
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Angus D Macleod
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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29
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Yu C, Deng XJ, Xu D. Microglia in epilepsy. Neurobiol Dis 2023; 185:106249. [PMID: 37536386 DOI: 10.1016/j.nbd.2023.106249] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/07/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
Epilepsy is one of most common chronic neurological disorders, and the antiseizure medications developed by targeting neurocentric mechanisms have not effectively reduced the proportion of patients with drug-resistant epilepsy. Further exploration of the cellular or molecular mechanism of epilepsy is expected to provide new options for treatment. Recently, more and more researches focus on brain network components other than neurons, among which microglia have attracted much attention for their diverse biological functions. As the resident immune cells of the central nervous system, microglia have highly plastic transcription, morphology and functional characteristics, which can change dynamically in a context-dependent manner during the progression of epilepsy. In the pathogenesis of epilepsy, highly reactive microglia interact with other components in the epileptogenic network by performing crucial functions such as secretion of soluble factors and phagocytosis, thus continuously reshaping the landscape of the epileptic brain microenvironment. Indeed, microglia appear to be both pro-epileptic and anti-epileptic under the different spatiotemporal contexts of disease, rendering interventions targeting microglia biologically complex and challenging. This comprehensive review critically summarizes the pathophysiological role of microglia in epileptic brain homeostasis alterations and explores potential therapeutic or modulatory targets for epilepsy targeting microglia.
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Affiliation(s)
- Cheng Yu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Xue-Jun Deng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China
| | - Da Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China.
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Asadi-Pooya AA, Brigo F, Lattanzi S, Blumcke I. Adult epilepsy. Lancet 2023; 402:412-424. [PMID: 37459868 DOI: 10.1016/s0140-6736(23)01048-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 07/31/2023]
Abstract
Epilepsy is a common medical condition that affects people of all ages, races, social classes, and geographical regions. Diagnosis of epilepsy remains clinical, and ancillary investigations (electroencephalography, imaging, etc) are of aid to determine the type, cause, and prognosis. Antiseizure medications represent the mainstay of epilepsy treatment: they aim to suppress seizures without adverse events, but they do not affect the underlying predisposition to generate seizures. Currently available antiseizure medications are effective in around two-thirds of patients with epilepsy. Neurosurgical resection is an effective strategy to reach seizure control in selected individuals with drug-resistant focal epilepsy. Non-pharmacological treatments such as palliative surgery (eg, corpus callosotomy), neuromodulation techniques (eg, vagus nerve stimulation), and dietary interventions represent therapeutic options for patients with drug-resistant epilepsy who are not suitable for resective brain surgery.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ingmar Blumcke
- Institute of Neuropathology, University Hospitals Erlangen, Erlangen, Germany; Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Malaník M, Čulenová M, Sychrová A, Skiba A, Skalicka-Woźniak K, Šmejkal K. Treating Epilepsy with Natural Products: Nonsense or Possibility? Pharmaceuticals (Basel) 2023; 16:1061. [PMID: 37630977 PMCID: PMC10459181 DOI: 10.3390/ph16081061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Epilepsy is a neurological disease characterized by recurrent seizures that can lead to uncontrollable muscle twitching, changes in sensitivity to sensory perceptions, and disorders of consciousness. Although modern medicine has effective antiepileptic drugs, the need for accessible and cost-effective medication is urgent, and products derived from plants could offer a solution. For this review, we have focused on natural compounds that have shown anticonvulsant activity in in vivo models of epilepsy at relevant doses. In some cases, the effects have been confirmed by clinical data. The results of our search are summarized in tables according to their molecular targets. We have critically evaluated the data we present, identified the most promising therapeutic candidates, and discussed these in the text. Their perspectives are supported by both pharmacokinetic properties and potential interactions. This review is intended to serve as a basis for future research into epilepsy and related disorders.
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Affiliation(s)
- Milan Malaník
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého 1946/1, 61200 Brno, Czech Republic; (A.S.); (K.Š.)
| | - Marie Čulenová
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého 1946/1, 61200 Brno, Czech Republic; (A.S.); (K.Š.)
| | - Alice Sychrová
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého 1946/1, 61200 Brno, Czech Republic; (A.S.); (K.Š.)
| | - Adrianna Skiba
- Department of Natural Products Chemistry, Faculty of Pharmacy, Medical University of Lublin, 1 Chodzki Str., 20-093 Lublin, Poland; (A.S.); (K.S.-W.)
| | - Krystyna Skalicka-Woźniak
- Department of Natural Products Chemistry, Faculty of Pharmacy, Medical University of Lublin, 1 Chodzki Str., 20-093 Lublin, Poland; (A.S.); (K.S.-W.)
| | - Karel Šmejkal
- Department of Natural Drugs, Faculty of Pharmacy, Masaryk University, Palackého 1946/1, 61200 Brno, Czech Republic; (A.S.); (K.Š.)
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Perrott S, Khan QI, Counsell CE, Macleod AD. Progressive multifocal leukoencephalopathy associated with carbamazepine-induced immune dysfunction and recovery after carbamazepine cessation. BMJ Case Rep 2023; 16:e255119. [PMID: 37419500 PMCID: PMC10347492 DOI: 10.1136/bcr-2023-255119] [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] [Indexed: 07/09/2023] Open
Abstract
A patient with epilepsy on carbamazepine developed a rapidly progressive cerebellar syndrome. Serial MRI showed progressive posterior fossa T2/fluid attenuated inversion recovery hyperintensity with gadolinium enhancement. Standard cerebrospinal fluid (CSF) analysis was normal. Detection of John Cunningham virus DNA in the CSF confirmed progressive multifocal leukoencephalopathy (PML). The only evidence of immune disfunction was hypogammaglobulinaemia and longstanding lymphopenia. After cessation of carbamazepine, the lymphocyte count and immunoglobulin levels returned to normal and the PML resolved, with good clinical recovery. No specific treatments for PML were given. We hypothesise that PML in this case was due to carbamazepine-induced prolonged mild immunosuppression with reconstitution of the immune system after carbamazepine cessation, resulting in recovery from PML. Effects of anticonvulsants on immune function and infection risk may contribute to epilepsy-related morbidity and mortality. Further investigation is needed to determine the frequency of immune dysfunction and infections in patients treated with anticonvulsants such as carbamazepine and whether interventions could reduce infection risk.
