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Rácz A, Galvis-Montes DS, Borger V, Becker AJ, Pitsch J. Focused review: Clinico-neuropathological aspects of late onset epilepsies: Pathogenesis. Seizure 2024:S1059-1311(24)00182-1. [PMID: 38918105 DOI: 10.1016/j.seizure.2024.06.015] [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: 01/24/2024] [Revised: 05/21/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of the present study was to review the current knowledge on the neuropathological spectrum of late onset epilepsies. Several terms including 'neuropathology*' AND 'late onset epilepsy' (LOE) combined with distinct neuropathological diagnostic terms were used to search PubMed until November 15, 2023. We report on the relevance of definitional aspects of LOE with implications for the diagnostic spectrum of epilepsies. The neuropathological spectrum in patients with LOE is described and includes vascular lesions, low-grade neuroepithelial neoplasms and focal cortical dysplasias (FCD). Among the latter, the frequency of the FCD subtypes appears to differ between LOE patients and those with seizure onset at a younger age. Neurodegenerative neuropathological changes in the seizure foci of LOE patients require careful interdisciplinary interpretation with respect to the differential diagnosis of primary neurodegenerative changes or epilepsy-related changes. Innate and adaptive neuroinflammation represents an important cause of LOE with intriguing therapeutic options.
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Affiliation(s)
- Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Albert J Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Julika Pitsch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Ha WS, Jang K, Cho S, Kim WJ, Chu MK, Heo K, Kim KM. Risk Factors and Temporal Patterns of Poststroke Epilepsy across Stroke Subtypes: Insights from a Nationwide Cohort Study in Korea. Neuroepidemiology 2024; 58:383-393. [PMID: 38599180 DOI: 10.1159/000538776] [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: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION We aimed to investigate the risk factors associated with poststroke epilepsy (PSE) among patients with different subtypes of stroke, focusing on age-related risk and time-varying effects of stroke subtypes on PSE development. METHODS A retrospective, nationwide, population-based cohort study was conducted using Korean National Health Insurance Service-National Sample Cohort data. Patients hospitalized with newly diagnosed stroke from 2005 to 2015 were included and followed up for up to 10 years. The primary outcome was the development of PSE, defined as having a diagnostic code and a prescription for anti-seizure medication. Multivariable Cox proportional hazard models were used to estimate PSE hazard ratios (HRs), and time-varying effects were also assessed. RESULTS A total of 8,305 patients with ischemic stroke, 1,563 with intracerebral hemorrhage (ICH), and 931 with subarachnoid hemorrhage (SAH) were included. During 10 years of follow-up, 4.6% of patients developed PSE. Among patients with ischemic stroke, significant risk factors for PSE were younger age (HR = 1.47), living in rural areas (HR = 1.35), admission through the emergency room (HR = 1.33), and longer duration of hospital stay (HR = 1.45). Time-varying analysis revealed elevated HRs for ICH and SAH, particularly in the first 2 years following the stroke. The age-specific HRs also showed an increased risk for those under the age of 65, with a noticeable decrease in risk beyond that age. CONCLUSION The risk of developing PSE varies according to stroke subtype, age, and other demographic factors. These findings underscore the importance of tailored poststroke monitoring and management strategies to mitigate the risk of PSE.
