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Cerulli Irelli E, Cocchi E, Morano A, Gesche J, Caraballo RH, Lattanzi S, Strigaro G, Rosati E, Catania C, Ferlazzo E, Casciato S, Di Gennaro G, Pizzanelli C, Giuliano L, Viola V, Mostacci B, Pignatta P, Fortunato F, Pulitano P, Panzini C, Gambardella A, Atalar AÇ, Labate A, Operto FF, Giallonardo AT, Baykan BB, Beier CP, Di Bonaventura C. Predictors of Seizure Recurrence in Women With Idiopathic Generalized Epilepsy Who Switch From Valproate to Another Medication. Neurology 2024; 102:e209222. [PMID: 38569127 DOI: 10.1212/wnl.0000000000209222] [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: 07/27/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the predictors of seizure recurrence in women of childbearing age with idiopathic generalized epilepsy (IGE) who switched from valproate (VPA) to alternative antiseizure medications (ASMs) and compare the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) as VPA alternatives after switch. METHODS This multicenter retrospective study included women of childbearing age diagnosed with IGE from 16 epilepsy centers. Study outcomes included worsening or recurrence of generalized tonic-clonic seizure (GTCS) at 12 months and 24 months after the switch from VPA to an alternative ASM. The comparative effectiveness of LEV and LTG as alternative ASM following VPA discontinuation was assessed through inverse probability treatment-weighted (IPTW) Cox regression analysis. RESULTS We included 426 women with IGE, with a median (interquartile range) age at VPA switch of 24 (19-30) years and a median VPA dosage of 750 (500-1,000) mg/d. The most common reason for VPA switch was teratogenicity concern in 249 women (58.6%), and the most common ASM used in place of VPA was LEV in 197 (46.2%) cases, followed by LTG in 140 (32.9%). GTCS worsening/recurrence occurred in 105 (24.6%) and 139 (32.6%) women at 12 and 24 months, respectively. Catamenial worsening of seizures, higher VPA dosage during switch, multiple seizure types, and shorter duration of GTCS freedom before switch were independent predictors of GTCS recurrence or worsening at 12 months according to mixed multivariable logistic regression analysis. After internal-external validation through 16 independent cohorts, the model showed an area under the curve of 0.71 (95% CI 0.64-0.77). In the subgroup of 337 women who switched to LEV or LTG, IPTW Cox regression analysis showed that LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG (adjusted hazard ratio 0.59, 95% CI 0.40-0.87, p = 0.008) during the 24-month follow-up. DISCUSSION Our findings can have practical implications for optimizing counselling and treatment choices in women of childbearing age with IGE and may help clinicians in making informed treatment decisions in this special population of patients. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for women with IGE switching from VPA, LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG.
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Affiliation(s)
- Emanuele Cerulli Irelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Enrico Cocchi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Alessandra Morano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Joanna Gesche
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Roberto H Caraballo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Simona Lattanzi
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Gionata Strigaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Eleonora Rosati
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Cecilia Catania
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Edoardo Ferlazzo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Sara Casciato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Giancarlo Di Gennaro
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Pizzanelli
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Loretta Giuliano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Veronica Viola
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Barbara Mostacci
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Pietro Pignatta
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesco Fortunato
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Patrizia Pulitano
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Chiara Panzini
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Antonio Gambardella
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Arife Çimen Atalar
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Angelo Labate
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Francesca Felicia Operto
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Anna T Giallonardo
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Betül B Baykan
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Christoph P Beier
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
| | - Carlo Di Bonaventura
- From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey
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11
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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