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Affiliation(s)
- Sarah Perrott
- School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Carl E Counsell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Angus D Macleod
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
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Whitney R, Sharma S, Jones KC, RamachandranNair R. Genetics and SUDEP: Challenges and Future Directions. Seizure 2023; 110:188-193. [PMID: 37413779 DOI: 10.1016/j.seizure.2023.07.002] [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: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related deaths in children and adults with epilepsy. The incidence of SUDEP in children and adults is equal, approximately 1.2 per 1000-person years. Although inroads have been made in our understanding of SUDEP, its pathophysiology remains unknown. The most important risk factor for SUDEP is the presence of tonic-clonic seizures. Recently there has been growing interest in the contribution of genetic risk factors to SUDEP deaths. Pathogenic variants in epilepsy-related and cardiac genes have been found in some cases of SUDEP post-mortem. Pleiotropy may occur in which a single gene when altered may cause multiple phenotypes (i.e., epilepsy and cardiac arrhythmia). Recently it has been shown that some developmental and epileptic encephalopathies (DEEs) may also be at heightened risk of SUDEP. In addition, polygenic risk has been postulated to effect SUDEP risk with current models evaluating the additive effect of variants in multiple genes. However, the mechanisms underpinning polygenic risk in SUDEP are likely more complex than this. Some preliminary studies also highlight the feasibility of detecting genetic variants in brain tissue post-mortem. Despite the advances in the field of SUDEP genetics, the use of molecular autopsy remains underutilized in SUDEP cases. Several challenges exist concerning genetic testing post-mortem in SUDEP cases, such as interpretation, cost of testing, and availability. In this focused review, we highlight the current landscape of genetic testing in SUDEP cases, its challenges, and future directions.
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Affiliation(s)
- Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada.
| | - Suvasini Sharma
- Neurology Division, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India
| | - Kevin C Jones
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rajesh RamachandranNair
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
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Alraddadi EA, Khojah AM, Alamri FF, Kecheck HK, Altaf WF, Khouqeer Y. Potential role of creatine as an anticonvulsant agent: evidence from preclinical studies. Front Neurosci 2023; 17:1201971. [PMID: 37456992 PMCID: PMC10339234 DOI: 10.3389/fnins.2023.1201971] [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: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Epilepsy is one of the most common neurological disorders affecting people of all ages representing a significant social and public health burden. Current therapeutic options for epilepsy are not effective in a significant proportion of patients suggesting a need for identifying novel targets for the development of more effective therapeutics. There is growing evidence from animal and human studies suggesting a role of impaired brain energy metabolism and mitochondrial dysfunction in the development of epilepsy. Candidate compounds with the potential to target brain energetics have promising future in the management of epilepsy and other related neurological disorders. Creatine is a naturally occurring organic compound that serves as an energy buffer and energy shuttle in tissues, such as brain and skeletal muscle, that exhibit dynamic energy requirements. In this review, applications of creatine supplements in neurological conditions in which mitochondrial dysfunction is a central component in its pathology will be discussed. Currently, limited evidence mainly from preclinical animal studies suggest anticonvulsant properties of creatine; however, the exact mechanism remain to be elucidated. Future work should involve larger clinical trials of creatine used as an add-on therapy, followed by large clinical trials of creatine as monotherapy.
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Affiliation(s)
- Eman A. Alraddadi
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulrahman M. Khojah
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Faisal F. Alamri
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Husun K. Kecheck
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Wid F. Altaf
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yousef Khouqeer
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Mbizvo GK, Schnier C, Ramsay J, Duncan SE, Chin RF. Epilepsy-related mortality during the COVID-19 pandemic: A nationwide study of routine Scottish data. Seizure 2023; 110:160-168. [PMID: 37393862 PMCID: PMC10257947 DOI: 10.1016/j.seizure.2023.06.010] [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: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To examine whether epilepsy-related deaths increased during the COVID-19 pandemic and if the proportion with COVID-19 listed as the underlying cause is different between people experiencing epilepsy-related deaths and those experiencing deaths unrelated to epilepsy. METHODS This was a Scotland-wide, population-based, cross-sectional study of routinely-collected mortality data pertaining to March-August of 2020 (COVID-19 pandemic peak) compared to the corresponding periods in 2015-2019. ICD-10-coded causes of death of deceased people of any age were obtained from a national mortality registry of death certificates in order to identify those experiencing epilepsy-related deaths (coded G40-41), deaths with COVID-19 listed as a cause (coded U07.1-07.2), and deaths unrelated to epilepsy (death without G40-41 coded). The number of epilepsy-related deaths in 2020 were compared to the mean observed through 2015-2019 on an autoregressive integrated moving average (ARIMA) model (overall, men, women). Proportionate mortality and odds ratios (OR) for deaths with COVID-19 listed as the underlying cause were determined for the epilepsy-related deaths compared to deaths unrelated to epilepsy, reporting 95% confidence intervals (CIs). RESULTS A mean number of 164 epilepsy-related deaths occurred through March-August of 2015-2019 (of which a mean of 71 were in women and 93 in men). There were subsequently 189 epilepsy-related deaths during the pandemic March-August 2020 (89 women, 100 men). This was 25 more epilepsy-related deaths (18 women, 7 men) compared to the mean through 2015-2019. The increase in women was beyond the mean year-to-year variation seen in 2015-2019. Proportionate mortality with COVID-19 listed as the underlying cause was similar between people experiencing epilepsy-related deaths (21/189, 11.1%, CI 7.0-16.5%) and deaths unrelated to epilepsy (3,879/27,428, 14.1%, CI 13.7-14.6%), OR 0.76 (CI 0.48-1.20). Ten of 18 excess epilepsy-related deaths in women had COVID-19 listed as an additional cause. CONCLUSIONS There is little evidence to suggest there have been any major increases in epilepsy-related deaths in Scotland during the COVID-19 pandemic. COVID-19 is a common underlying cause of both epilepsy-related and unrelated deaths.