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Affiliation(s)
- Woo-Seok Ha
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kimoon Jang
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chen L, Yang W, Yang F, Yu Y, Xu T, Wang D, Zhao Q, Wu Q, Han Y. The crosstalk between epilepsy and dementia: A systematic review and meta-analysis. Epilepsy Behav 2024; 152:109640. [PMID: 38301455 DOI: 10.1016/j.yebeh.2024.109640] [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: 08/12/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Epilepsy and dementia are bidirectional. The purpose of this review was to investigate the epidemiological characteristics of and to identify the risk factors for epilepsy in patients with dementia and dementia in patients with epilepsy. METHODS We retrieved the PubMed, Embase, Cochrane and Web of Science databases through January 2023. Two individuals screened the articles, extracted the data, and used a random effects model to pool the estimates and 95% confidence intervals (CIs). RESULTS From 3475 citations, 25 articles were included. The prevalence of seizures/epilepsy was 4% among dementia patients and 3% among Alzheimer's disease (AD) patients. For vascular dementia, Lewy body dementia, and frontotemporal dementia, the pooled period prevalence of seizures/epilepsy was 6%, 3%, and 2%, respectively. Baseline early-onset AD was associated with the highest risk of 5-year epilepsy (pooled hazard ratios: 4.06; 95% CI: 3.25-5.08). Dementia patients had a 2.29-fold greater risk of seizures/epilepsy than non-dementia patients (95% CI: 1.37-3.83). Moreover, for baseline epilepsy, the pooled prevalence of dementia was 17% (95% CI: 10-25%), and that of AD was 15% (95% CI: 9-21%). The pooled results suggested that epilepsy is associated with a greater risk of dementia (risk ratio: 2.83, 95% CI: 1.64-4.88). CONCLUSIONS There are still gaps in epidemiology regarding the correlation between dementia types and epilepsy, vascular risk factors, and the impact of antiseizure medication or cognitive improvement drugs on epilepsy and AD comorbidity.
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Affiliation(s)
- Lu Chen
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Wenqian Yang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Fei Yang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanying Yu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Tingwan Xu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Dan Wang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Qingqing Zhao
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
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Winter Y, Sandner K, Vieth T, Gonzalez-Escamilla G, Stuckrad-Barre SV, Groppa S. Third-Generation Antiseizure Medication in the Treatment of Benzodiazepine-Refractory Status Epilepticus in Poststroke Epilepsy: A Retrospective Observational Register-Based Study. CNS Drugs 2023; 37:929-936. [PMID: 37784006 PMCID: PMC10570217 DOI: 10.1007/s40263-023-01039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Status epilepticus in poststroke epilepsy is a challenging condition because of multiple vascular comorbidities and the advanced age of patients. Data on third-generation antiseizure medication (ASM) in this condition are limited. The aim of this study was to evaluate the efficacy of third-generation ASMs in the second- or third-line therapy of benzodiazepine-refractory status epilepticus in poststroke epilepsy following acute ischemic stroke. METHODS Data on the effectiveness of third-generation ASMs in patients with status epilepticus in poststroke epilepsy were gathered from two German Stroke Registries and the Mainz Epilepsy Registry. We included only cases with epilepsy remote to the ischemic event. No patients with acute symptomatic seizures were included. The following third-generation ASMs were included: brivaracetam, lacosamide, eslicarbazepine, perampanel, topiramate, and zonisamide. The assessment of effectiveness was based on seizure freedom within 48 h since the start of therapy with the respective ASM. Seizure freedom was evaluated both clinically (clinical evaluation at least three times per day) and by daily electroencephalogram records. RESULTS Of the 138 patients aged 70.8 ± 8.1 years with benzodiazepine-refractory status epilepticus in ischemic poststroke epilepsy, 33 (23.9%) were treated with lacosamide, 24 (17.4%) with brivaracetam, 23 (16.7%) with eslicarbazepine, 21 (15.2%) with perampanel, 20 (14.5%) with topiramate, and 17 (12.3%) with zonisamide. Seizure freedom within 48 h was achieved in 66.7% of patients with lacosamide, 65.2% with eslicarbazepine, 38.1% with perampanel, 37.5% with brivaracetam, 35.0% with topiramate, and 35.3% with zonisamide (p < 0.05 for comparison of lacosamide or eslicarbazepine to other ASMs). CONCLUSIONS Based on these data, lacosamide and eslicarbazepine might be more favorable in the treatment of refractory status epilepticus in poststroke epilepsy, when administered as second- or third-line ASMs before anesthesia. Because of the fact that these ASMs share the same mechanism of action (slow inactivation of sodium channels), our findings could motivate further research on the role that this pharmaceutical mechanism of action has in the treatment of poststroke epilepsy. CLINICAL TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05267405).
