Gender and Socioeconomic Disparities in Global Burden of Epilepsy: An Analysis of Time Trends From 1990 to 2017

Novel nonsense mutation in gene CHRNA2 identified by whole-genome sequencing in infant with epilepsy disorder: A case report

Epilepsy is one of the most common neurological disorders affecting approximately 50 million people worldwide. It impacts people of all genders and ages, but evidence suggests a higher incidence rate in children and the elderly. Given that childhood epilepsy has the risk of causing developmental epileptic encephalopathy, which is associated with intellectual, behavioral, and/or motor disabilities, proper assessment of children with new-onset epilepsy at an early stage is essential to prevent threats affecting neurodevelopmental processes. The aim of this study was to investigate whole genome sequencing data of children diagnosed with epilepsy. Our results revealed an identification of a novel mutation in a 2-year-old male patient who suffered from recurrent epileptic seizures of unknown etiology. The detected variant is heterozygous and located in gene CHRNA2 (chr8:27321348, NM_000742, c.612G > A, p.Trp204∗) in exon 6. The databases such as Varsome, GeneCards, and NCBI did not reveal any matches with previously identified variants, implying the novelty of the finding. Moreover, according to various prediction tools (MutationTaster, SIFT, CADD, FATHMM-MKL, LRT, DANN, Eigen, and BayesDel), the mutation is characterized as pathogenic, which corresponds to the American College of Medical Genetics and Genomics (ACMG) classification. According to the findings, mutation of the CHRNA2 gene is closely associated with two disorders known as autosomal dominant nocturnal frontal epilepsy (ADNFLE), and benign familial infantile epilepsy (BFIS). Comparison of proband's clinical manifestations showed that it is difficult to attribute precisely the patient's symptoms to either of the conditions, however the evidence suggests that the patient's symptoms are more consistent with those of ADNFLE. In this report, we expanded the spectrum of existing variations in the CHRNA2 gene contributing and associated with the development of epilepsy with the important and novel causative genetic variant.

Not All Seizures Are Created Equal: The Sex Factor in Epilepsy

Sex Differences in Physiological Response to Increased Neuronal Excitability in a Knockin Mouse Model of Pediatric Epilepsy Hammer MF, Krzyzaniak CT, Bahramnejad E, Smelser KJ, Hack JB, Watkins JC, Ronaldson PT. Clin Sci (Lond). 2024;138(4):205–223. doi:10.1042/CS20231572. PMID: 38348743; PMCID: PMC10881277. Background: Epilepsy is a common neurological disease; however, few if any of the currently marketed antiseizure medications prevent or cure epilepsy. Discovery of pathological processes in the early stages of epileptogenesis has been challenging given the common use of preclinical models that induce seizures in physiologically normal animals. Moreover, despite known sex dimorphism in neurological diseases, females are rarely included in preclinical epilepsy models. Methods: We characterized sex differences in mice carrying a pathogenic knockin variant (p.N1768D) in the Scn8a gene that causes spontaneous tonic-clonic seizures (TCs) at ∼3 months of age and found that heterozygous females are more resilient than males in mortality and morbidity. To investigate the cellular mechanisms that underlie female resilience, we utilized blood-brain barrier (BBB) and hippocampal transcriptomic analyses in heterozygous mice before seizure onset (pre-TC) and in mice that experienced ∼20 TCs (post-TC). Results: In the pre-TC latent phase, both sexes exhibited leaky BBB; however, patterns of gene expression were sexually dimorphic. Females exhibited enhanced oxidative phosphorylation and protein biogenesis, while males activated gliosis and CREB signaling. After seizure onset (chronic phase), females exhibited a metabolic switch to lipid metabolism, while males exhibited increased gliosis and BBB dysfunction and a strong activation of neuroinflammatory pathways. Conclusion: The results underscore the central role of oxidative stress and BBB permeability in the early stages of epileptogenesis, as well as sex dimorphism in response to increasing neuronal hyperexcitability. Our results also highlight the need to include both sexes in preclinical studies to effectively translate results of drug efficacy studies.

Clinical characteristics, etiology, and treatment of young adult-onset epilepsy: A 24-year retrospective study

OBJECTIVE

To analyze the clinical characteristics, etiology, drug treatment, and related factors of patients with young adult-onset epilepsy.

METHODS

The study included patients with epilepsy aged between 18 and 44 years and aimed to analyze the clinical characteristics of epilepsy in young people and their response to antiseizure medication (ASM) over a 24-year period (February 1999 and March 2023).