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Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom; Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Christian Schnier
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Julie Ramsay
- Vital Events Statistics, National Records of Scotland, Edinburgh, United Kingdom
| | - Susan E Duncan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | - Richard Fm Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, Edinburgh, United Kingdom
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Klein P, Krauss GL, Steinhoff BJ, Devinsky O, Sperling MR. Failure to use new breakthrough treatments for epilepsy. Epilepsia 2023; 64:1458-1465. [PMID: 36855241 DOI: 10.1111/epi.17564] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/29/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023]
Abstract
Despite the approval of ~20 additional antiseizure medications (ASMs) since the 1980s, one-third of epilepsy patients experience seizures despite therapy. Drug-resistant epilepsy (DRE) is associated with cognitive and psychiatric comorbidities, socioeconomic impairment, injuries, and a 9.3-13.4 times higher mortality rate than in seizure-free patients. Improved seizure control can reduce morbidity and mortality. Two new ASMs were launched in the United States in 2020: cenobamate for focal epilepsy in adults and fenfluramine for Dravet syndrome (DS). They offer markedly improved efficacy. Cenobamate achieved 21% seizure freedom with the highest dose and decreased tonic-clonic seizures by 93% during maintenance treatment in a randomized clinical trial (RCT). In long-term, open-label studies, 10%-36% of patients were seizure-free for a median duration of ~30-45 months. Fenfluramine treatment in DS reduced convulsive seizure frequency by 56% over placebo at the highest dose, with 8% of patients free of convulsive seizures, and 25% with only one convulsive seizure over 14 weeks. These results were sustained for up to 3 years in open-label extension studies. Mortality was reduced 5-fold. These results are superior to all other approved ASMs, placing these two drugs among the most effective antiseizure therapies. The adverse event profiles resemble those of other ASMs. Despite greater efficacy and similar toxicity, these medications are infrequently used. Two years after US market entry, < 5% of either adults with focal DRE or patients with DS were treated with either cenobamate or fenfluramine. We believe this is a failure of our medical system, resulting from limited knowledge about these drugs stemming partly from the separation of academia from industry; restrictions to access created by health care payors, hospitals, and regulatory agencies; and insufficient post-launch information about the efficacy and safety of these ASMs.
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Affiliation(s)
- Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, Maryland, USA
| | - Bernhard J Steinhoff
- Epilepsiezentrum Kork, Kehl-Kork, Germany and Medical Faculty, Albert-Ludwigs University, Freiburg, Germany
| | - Orrin Devinsky
- NYU Langone School of Medicine, Department of Neurology, New York, New York, USA
| | - Michael R Sperling
- Thomas Jefferson University, Department of Neurology, Philadelphia, Pennsylvania, USA
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Mbizvo GK, Schnier C, Simpson CR, Duncan SE, Chin RFM. Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death. Brain 2023; 146:2418-2430. [PMID: 36477471 PMCID: PMC10232261 DOI: 10.1093/brain/awac463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/29/2022] [Accepted: 11/26/2022] [Indexed: 02/17/2024] Open
Abstract
This study aimed to develop a risk prediction model for epilepsy-related death in adults. In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009 and 2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index-the Scottish Epilepsy Deaths Study Score. Odds ratios were estimated with 95% confidence intervals (CIs). Here, 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency attendance (odds ratio 5.1, 95% CI 3.2-8.3), living in deprived areas (odds ratio 2.5, 95% CI 1.6-4.0), developmental epilepsy (odds ratio 3.1, 95% CI 1.7-5.7), raised Charlson Comorbidity Index score (odds ratio 2.5, 95% CI 1.2-5.2), alcohol abuse (odds ratio 4.4, 95% CI 2.2-9.2), absent recent neurology review (odds ratio 3.8, 95% CI 2.4-6.1) and generalized epilepsy (odds ratio 1.9, 95% CI 1.2-3.0). Scottish Epilepsy Deaths Study Score model variables were derived from the first four listed before, with Charlson Comorbidity Index ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points and recent epilepsy-related accident and emergency attendance given 3 points. Compared to having a Scottish Epilepsy Deaths Study Score of 0, those with a Scottish Epilepsy Deaths Study Score of 1 remained low risk, with odds ratio 1.6 (95% CI 0.5-4.8). Those with a Scottish Epilepsy Deaths Study Score of 2-3 had moderate risk, with odds ratio 2.8 (95% CI 1.3-6.2). Those with a Scottish Epilepsy Deaths Study Score of 4-5 and 6-8 were high risk, with odds ratio 14.4 (95% CI 5.9-35.2) and 24.0 (95% CI 8.1-71.2), respectively. The Scottish Epilepsy Deaths Study Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation.