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Affiliation(s)
- Yaroslav Winter
- Department of Neurology, Mainz Comprehensive Epilepsy and Sleep Medicine Center, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Katharina Sandner
- Department of Neurology, Mainz Comprehensive Epilepsy and Sleep Medicine Center, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
| | - Thomas Vieth
- Rudolf Frey Educational Clinic, Johannes Gutenberg University, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Focus Program Translational Neuroscience (FTN), Department of Neurology, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Sergiu Groppa
- Focus Program Translational Neuroscience (FTN), Department of Neurology, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Romigi A, Costa C, Sen A, Giorgi FS. Editorial: Epilepsy in older adults: From physiopathology to improvements in diagnosis and management. Front Neurol 2022; 13:1063299. [PMID: 36388177 PMCID: PMC9665049 DOI: 10.3389/fneur.2022.1063299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Andrea Romigi
- Sleep Medicine Center, IRCCS Neuromed Istituto Neurologico Mediterraneo, Pozzilli, Italy,*Correspondence: Andrea Romigi
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Arjune Sen
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom,Oxford Epilepsy Research Group, National Institute of Health and Care Research (NIHR) Biomedical Research Centre, Nueld Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Filippo Sean Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Vemulapalli S, Betdur AL, Harikrishna GV, Mala K, Kodapala S. Evaluation of Acute Symptomatic Seizures and Etiological Factors in a Tertiary Care Hospital From a Developing Country. Cureus 2022; 14:e26294. [PMID: 35898374 PMCID: PMC9308980 DOI: 10.7759/cureus.26294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: The etiologies of acute symptomatic seizures (ASS) differ across the globe. We aimed to evaluate the etiological spectrum of acute seizures and to observe the pattern of seizure types among study participants. Methodology: We conducted this prospective study from 2016 to 18. We included all patients aged 20 years or older, presenting with ASS. We excluded those with pseudoseizures. We performed appropriate descriptive analyses to describe the demographic details, etiology of ASS, and pattern of ASS. Results: One hundred and thirty-eight patients were enrolled, constituting about 0.8% of total hospital admissions. The mean age at presentation was 44.33 ± 17.73 years. The most common etiologies for ASS were cerebrovascular accidents (CVA - 32.6%), neuroinfections (26.8%), metabolic derangements (13%), alcohol withdrawal (10.9%), and intracranial tumors (4.3%). 71% of the patients presented with only a single episode of ASS. The predominant type of seizure was generalized tonic-clonic seizures, seen in 70.2% of all patients, followed by focal with the bilateral tonic-clonic type (15.9%) and focal seizures (10.1%). New-onset seizures presenting as status epilepticus were observed in 3.6%. Discussion: CVA and neuroinfections were the most common causes of ASS in our study, highlighting the need for community awareness of these conditions and the need to seek rapid care. The majority of our patients had only a single episode of seizures, with generalized seizures being the most common type, followed by focal onset seizures.
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Green SF, Loefflad N, Heaney DC, Rajakulendran S. New-onset seizures in older people: Clinical features, course and outcomes. J Neurol Sci 2021; 429:118065. [PMID: 34492571 DOI: 10.1016/j.jns.2021.118065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The incidence of epilepsy increases with age. With current demographic trends, this presents a healthcare challenge. We investigated the clinical spectrum of first seizures, evaluated neuroimaging and EEG findings, and determined clinical outcomes, including anti-seizure medication (ASM) response in older people. In addition, we sought to understand the relative effects of age and frailty on ASM response. METHODS A retrospective single centre cohort study of 207 cases ≥60 years' old, 113 of whom were eventually diagnosed with a first seizure in a specialist epilepsy clinic. RESULTS 65/113 (57.5%) presented with either focal aware or focal impaired awareness seizures. Stroke was the most common aetiological association (31.9%, 36/113), and odds of seizure recurrence did not significantly differ between aetiologies. 55/86 (64.0%) who started an ASM had no seizure recurrence. 14/48 (29.2%) who underwent EEG had epileptiform abnormalities, however EEG result directly affected management in only 4/48 (8.3%). The most common MRI findings were small vessel disease (37/93, 39.8%), stroke (27/93, 29.0%) and global atrophy (14/93, 15.1%). Increasing age and frailty did not affect the odds of seizure recurrence or of experiencing ASM side effects. Severity of small vessel disease or atrophy did not affect odds of seizure recurrence. CONCLUSION Our data inform the management of first seizures in older people and provisionally support the use of ASMs in patients with increasing age and frailty, despite concerns over polypharmacy and comorbidity. Our findings should be replicated in larger cohorts.