RESULTS

A total of 4227 patients experienced epilepsy onset between 18 and 44 years of age. The median age of onset was 26 years (interquartile range [IQR]: 21-33), and the median duration from the first seizure to starting treatment was 3 months (IQR: 1.0-6.0). Structural etiology was the most common cause of epilepsy, accounting for 43.2% (1827/4227) of cases, of which head trauma and a history of craniotomy accounted for 64.9% (1186/1827). However, these two causes did not necessarily result in prompt medication or poor epilepsy control. Co-morbid cognitive decline was more prevalent than headache and anxiety/depression. Multifactorial regression analysis showed that the factors associated with poor seizure control included longer seizure duration (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.58-2.16; p < 0.001), electroencephalography (EEG) epileptic discharge (OR 1.37; 95% CI 1.17-1.67; p < 0.001), focal seizure (OR 1.69; 95% CI 1.38-2.07; p < 0.001), and seizure clusters (OR 3.35; 95% CI 2.70-4.15; p < 0.001). Initiating treatment after two seizures (OR, 1.18; 95% CI 0.98-1.15; p = .08) or 6 months after the first seizure (OR 0.84; 95% CI 0.67-1.03; p = .09) did not worsen effectiveness.

SIGNIFICANCE

Young adult-onset epilepsy was frequently caused by head trauma or craniotomies. Co-morbid cognitive decline was more prevalent than headache and anxiety/depression. The median time from the first seizure to follow-up treatment was 3 months (IQR: 1.0-6.0). Initiating treatment after two seizures did not necessarily indicate poor drug effectiveness.

PLAIN LANGUAGE SUMMARY

In this article, we observed that young adult-onset epilepsy was mainly caused by head trauma and craniotomy; co-morbid cognitive decline was more common. The median duration from first seizure to initiation of treatment for young-onset epilepsy was 3 months, and more than one-third of patients experienced more than two seizures prior to treatment, but this factor had no effect on the drug effectiveness.

The impact of an epilepsy peer education program on knowledge, attitudes, and first aid approaches: A quasi-experimental design

OBJECTIVE

This study aimed to evaluate the effect of a peer education program on students' epilepsy knowledge, attitudes, and seizure first aid approaches.

METHODS

This study utilized a one-group pretest/posttest quasi-experimental design. Peer educators provided training to 1343 peer students. The program consisted of two face-to-face sessions, each lasting 60 min. Data were collected using a demographic questionnaire, first aid management information form, The Epilepsy Knowledge Level Scale, and The Epilepsy Attitude Scale. Descriptive statistics, paired samples t-test, and Pearson correlation analysis were used to analyze the data. The significance level was set at p < 0.05.

RESULTS

The Epilepsy Knowledge Scale score increased from 8.17(±3.46) to 12.50(±2.41), and The Epilepsy Attitude Scale score increased from 59.39(±7.32) to 61.01(±6.95) after the training. There was a significant positive correlation between students' knowledge and attitudes both before training (r = 0.305, p < 0.05) and after training (r = 0.344, p < 0.05). After the training, the percentage of students who felt competent for seizure first aid intervention increased from 20.5 % to 54.4 % (p < 0.001). After the training, the results regarding recognizing seizure symptoms and what to do during a seizure were statistically significant (p < 0.05).

SIGNIFICANCE

Our results show that peer-mediated learning is highly acceptable and that the training improves students' knowledge, positive attitudes, and seizure first aid approaches. Given these results, it is suggested that school-based epilepsy peer education programs be developed and implemented for students who will become future health professionals.

A population-based analysis of the global burden of epilepsy across all age groups (1990-2021): utilizing the Global Burden of Disease 2021 data

Objective

To investigate the trends in epilepsy prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) in all ages, with risk factors for epilepsy - associated death, from 1990 to 2021.

Methods

Using the standardized Global Burden of Disease (GBD) methodologies, we evaluated the burden of epilepsy in 204 countries and regions from 1990 to 2021, aiming to derive a more precise representation of the health burden posed by epilepsy by considering four distinct types of epidemiological data, namely the prevalence, incidence, mortality, and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardized rates per 100,000 persons of the population. All estimates were calculated with 95% uncertainty intervals (UI).

Finding

In 2021, there were 24,220,856 (95% UI: 18,476,943-30,677,995) patients with epilepsy, with an age-standardized prevalence rate (ASPR) of 307.38 per 100,000 persons (95% UI: 234.71-389.02) and an age-standardized incidence rate (ASIR) of 42.821 per 100,000 persons (95% UI: 31.24-53.72).The global age-standardized mortality rate (ASMR) of epilepsy was 1.74 per 100,000 population (95% UI: 1.46-1.92); The age-standardized DALYs rate (ASDR) were 177.85 per 100,000 population (95% UI: 137.66-225.90); 154.25 per 100,000 population for females [114.73-201.76], and 201.29 per 100,000 population for males [157.93-252.74]. All of the ASPR, ASIR, ASMR and ASDR of males were higher than those of females, and the ASIR of epilepsy was the highest in children aged 0-14, at 61.00(95% UI: 39.09-86.21), while the older adult group aged 70+ has the highest ASMR of 5.67(95% UI: 4.76-6.18). From 1990 to 2021, the number of epilepsy-related deaths and DALYs both decreased. However, the ASPR of epilepsy increased by about 6.9% (95% UI: -0.10-0.26), and the ASIR increased by almost 12% (95% UI: 0.05-0.33). The trends in ASPR, ASIR, ASMR and ASDR exhibited notable variations across different regions.