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Affiliation(s)
- Gashirai K Mbizvo
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK
| | | | - Colin R Simpson
- Usher Institute, University of Edinburgh, Edinburgh EH16 4UX, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington 6140, New Zealand
| | - Susan E Duncan
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh EH16 4SA, UK
| | - Richard F M Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4TJ, UK
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
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Schnier C, Chin RF. Mortality in children with epilepsy: Cohort study using the clinical practice research datalink. Seizure 2023; 109:77-82. [PMID: 37269743 DOI: 10.1016/j.seizure.2023.05.020] [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: 03/07/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To estimate Mortality Rate (MR) in UK children with epilepsy (CWE) compared to children without epilepsy (CWOE), describe causes of death, determine Mortality Rate Ratios (MRRs) for cause-specific mortality, and to analyse the contribution of co-morbidities (respiratory disease, neoplasm, and congenital disorders) to mortality rate. METHOD Retrospective cohort study of children born between 1998 and 2017, using linked data from the Clinical Practice Research Datalink Gold (Set 18). Epilepsy diagnoses were identified using previously validated codes. Causes of death were defined as natural or non-natural. Epilepsy-related deaths in CWE were those where underlying or contributing cause of death was epilepsy, status epilepticus, seizures, ill-defined/unknown cause or sudden death. We used Cox proportional hazard analysis to investigate associations of epilepsy and mortality. RESULTS There were 1,191,304 children followed for 13,994,916 person-years (median: 12) if which 9665 (0.8%) had epilepsy. Amongst CWE, 3.4% died. MR of CWE was 4.1 (95%CI 3.7-4.6)/1,000 person-years. CWE had an increased adjusted all-cause mortality (MRR 50.9,95%CI 44.8-57.7) compared to CWOE. Amongst the 330 deaths in CWE, 323 (98%) were natural, 7 (2%) non-natural, 80 (24%) epilepsy-related. MRR of non-natural deaths was 2.09 (95%CI 0.92,4.74, p = 0.08). SIGNIFICANCE Amongst CWE, 3.4% died during the study period. All-cause mortality rate in CWE was 4/1,000 person-years representing a fifty-fold increased mortality risk, after taking into account sex and socioeconomic status, compared to similarly aged children who did not have epilepsy. Causes of death mostly were not seizure-related. Non-natural death in CWE was uncommon.
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Affiliation(s)
- Christian Schnier
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh
| | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh; Royal Hospital for Children and Young People, Edinburgh.
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Nunes KZ, Scorza FA, Cavalheiro EA, Vassallo DV. Reduction of vascular reactivity in rat aortas following pilocarpine-induced status epilepticus. Clinics (Sao Paulo) 2023; 78:100195. [PMID: 37099815 PMCID: PMC10149400 DOI: 10.1016/j.clinsp.2023.100195] [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: 10/06/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVE The authors investigated changes in vascular reactivity in rats following pilocarpine-induced status epilepticus. METHOD Male Wistar rats weighing between 250g and 300g were used. Status epilepticus was induced using 385 mg/kg i.p. pilocarpine. After 40 days the thoracic aorta was dissected and divided into 4 mm rings and the vascular smooth muscle reactivity to phenylephrine was evaluated. RESULTS Epilepsy decreased the contractile responses of the aortic rings to phenylephrine (0.1 nM-300 mM). To investigate if this reduction was induced by increasing NO production with/or hydrogen peroxide L-NAME and Catalase were used. L-NAME (N-nitro-L arginine methyl ester) increased vascular reactivity but the contractile response to phenylephrine increased in the epileptic group. Catalase administration decreased the contractile responses only in the rings of rats with epilepsy. CONCLUSIONS Our findings demonstrated for the first time that epilepsy is capable of causing a reduction of vascular reactivity in rat aortas. These results suggest that vascular reactivity reduction is associated with increased production of Nitric Oxide (NO) as an organic attempt to avoid hypertension produced by excessive sympathetic activation.
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Affiliation(s)
- Karolini Zuqui Nunes
- Postgraduate Program in Nutrition and Health, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
| | - Fulvio Alexandre Scorza
- Discipline of Neuroscience, Universidade Federal de São Paulo/Escola Paulista de Medicina, São PauloSP, Brazil
| | - Esper Abrão Cavalheiro
- Discipline of Neuroscience, Universidade Federal de São Paulo/Escola Paulista de Medicina, São PauloSP, Brazil
| | - Dalton Valentim Vassallo
- Graduate Program in Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Strzelczyk A, Aledo-Serrano A, Coppola A, Didelot A, Bates E, Sainz-Fuertes R, Lawthom C. The impact of epilepsy on quality of life: Findings from a European survey. Epilepsy Behav 2023; 142:109179. [PMID: 37058861 DOI: 10.1016/j.yebeh.2023.109179] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Epilepsy is a serious neurological disorder affecting the quality of life (QoL) of people with this condition. A survey was conducted in five European countries (France, Germany, Italy, Spain, and the UK) to understand the impact and burden of epilepsy and its treatment on the lives of people with epilepsy (PWE). METHODS Five hundred PWE (taking >1 antiseizure medication [ASM]) and 500 matched controls completed a 30-minute online questionnaire. The 12-Item Short Form Survey (SF-12) was used to measure QoL and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was used to screen for major depressive disorder (MDD) symptoms. RESULTS Comorbidities such as migraine, high cholesterol, osteoporosis, and Type 1 diabetes were reported more commonly in PWE, while anxiety disorders, high blood pressure, skin disorders, and mood disorders were more common in controls. However, compared to controls, a significantly higher percentage of PWE had an NDDI-E score of 15-24 (54% vs 35%; p < 0.0001), indicative of MDD symptoms. Significantly more PWE than controls were part-time employed (15% vs 11%; p = 0.03). People with epilepsy had a significantly lower total SF-12 score than controls across the physical and the mental components; compared to controls, a significantly higher proportion of PWE defined their general health as 'poor' or 'fair' and felt limited in carrying out daily and work activities. Among PWE, those taking ≥3 ASMs were more likely to experience difficulties in carrying out these activities than those on two ASMs. Ability to drive, mood, and level of self-esteem were reported as concerns for PWE. CONCLUSION Epilepsy has a major impact on the physical and mental health of PWE, interfering with their daily and work activities and overall QoL, and its treatment might also contribute to a lower QoL. The impact of epilepsy on mood and mental health might be under-recognized.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.