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Affiliation(s)
- Sebastian F Green
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, London, UK; Institute of Clinical Neurosciences, North Bristol NHS Trust, Bristol, UK
| | | | - Dominic C Heaney
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sanjeev Rajakulendran
- Epilepsy Department, National Hospital for Neurology and Neurosurgery, London, UK; UCL Queen Square Institute of Neurology, London, UK.
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Sundelin HEK, Tomson T, Zelano J, Söderling J, Bang P, Ludvigsson JF. Pediatric Ischemic Stroke and Epilepsy: A Nationwide Cohort Study. Stroke 2021; 52:3532-3540. [PMID: 34470493 DOI: 10.1161/strokeaha.121.034796] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose The risk of epilepsy after stroke has not been thoroughly explored in pediatric ischemic stroke. We examined the risk of epilepsy in children with ischemic stroke as well as in their first-degree relatives. Methods In Swedish National Registers, we identified 1220 children <18 years with pediatric ischemic stroke diagnosed 1969 to 2016, alive 7 days after stroke and with no prior epilepsy. We used 12 155 age- and sex-matched individuals as comparators. All first-degree relatives to index individuals and comparators were also identified. The risk of epilepsy was estimated in children with ischemic stroke and in their first-degree relatives using Cox proportional hazard regression model. Results Through this nationwide population-based study, 219 (18.0%) children with ischemic stroke and 91 (0.7%) comparators were diagnosed with epilepsy during follow-up corresponding to a 27.8-fold increased risk of future epilepsy (95% CI, 21.5–36.0). The risk of epilepsy was still elevated after 20 years (hazard ratio [HR], 7.9 [95% CI, 3.3–19.0]), although the highest HR was seen in the first 6 months (HR, 119.4 [95% CI, 48.0–297.4]). The overall incidence rate of epilepsy was 27.0 per 100 000 person-years (95% CI, 21.1–32.8) after ischemic stroke diagnosed ≤day 28 after birth (perinatal) and 11.6 per 100 000 person-years (95% CI, 9.6–13.5) after ischemic stroke diagnosed ≥day 29 after birth (childhood). Siblings and parents, but not offspring, to children with ischemic stroke were at increased risk of epilepsy (siblings: HR, 1.64 [95% CI, 1.08–2.48] and parents: HR, 1.41 [95% CI, 1.01–1.98]). Conclusions The risk of epilepsy after ischemic stroke in children is increased, especially after perinatal ischemic stroke. The risk of epilepsy was highest during the first 6 months but remained elevated even 20 years after stroke which should be taken into account in future planning for children affected by stroke.
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Affiliation(s)
- Heléne E K Sundelin
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Sweden (H.E.K.S., P.B.).,Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital (H.E.K.S.), Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Johan Zelano
- Sahlgrenska University Hospital, Institute of Neuroscience and Physiology, Gothenburg University, Sweden (J.Z.)
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine (Solna) (J.S.), Karolinska Institutet, Stockholm, Sweden
| | - Peter Bang
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Sweden (H.E.K.S., P.B.)
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics (J.F.L.), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Sweden (J.F.L.).,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (J.F.L.).,Department of Medicine, Columbia University, NY (J.F.L.)
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Xu Y, Lavrencic L, Radford K, Booth A, Yoshimura S, Anstey KJ, Anderson CS, Peters R. Systematic review of coexistent epileptic seizures and Alzheimer's disease: Incidence and prevalence. J Am Geriatr Soc 2021; 69:2011-2020. [PMID: 33740274 DOI: 10.1111/jgs.17101] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND/OBJECTIVES Coexistent seizures add complexity to the burden of Alzheimer's disease (AD). We aim to estimate the incidence and prevalence of coexistent seizures and AD and summarize characteristics. DESIGN A systematic review and meta-analysis (PROSPERO protocol registration CRD42020150479). SETTING Population-, community-, hospital-, or nursing home-based. PARTICIPANTS AND MEASUREMENTS Thirty-nine studies reporting on seizure incidence and prevalence in 21,198 and 380,777 participants with AD, respectively, and AD prevalence in 727,446 participants with seizures. When statistical heterogeneity and inconsistency (assessed by Q statistic and I2 ) were not shown, rates were synthesized using random effect. RESULTS Studies were conducted in Australia, Brazil, Finland, France, Ireland, Italy, Japan, Netherlands, Portugal, Sweden, Taiwan, United Kingdom, and United States. The incidence of seizures among people with clinically diagnosed AD ranged from 4.2 to 31.5 per 1000 person-years. Prevalence of seizures among people with clinically diagnosed AD ranged from 1.5% to 12.7% generally, but it rose to the highest (49.5% of those with early-onset AD) in one study. Meta-analysis reported a combined seizure prevalence rate among people with pathologically verified AD at 16% (95% confidence interval [CI] 14-19). Prevalence of seizure in autosomal dominant AD (ADAD) ranged from 2.8% to 41.7%. Being younger was associated with higher risk of seizure occurrence. Eleven percent of people with adult-onset seizures had AD (95%CI, 7-14). CONCLUSION Seizures are common in those with AD, and seizure monitoring may be particularly important for younger adults and those with ADAD.
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Affiliation(s)
- Ying Xu
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Louise Lavrencic
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Peking University Health Science Centre, Beijing, China.,Neurology Department, Sydney Local Area Health District, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ruth Peters
- Neuroscience Research Australia, Sydney, New South Wales, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health, Imperial College London, London, UK
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10
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Bacellar A, Assis TRD, Pedreira BB, CÔrtes L, Santana S, Nascimento OJMD. Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:687-694. [PMID: 33263637 DOI: 10.1590/0004-282x20200062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Population ageing is a global phenomenon, and life expectancy in Brazil is growing fast. Epilepsy is the third most important chronic neurological disorder, and its incidence is higher among elderly patients than in any other segment of the population. The prevalence of epilepsy is greater among inpatients than in the general population and it is related to long length of hospital stay (LOS), which is associated with hospital mortality and higher healthcare costs. Despite these facts, reports of elderly inpatients admitted with seizures and associated outcomes are scarce. To identify predictors of long LOS among elderly inpatients admitted with seizures. METHODS We prospectively enrolled elders admitted with epileptic seizures or who experienced seizures throughout hospitalization between November 2015 and August 2019. We analysed demographic data, neurological disorders, clinical comorbidities, and seizure features to identify risk factors. RESULTS The median LOS was 11 days, with an interquartile range (IQR) of 5-21 days. The frequency of long LOS (defined as a period of hospitalization ≥12 days) was 47%. Multivariate analysis showed there was an exponential increase in long LOS if a patient showed any of the following conditions: intensive care unit (ICU) admission (OR=4.562), urinary tract infection (OR=3.402), movement disorder (OR=5.656), early seizure recurrence (OR=2.090), and sepsis (OR=4.014). CONCLUSION Long LOS was common among elderly patients admitted with seizures, and most predictors of long LOS found in this cohort might be avoidable; these findings should be confirmed with further research.
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Affiliation(s)
- Aroldo Bacellar
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Telma Rocha de Assis
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Bruno Bacellar Pedreira
- Hospital São Rafael, Department of Neurology, D'Or Institute for Research and Education, Salvador BA, Brazil
| | - Luan CÔrtes
- Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil
| | - Silas Santana
- Resident of the Department of Neurology, Hospital São Rafael, Monte Tabor Foundation, Italian-Brazilian Centre for Health Promotion, Salvador BA, Brazil
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11
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Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet 2020; 395:735-748. [PMID: 32113502 DOI: 10.1016/s0140-6736(19)33064-8] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/23/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population, discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular risk factors might be an important strategy to reduce the probability of developing epilepsy.