| | - Angel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain
| | - Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Odontostomatological and Reproductive Sciences, Federico II University of Naples, Naples, Italy
| | - Adrien Didelot
- Department of Neurology, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | | | - Charlotte Lawthom
- Department of Neurology, Aneurin Bevan University Health Board, Newport, United Kingdom
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RamachandranNair R, Whitney R, Jones KC, Jack SM. Life after SUDEP: Experiences of traumatic loss and growth. Epilepsy Behav 2023; 141:109157. [PMID: 36889062 DOI: 10.1016/j.yebeh.2023.109157] [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: 12/23/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To understand the experiences of bereaved relatives of individuals who passed due to sudden unexpected death in epilepsy (SUDEP) and to explore the impacts of death in their lives. METHODS The principles of fundamental qualitative description informed all design decisions. Stratified purposeful sampling included 21 bereaved relatives (parent, sibling, or spouse/partner), aged at least 18 years, of persons who passed away because of SUDEP. In-depth one-to-one interviews were conducted. Directed content analysis was used to code, categorize, and synthesize the interview data. RESULTS There was some criticism of emergency response and medical professionals involved in providing insensitive or poor care immediately after SUDEP occurred. Personal hardships described by participants following SUDEP included loss of personal identity, feeling depressed, experiencing guilt, having panic attacks, requiring therapy, as well as having difficulty with anniversaries, dates, and cleaning up a child's room. Bereaved spouses and parents in particular spoke of experiencing challenges in maintaining other relationships following the death. Some participants spoke of experiencing increased financial hardships. Ways of coping included keeping oneself busy, honoring the memory of the loved one, relying on friends and families, and engaging in advocacy/community work, including raising awareness on epilepsy and SUDEP. CONCLUSIONS Sudden unexpected death in epilepsy affected several aspects of the day-to-day lives of bereaved relatives. Though methods of coping were similar to the usual strategies adopted by all bereaved relatives, advocacy work related to raising awareness about epilepsy and SUDEP was unique to this group. Guidelines on SUDEP should ideally include recommendations for trauma-informed support and assessment for depression and anxiety to the bereaved relatives as well.
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Affiliation(s)
- Rajesh RamachandranNair
- Department of Pediatrics (Neurology), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Robyn Whitney
- Department of Pediatrics (Neurology), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Kevin C Jones
- Department of Pediatrics (Neurology), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Susan M Jack
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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Pang EW, Lawn ND, Lee J, Dunne JW. Mortality after a first-ever unprovoked seizure. Epilepsia 2023; 64:1266-1277. [PMID: 36861353 DOI: 10.1111/epi.17567] [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: 10/29/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Although increased mortality associated with epilepsy is well understood, data in patients after their first-ever seizure are limited. We aimed to assess mortality after a first-ever unprovoked seizure and identify causes of death (CODs) and risk factors. METHODS A prospective cohort study was undertaken of patients with first-ever unprovoked seizure between 1999 and 2015 in Western Australia. Two age-, gender-, and calendar year-matched local controls were obtained for each patient. Mortality data, including COD, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes, were obtained. Final analysis was performed in January 2022. RESULTS One thousand two hundred seventy-eight patients with a first-ever unprovoked seizure were compared to 2556 controls. Mean follow-up was 7.3 years (range = .1-20). Overall hazard ratio (HR) for death after a first unprovoked seizure compared to controls was 3.06 (95% confidence interval [CI] = 2.48-3.79), with HRs of 3.30 (95% CI = 2.26-4.82) for those without seizure recurrence and 3.21 (95% CI = 2.47-4.16) after a second seizure. Mortality was also increased in patients with normal imaging and no identified cause (HR = 2.50, 95% CI = 1.82-3.42). Multivariate predictors of mortality were increasing age, remote symptomatic causes, first seizure presentation with seizure cluster or status epilepticus, neurological disability, and antidepressant use at time of first seizure. Seizure recurrence did not influence mortality rate. The commonest CODs were neurological, most relating to the underlying cause of seizures rather than being seizure-related. Substance overdoses and suicide were more frequent CODs in patients compared to controls and were commoner than seizure-related deaths. SIGNIFICANCE Mortality is increased two- to threefold after a first-ever unprovoked seizure, independent of seizure recurrence, and is not only attributable to the underlying neurological etiology. The greater likelihood of deaths related to substance overdose and suicide highlights the importance of assessing psychiatric comorbidity and substance use in patients with first-ever unprovoked seizure.
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Affiliation(s)
- Elaine W Pang
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Nicholas D Lawn
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Judy Lee
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - John W Dunne
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia.,Discipline of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
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Monté CPJA, Arends JBAM, Lazeron RHC, Tan IY, Boon PAJM. Seizure-related complication rate in a residential population with epilepsy and intellectual disability (ECOMRAID-trial). Epilepsy Behav 2023; 140:108995. [PMID: 36822042 DOI: 10.1016/j.yebeh.2022.108995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 02/23/2023]
Abstract
INTRODUCTION The aim of the ECOMRAID trial (Epileptic seizure related Complication RAte in residential population of persons with epilepsy and Intellectual Disability) was to study seizure-related complications (status epilepticus, respiratory complications, or other severe complications) in people with epilepsy and intellectual disability living in a residential setting. The results of the present study are a prerequisite for performing a prospective study into the effectiveness of nocturnal surveillance patients with high risk for Sudden unexpected death in epilepsy (SUDEP). MATERIAL AND METHODS A retrospective study was conducted in three general residential care institutions and one residential specialized epilepsy clinic. In this 5-year cohort, we collected the following data: age (at inclusion and in case of death), sex, type of residential care, different types of complications, rescue/emergency medication administration, transfers to another department (internal midcare / monitoring unit or general hospital) and a self-designed SUDEP risk score. Our primary research questions were to assess the number of patients who experienced seizure-related complications and their individual complication rates. The secondary research questions were to document the relationship of these complications with the SUDEP risk score, with the type of residential living, and with the frequency of interventions by caregivers. RESULTS We included 370 patients (1790 patient-years) and in 135 of them, we found 717 seizure-related complications. The following complication rates were found: all complications: at 36%, status epilepticus: at 13%, respiratory complications: at 5%, and other complications at 26%. In residential care institutions, we found fewer patients with complications compared to the specialized epilepsy clinic (all complications 24% vs 42%, OR 0.44, p < 0.01; status epilepticus 5% vs 17%, OR 0.27, p < 0.01; other: complications 19% vs 30%, OR 0.56, p < 0.05). In residential care institutions, we found more "other complications" than in the specialized epilepsy clinic (89% vs 71%, OR 3.13, p < 0.0001). The annual frequency of all complications together was higher in residential care institutions (range 0 to 21 vs 0 to 10, p < 0.05). Rescue medication was given to 75% of the patients, but more often in the specialized epilepsy clinic (median 2.6 vs 0.5 times/patient/year, p < 0.001). In the specialized epilepsy clinic, more patients were transferred to a midcare / monitoring unit or general hospital (56% vs 9%, OR 13.44, p < 0.0001) with higher yearly frequencies (median 0.2 vs 0.0, p < 0.001). There were no reported cases of SUDEP. The median SUDEP risk score was higher in the specialized epilepsy clinic (5 vs 4, p < 0.05) and was weakly correlated with the status epilepticus (ρ = 0.20, p < 0.001) and (total) complication rate (ρ = 0.18, p < 0.001). CONCLUSION We found seizure-related complications in more than one-third of the patients with epilepsy and intellectual disability living in a residential setting over a period of 5 years. The data also quantify seizure-related complications in patients with epilepsy and intellectual disability.
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Affiliation(s)
- C P J A Monté
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Private Practice of Neurology, Zottegem, Belgium.
| | - J B A M Arends
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands
| | - R H C Lazeron
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands
| | - I Y Tan
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands
| | - P A J M Boon
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands; Department of Neurology, Ghent University Hospital, Gent, Belgium
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Huang TH, Lai MC, Chen YS, Huang CW. The Roles of Glutamate Receptors and Their Antagonists in Status Epilepticus, Refractory Status Epilepticus, and Super-Refractory Status Epilepticus. Biomedicines 2023; 11:biomedicines11030686. [PMID: 36979664 PMCID: PMC10045490 DOI: 10.3390/biomedicines11030686] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/30/2023] Open
Abstract
Status epilepticus (SE) is a neurological emergency with a high mortality rate. When compared to chronic epilepsy, it is distinguished by the durability of seizures and frequent resistance to benzodiazepine (BZD). The Receptor Trafficking Hypothesis, which suggests that the downregulation of γ-Aminobutyric acid type A (GABAA) receptors, and upregulation of N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors play major roles in the establishment of SE is the most widely accepted hypothesis underlying BZD resistance. NMDA and AMPA are ionotropic glutamate receptor families that have important excitatory roles in the central nervous system (CNS). They are both essential in maintaining the normal function of the brain and are involved in a variety of neuropsychiatric diseases, including epilepsy. Based on animal and human studies, antagonists of NMDA and AMPA receptors have a significant impact in ending SE; albeit most of them are not yet approved to be in clinically therapeutic guidelines, due to their psychomimetic adverse effects. Although there is still a dearth of randomized, prospective research, NMDA antagonists such as ketamine, magnesium sulfate, and the AMPA antagonist, perampanel, are regarded to be reasonable optional adjuvant therapies in controlling SE, refractory SE (RSE) or super-refractory SE (SRSE), though there are still a lack of randomized, prospective studies. This review seeks to summarize and update knowledge on the SE development hypothesis, as well as clinical trials using NMDA and AMPA antagonists in animal and human studies of SE investigations.
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Affiliation(s)
- Tzu-Hsin Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70142, Taiwan
- Zhengxin Neurology & Rehabilitation Center, Tainan 70459, Taiwan
| | - Ming-Chi Lai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Yu-Shiue Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70142, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70142, Taiwan
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Zheng B, Liu DD, Theyel BB, Abdulrazeq H, Kimata AR, Lauro PM, Asaad WF. Thalamic neuromodulation in epilepsy: A primer for emerging circuit-based therapies. Expert Rev Neurother 2023; 23:123-140. [PMID: 36731858 DOI: 10.1080/14737175.2023.2176752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Epilepsy is a common, often debilitating disease of hyperexcitable neural networks. While medically intractable cases may benefit from surgery, there may be no single, well-localized focus for resection or ablation. In such cases, approaching the disease from a network-based perspective may be beneficial. AREAS COVERED Herein, the authors provide a narrative review of normal thalamic anatomy and physiology and propose general strategies for preventing and/or aborting seizures by modulating this structure. Additionally, they make specific recommendations for targeting the thalamus within different contexts, motivated by a more detailed discussion of its distinct nuclei and their respective connectivity. By describing important principles governing thalamic function and its involvement in seizure networks, the authors aim to provide a primer for those now entering this fast-growing field of thalamic neuromodulation for epilepsy. EXPERT OPINION The thalamus is critically involved with the function of many cortical and subcortical areas, suggesting it may serve as a compelling node for preventing or aborting seizures, and so it has increasingly been targeted for the surgical treatment of epilepsy. As various thalamic neuromodulation strategies for seizure control are developed, there is a need to ground such interventions in a mechanistic, circuit-based framework.