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Affiliation(s)
- Arjune Sen
- Oxford Epilepsy Research Group, National Institute for Health Research Oxford Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Masud Husain
- Department of Psychology, University of Oxford, Oxford UK
| | - Josemir W Sander
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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12
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Guzzo EFM, Pedrini DB, Breigeiron MK. Inflammatory signs and epileptic crisis in patients admitted in an emergency unit. Rev Gaucha Enferm 2020; 41:e20190074. [DOI: 10.1590/1983-1447.2020.20190074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/27/2019] [Indexed: 05/30/2023] Open
Abstract
ABSTRACT Objective: To evaluate inflammatory signs presented in medical records of patients with a main diagnosis of epileptic seizures, admitted in an emergency unit. Method: Cross-sectional and retrospective study. The sample was composed of 191 medical records, from children, adolescents, adults, and elders, with a clinical diagnosis of epileptic seizures, admitted between June 2016 and June 2017 at the emergency unit of a hospital in Porto Alegre/RS. Results: The prevalent inflammatory signs were tachypnea (33.5%) and/or fever (27.2%) associated with leukocytosis (P=0.030). Children/adolescents had seizures less frequently (P=0.010) and these were due to fever (P=0.000). Adults presented seizures more frequently (P=0.006), which were related to medication/intoxication (P=0.000). In elders, seizures occurred due to metabolic or circulatory abnormalities (P=0.000), less often due to fever (P=0.005). Conclusion: Seizures are related to fever and tachypnea, being caused by different etiologies according to age, being more frequent in adults. Fever is related to leukocytosis, regardless of age.
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Assis T, Bacellar A, Costa G, Pires E, Nascimento O. Predictors of early seizure recurrence among elderly inpatients admitted to a tertiary center: A prospective cohort study. Epilepsy Behav 2019; 98:145-152. [PMID: 31374470 DOI: 10.1016/j.yebeh.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Early seizure recurrence is common among elderly inpatients and is related to increased morbidity and a longer length of hospital stay. There are few studies on the short-term outcomes of seizures in the elderly population. We aimed to identify the predictors of early seizure recurrence among elderly inpatients. METHODS We prospectively enrolled patients aged 60 years and older from a tertiary center who had seizures that either led to their hospital admission or occurred during hospitalization. We analyzed the demographic and hospitalization data, characteristics and etiology of seizures, and neurological and clinical comorbidities. Kaplan-Meier analysis was performed to determine the 30-day cumulative recurrence rates. The logrank test was used to analyze the risk of seizure recurrence within 30 days after the index seizure. Multivariable logistic regression analysis was used to identify risk factors for the recurrence of seizures within 30 days. RESULTS Overall, 109 patients (mean age: 75.9 ± 9.6 years) were enrolled. The mean age at the first-ever seizure was 74 ± 11.7 years. Unprovoked seizures occurred in 59.6% of the patients. Cerebrovascular disorders were the most prevalent etiology (52.3%). Early seizure recurrence, defined as within 30 days, occurred in 27.5% of patients. Multimorbidity was found in 95.4% of our inpatients (6.3 ± 2.3 [95% confidence interval, 5.4-7.2]), and the number of comorbidities was higher among those who had seizure recurrence than that among those who did not have seizure recurrence (p = 0.02). The probability of seizure recurrence was similar among the subgroups of patients who experienced acute seizures versus unprovoked seizures (both p = 0.03), and seizure recurrence was associated with a longer length of hospital stay (p = 0.005) compared to that of patients who did not experience seizure recurrence. After multivariate analysis, sepsis (p = 0.011), psychiatric disorders (p = 0.032), and cardiac arrhythmias (p = 0.037) were identified as risk factors for early seizure recurrence. CONCLUSIONS Higher multimorbidity and a longer length of stay were associated with early seizure recurrence; and sepsis, psychiatric disorders, and cardiac arrhythmias were independent risk factors for early seizure recurrence among elderly inpatients.