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Affiliation(s)
- Bryan Zheng
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - David D Liu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brian B Theyel
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Hael Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Anna R Kimata
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - Peter M Lauro
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA.,Department of Neuroscience, Brown University, Providence, RI, USA.,The Carney Institute for Brain Science, Brown University, Providence, RI, USA.,The Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, RI, USA
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Pong AW, Tyrlikova I, Giermek AJ, Klein P. Impact of regulatory safety warnings and restrictions on drug treatment of epilepsy. Expert Opin Drug Saf 2023; 22:111-114. [PMID: 36881668 DOI: 10.1080/14740338.2023.2188189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Amanda W Pong
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, United States
| | - Ivana Tyrlikova
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, United States
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, United States
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Erridge S, Holvey C, Coomber R, Hoare J, Khan S, Platt MW, Rucker JJ, Weatherall MW, Beri S, Sodergren MH. Clinical Outcome Data of Children Treated with Cannabis-Based Medicinal Products for Treatment Resistant Epilepsy - Analysis from the UK Medical Cannabis Registry. Neuropediatrics 2023; 54:174-181. [PMID: 36539215 PMCID: PMC10166640 DOI: 10.1055/a-2002-2119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is a paucity of high-quality evidence of the efficacy and safety of cannabis-based medicinal products in treatment of treatment-resistant epilepsy (TRE) in children. METHODS A case series of children (<18 years old) with TRE from the UK Medical Cannabis Registry was analyzed. Primary outcomes were ≥50% reduction in seizure frequency, changes in the Impact of Pediatric Epilepsy Score (IPES), and incidence of adverse events. RESULTS Thirty-five patients were included in the analysis. Patients were prescribed during their treatment with the following: CBD isolate oils (n = 19), CBD broad-spectrum oils (n = 17), and CBD/Δ9-THC combination therapy (n = 17). Twenty-three (65.7%) patients achieved a ≥50% reduction in seizure frequency. 94.1% (n = 16) of patients treated with CBD and Δ9-THC observed a ≥50% reduction in seizure frequency compared to 31.6% (n = 6) and 17.6% (n = 3) of patients treated with CBD isolates and broad-spectrum CBD products, respectively (p< 0.001). Twenty-six (74.3%) adverse events were reported by 16 patients (45.7%). The majority of these were mild (n = 12; 34.2%) and moderate (n = 10; 28.6%). CONCLUSION The results of this study demonstrate a positive signal of improved seizure frequency in children treated with Cannabis-based medicinal products (CBMPs) for TRE. Moreover, the results suggest that CBMPs are well-tolerated in the short term. The limitations mean causation cannot be determined in this open-label, case series.
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Affiliation(s)
- Simon Erridge
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
| | - Carl Holvey
- Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
| | - Ross Coomber
- Department of Medicine, Sapphire Medical Clinics, London, United Kingdom.,Department of Trauma & Orthopaedics, St Georges NHS Healthcare Trust, London, United Kingdom
| | - Jonathan Hoare
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
| | - Shaheen Khan
- Department of Medicine, Sapphire Medical Clinics, London, United Kingdom.,Department of Palliative Medicine, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael W Platt
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
| | - James J Rucker
- Department of Medicine, Sapphire Medical Clinics, London, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom.,Centre for Affective Disorders, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mark W Weatherall
- Department of Medicine, Sapphire Medical Clinics, London, United Kingdom.,Department of Neurology, Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | - Sushil Beri
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
| | - Mikael H Sodergren
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom.,Department of Medicine, Sapphire Medical Clinics, London, United Kingdom
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Lemoine É, Neves Briard J, Rioux B, Podbielski R, Nauche B, Toffa D, Keezer M, Lesage F, Nguyen DK, Bou Assi E. Computer-assisted analysis of routine electroencephalogram to identify hidden biomarkers of epilepsy: protocol for a systematic review. BMJ Open 2023; 13:e066932. [PMID: 36693684 PMCID: PMC9884857 DOI: 10.1136/bmjopen-2022-066932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The diagnosis of epilepsy frequently relies on the visual interpretation of the electroencephalogram (EEG) by a neurologist. The hallmark of epilepsy on EEG is the interictal epileptiform discharge (IED). This marker lacks sensitivity: it is only captured in a small percentage of 30 min routine EEGs in patients with epilepsy. In the past three decades, there has been growing interest in the use of computational methods to analyse the EEG without relying on the detection of IEDs, but none have made it to the clinical practice. We aim to review the diagnostic accuracy of quantitative methods applied to ambulatory EEG analysis to guide the diagnosis and management of epilepsy. METHODS AND ANALYSIS The protocol complies with the recommendations for systematic reviews of diagnostic test accuracy by Cochrane. We will search MEDLINE, EMBASE, EBM reviews, IEEE Explore along with grey literature for articles, conference papers and conference abstracts published after 1961. We will include observational studies that present a computational method to analyse the EEG for the diagnosis of epilepsy in adults or children without relying on the identification of IEDs or seizures. The reference standard is the diagnosis of epilepsy by a physician. We will report the estimated pooled sensitivity and specificity, and receiver operating characteristic area under the curve (ROC AUC) for each marker. If possible, we will perform a meta-analysis of the sensitivity and specificity and ROC AUC for each individual marker. We will assess the risk of bias using an adapted QUADAS-2 tool. We will also describe the algorithms used for signal processing, feature extraction and predictive modelling, and comment on the reproducibility of the different studies. ETHICS AND DISSEMINATION Ethical approval was not required. Findings will be disseminated through peer-reviewed publication and presented at conferences related to this field. PROSPERO REGISTRATION NUMBER CRD42022292261.