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Affiliation(s)
- Telma Assis
- Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil.
| | - Aroldo Bacellar
- Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil
| | - Gersonita Costa
- Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil
| | - Emanoel Pires
- Research Training of Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil
| | - Osvaldo Nascimento
- Pos-Graduating Program on Neurology/Neuroscience, Universidade Federal Fluminense, Av. Marquês do Paraná, 303, Niterói, RJ, Brazil
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Aetiological Features of Elderly Patients with Newly Diagnosed Symptomatic Epilepsy in Western China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4104691. [PMID: 29854751 PMCID: PMC5941785 DOI: 10.1155/2018/4104691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/08/2018] [Indexed: 01/22/2023]
Abstract
Aims Recent epidemiological studies have indicated that the incidence of epilepsy peaks after 60 years old, and epilepsy has become increasingly prevalent in elderly populations. The aim of this study is to identify the aetiologic characteristics of epilepsy in the elderly. Methods We retrospectively recruited elderly patients with newly diagnosed epilepsy identified in three epilepsy centres in western China; elderly patients were defined as individuals aged 60 years or older. Demographic characteristics, clinical epilepsy data, and the diagnosis and aetiology of epilepsy were recorded. Results A total of 760 patients with newly diagnosed epilepsy were enrolled in our study. Of these patients, 25% had experienced one or more episodes of status epilepticus, and 62.4% were confirmed as symptomatic. Among the symptomatic cohort, stroke and traumatic brain injury (TBI) were the two most common causes of epilepsy, followed by cerebral tumour, dementia, hippocampal sclerosis (HS), and central nervous system (CNS) infection. When analysed by residence and age, ischaemic stroke was the most common cause of epilepsy in urban patients, whereas traumatic brain injury was the leading cause of epilepsy in rural patients. Conclusion More than three-fifths of newly diagnosed epilepsy cases in elderly patients were confirmed as symptomatic, and stroke and traumatic brain injury were the primary aetiologies in elderly epileptic patients.
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Kaur S, Garg R, Aggarwal S, Chawla SPS, Pal R. Adult onset seizures: Clinical, etiological, and radiological profile. J Family Med Prim Care 2018; 7:191-197. [PMID: 29915758 PMCID: PMC5958567 DOI: 10.4103/jfmpc.jfmpc_322_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Adult onset seizure disorder is a major public health concern in terms of burden of disease, nature of illness, and its impact on individual, family, and community. This study was done to assess the clinical profile and etiology of adult onset seizures and correlates of clinical and radiological pattern. Materials and Methods: This was a prospective cross-sectional hospital-based study conducted on 100 cases presenting with adult onset seizures. Results: Adult onset seizures were most prevalent in the young and middle-aged adults than elderly; generalized seizures were more common than focal seizures. However, the incidence of generalized seizures showed a falling trend as the age advanced whereas focal seizures increased in incidence with advancing age. Overall, the most common etiology of seizures was stroke, followed by idiopathic and central nervous system infections; yet, most common etiology of adult onset generalized and focal seizures was idiopathic and stroke, respectively. Regarding etiology, among younger adults, idiopathic seizures were predominant, whereas among middle aged and elderly, stroke was the most common etiology. Conclusions: It is mandatory to deal carefully with each case of adult onset seizure with a tailor-made approach. Identification and awareness about the etiological factors and seizure type help in better management of these patients. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis. In the face of recent advances in neuroimaging techniques, the future prospective management of adult onset seizures appears bright and convincing.