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Affiliation(s)
- Émile Lemoine
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, Québec, Canada
| | - Joel Neves Briard
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Bastien Rioux
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Renata Podbielski
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Bénédicte Nauche
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Denahin Toffa
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Mark Keezer
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Frédéric Lesage
- Institute of Biomedical Engineering, Ecole Polytechnique de Montreal, Montreal, Québec, Canada
| | - Dang K Nguyen
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
| | - Elie Bou Assi
- Department of Neurosciences, University of Montreal, Montreal, Québec, Canada
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
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Dreier JW, Laursen TM, Tomson T, Plana-Ripoll O, Christensen J. Cause-specific mortality and life years lost in people with epilepsy: a Danish cohort study. Brain 2023; 146:124-134. [PMID: 35234848 DOI: 10.1093/brain/awac042] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/16/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023] Open
Abstract
Mortality rates are two to three times higher in people with epilepsy than in the general population. This study aimed to quantify how this increased mortality translates into reduced life expectancy and to identify the underlying causes of deaths, thereby offering suggestions for how to reduce mortality associated with epilepsy. In this population-based cohort study, we included all individuals aged 0-94 years who were living in Denmark between 2000 and 2015. Using the nationwide registers, we identified people diagnosed with epilepsy and estimated the excess of life years lost due to 13 overall and nine specific causes of death. Among 6 022 160 people, we identified 129 598 with epilepsy (52.6% males), with a mean age of epilepsy onset of 36.5 years (standard deviation = 26.3 years). During the 16 years of follow-up, 851 087 individuals died, and of these 36 923 had been diagnosed with epilepsy. The average reduction in life expectancy in people with epilepsy was 11.84 years in males (95% confidence interval: 11.66-12.00) and 10.91 years in females (95% confidence interval: 10.70-11.11) compared to the general population. Life expectancy was reduced irrespective of epilepsy aetiology (symptomatic ∼14 years; idiopathic ∼8-10 years), and in particular in people with epilepsy and psychiatric comorbidity (∼13-16 years). Excess mortality was evident across all causes of death including cardiovascular disorders, accidents, and suicide. People with epilepsy experience a substantial reduction in lifespan that can only partly be explained by underlying conditions. Prevention of epilepsy-related deaths should focus on the consequences of psychiatric comorbidity and on modifiable risk factors associated with preventable causes of death such as accidents and neurological and cardiovascular disorders.
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Affiliation(s)
- Julie Werenberg Dreier
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Lamrani Y, Tran TPY, Toffa DH, Robert M, Bérubé AA, Nguyen DK, Bou Assi E. Unexpected cardiorespiratory findings postictally and at rest weeks prior to SUDEP. Front Neurol 2023; 14:1129395. [PMID: 37034071 PMCID: PMC10080096 DOI: 10.3389/fneur.2023.1129395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Mechanisms underlying sudden unexpected death in epilepsy (SUDEP) are unclear, but autonomic disorders are thought to play a critical role. However, those dysfunctions have mainly been reported in the peri-ictal context of generalized tonic-clonic seizures. Here, we explored whether heart rate variability (HRV), heart rate (HR), and breathing rate (BR) changes could be observed perictally during focal seizures with or without impaired awareness as well as interictally to assess the risk of SUDEP. We report the case of a 33-year-old patient with drug-resistant bilateral temporal lobe epilepsy who died at home probably from an unwitnessed nocturnal seizure ("probable SUDEP"). Methods Ictal and interictal HRV as well as postictal cardiorespiratory analyses were conducted to assess autonomic functions and overall SUDEP risk. The SUDEP patient was compared to two living male patients from our local database matched for age, sex, and location of the epileptic focus. Results Interictal HRV analysis showed that all sleep HRV parameters and most awake HRV parameters of the SUDEP patient were significantly lower than those of our two control subjects with bitemporal lobe epilepsy without SUDEP (p < 0.01). In two focal with impaired awareness seizures (FIAS) of the SUDEP patient, increased postictal mean HR and reduced preictal mean high frequency signals (HF), known markers of increased seizure severity in convulsive seizures, were seen postictally. Furthermore, important autonomic instability and hypersensitivity were seen through fluctuations in LF/HF ratio following two seizures of the SUDEP patient, with a rapid transition between sympathetic and parasympathetic activity. In addition, a combination of severe hypopnea (202 s) and bradycardia (10 s), illustrating autonomic dysfunction, was found after one of the SUDEP patient's FIAS. Discussion The unusual cardiorespiratory and HRV patterns found in this case indicated autonomic abnormalities that were possibly predictive of an increased risk of SUDEP. It will be interesting to perform similar analyses in other SUDEP cases to see whether our findings are anecdotal or instead suggestive of reliable biomarkers of high SUDEP risk in focal epilepsy, in particular focal with or without impaired awareness seizures.
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Affiliation(s)
- Yassine Lamrani
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- *Correspondence: Yassine Lamrani,
| | - Thi Phuoc Yen Tran
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Dènahin Hinnoutondji Toffa
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Manon Robert
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Arline-Aude Bérubé
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Dang Khoa Nguyen
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
- Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada
| | - Elie Bou Assi
- University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
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