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Affiliation(s)
- Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Simmi Aggarwal
- Department of Radiodiagnosis, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ranabir Pal
- Department of Community Medicine, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
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Verma A, Kumar A. Clinical and etiological profile of epilepsy in elderly: a hospital-based study from rural India. Acta Neurol Belg 2017; 117:139-144. [PMID: 27878560 DOI: 10.1007/s13760-016-0719-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/29/2016] [Indexed: 11/25/2022]
Abstract
To determine the clinical profile and etiology of epilepsy in elderly patients in rural population of India which is in a phase of demographic transition with steadily growing geriatric population. A cross-sectional, prospective, hospital-based clinicoepidemiological study was performed from October 2014 to November 2015. Patients having onset of epilepsy after 60 years were incorporated in the study. We excluded the acute symptomatic seizures. One hundred and ten patients were enrolled and were divided into three standard subgroups: subgroup A (aged 60-70), subgroup B (aged 71-80), and subgroup C (aged 81-90). Out of 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. The most common etiology was cerebrovascular disease (46.36%), followed by focal cerebral calcifications single or multiple (11.81%), tumors (9.09%), trauma (6.36%) dementias (6.36%) and unknown (16.63%). In our study, the frequency of epilepsy decreases with advancing age which was 77.27% in group A (less than 70 years), 16.36% in group B and 6.36% in group C (70-90 years).The most common type of seizure in the group studied was focal 59.09% followed by generalized seizures 37.27%. Hypertension was the most common co-morbidity found in 40 (36.36%) patients. The present study proposes that epilepsy in the elderly patients have etiological relationship with stroke, focal cerebral calcifications, tumors and dementias. CNS infections account for a significant number of cases of remote symptomatic epilepsy in elderly in our region where neurocysticercosis is endemic.
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Affiliation(s)
- Archana Verma
- Department of Neurology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, 206301, India.
| | - Alok Kumar
- Forensic Medicine and Toxicology, UP RIMS & R, Saifai, Etawah, Uttar Pradesh, 206130, India
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Abstract
With increasing age, the prevalence and incidence of epilepsy and seizures increases correspondingly. New-onset epilepsy in elderly people often has underlying etiology, including cerebrovascular diseases, primary neuron degenerative disorders, intracerebral tumors, and traumatic head injury. In addition, an acute symptomatic seizure cannot be called epilepsy, which manifests usually as a common symptom secondary to metabolic or toxicity factors in older people. In this review, we have mainly focused on the causes of new-onset epilepsy and seizures in elderly people. This knowledge will certainly help us to understand the reasons for high incidences of epilepsy and seizures in elderly people. We look forward to controlling epileptic seizures via the treatment of primary diseases in the future.
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Affiliation(s)
- Shasha Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Weihua Yu
- Department of Anatomy, Institute of Neuroscience, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Josephson CB, Engbers JDT, Sajobi TT, Jette N, Agha-Khani Y, Federico P, Murphy W, Pillay N, Wiebe S. Towards a clinically informed, data-driven definition of elderly onset epilepsy. Epilepsia 2015; 57:298-305. [PMID: 26648047 DOI: 10.1111/epi.13266] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Elderly onset epilepsy represents a distinct subpopulation that has received considerable attention due to the unique features of the disease in this age group. Research into this particular patient group has been limited by a lack of a standardized definition and understanding of the attributes associated with elderly onset epilepsy. METHODS We used a prospective cohort database to examine differences in patients stratified according to age of onset. Linear support vector machine learning incorporating all significant variables was used to predict age of onset according to prespecified thresholds. Sensitivity and specificity were calculated and plotted in receiver-operating characteristic (ROC) space. Feature coefficients achieving an absolute value of 0.25 or greater were graphed by age of onset to define how they vary with time. RESULTS We identified 2,449 patients, of whom 149 (6%) had an age of seizure onset of 65 or older. Fourteen clinical variables had an absolute predictive value of at least 0.25 at some point over the age of epilepsy-onset spectrum. Area under the curve in ROC space was maximized between ages of onset of 65 and 70. Features identified through machine learning were frequently threshold specific and were similar, but not identical, to those revealed through simple univariable and multivariable comparisons. SIGNIFICANCE This study provides an empirical, clinically informed definition of "elderly onset epilepsy." If validated, an age threshold of 65-70 years can be used for future studies of elderly onset epilepsy and permits targeted interventions according to the patient's age of onset.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jordan D T Engbers
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yahya Agha-Khani
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - William Murphy
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Liao H, Jiang G, Wang X. Music therapy as a non-pharmacological treatment for epilepsy. Expert Rev Neurother 2015. [DOI: 10.1586/14737175.2015.1071191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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