Conclusion

Epilepsy is an increasing global health challenge with rising prevalence and incidence. Results of this cross-sectional study suggest that despite the global decline in deaths and DALYs, Epilepsy remains an important cause of disability and death, especially in low SDI regions. An improved understanding of the epidemiology of epilepsy may potentially have considerable benefits in reducing the global burden of epilepsy, by aiding in policy-making in low-income countries, provide data support for research on epilepsy medications and treatment methods.

Air Pollution and Temperature in Seizures and Epilepsy: A Scoping Review of Epidemiological Studies

PURPOSE OF THE REVIEW

Seizures and epilepsy can be debilitating neurological conditions and have few known causes. Emerging evidence has highlighted the potential contribution of environmental exposures to the etiology of these conditions, possibly manifesting via neuroinflammation and increased oxidative stress in the brain. We conducted a scoping review of epidemiological literature linking air pollution and temperature exposures with incidence and acute aggravation of seizures and epilepsy. We systematically searched PubMed, Embase, Web of Science, and APA PsycINFO databases for peer-reviewed journal articles published in English from inception to February 7, 2024.

RECENT FINDINGS

We identified a total of 34 studies: 16 examined air pollution exposure, 12 ambient temperature, and six examined both air pollution and ambient temperature. Most studies were conducted in Asia (China, Taiwan, South Korea, and Japan). Nearly all studies retrospectively derived acute (daily average), ambient, and postnatal exposure estimates from ground monitoring systems and ascertained epilepsy cases or seizure events through record linkage with medical records, health registry systems, or insurance claims data. Commonly assessed exposures were particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and daily mean ambient temperature. Overall, the main findings across studies lacked consistency, with mixed results reported for the associations of air pollutants and temperature metrics with both seizure incidence and acute aggravations of epilepsy.

Epilepsy is associated with the accelerated aging of brain activity in sleep

Objective

Although seizures are the cardinal feature, epilepsy is associated with other forms of brain dysfunction including impaired cognition, abnormal sleep, and increased risk of developing dementia. We hypothesized that, given the widespread neurologic dysfunction caused by epilepsy, accelerated brain aging would be seen. We measured the sleep-based brain age index (BAI) in a diverse group of patients with epilepsy. The BAI is a machine learning-based biomarker that measures how much the brain activity of a person during overnight sleep deviates from chronological age-based norms.

Methods

This case-control study drew information of age-matched controls without epilepsy from home sleep monitoring volunteers and from non-epilepsy patients with Sleep Lab testing. Patients with epilepsy underwent in-patient monitoring and were classified by epilepsy type and seizure burden. The primary outcomes measured were BAI, processed from electroencephalograms, and epilepsy severity metrics (years with epilepsy, seizure frequency standardized by year, and seizure burden [number of seizures in life]). Subanalyses were conducted on a subset with NIH Toolbox cognitive testing for total, fluid, and crystallized composite cognition.

Results

138 patients with epilepsy (32 exclusively focal and 106 generalizable [focal seizures with secondary generalization]) underwent in-patient monitoring, and age-matched, non-epilepsy controls were analyzed. The mean BAI was higher in epilepsy patients vs controls and differed by epilepsy type: -0.05 years (controls) versus 5.02 years (all epilepsy, p < 0.001), 5.53 years (generalizable, p < 0.001), and 3.34 years (focal, p = 0.03). Sleep architecture was disrupted in epilepsy, especially in generalizable epilepsy. A higher BAI was positively associated with increased lifetime seizure burden in focal and generalizable epilepsies and associated with lower crystallized cognition. Lifetime seizure burden was inversely correlated with fluid, crystallized, and composite cognition.

Significance

Epilepsy is associated with accelerated brain aging. Higher brain age indices are associated with poorer cognition and more severe epilepsy, specifically generalizability and higher seizure burden. These findings strengthen the use of the sleep-derived, electroencephalography-based BAI as a biomarker for cognitive dysfunction in epilepsy.

Romanian Translation and Cultural Adaptation of the Seizure Severity Questionnaire

The aim of this study was to report the translation into Romanian of the Seizure Severity Questionnaire (SSQ), an instrument for the evaluation of the frequency and severity of epileptic seizures, and the results of applying it to a group of patients with epilepsy evaluated at a hospital in Romania.

METHODS

Four translators were involved in obtaining conceptual analogies and the cultural importance of the translated notions. The final version was obtained for the Romanian population, with the same appearance as the original instrument. Sixty-seven patients with epilepsy completed the SSQ and the Patient-Weighted Quality of Life in Epilepsy Inventory-QOLIE-31-P.

RESULTS

Females had a lower mean SSQ total score (TS) and perceived seizures less seriously than men. Patients with epilepsy with aura had a higher mean SSQ TS, with a more severe seizure perception, compared to those without aura. According to the frequency of seizures, patients with epilepsy with rare seizures had the lowest mean SSQ total score (TS) compared to those with frequent seizures. Patients who were on monotherapy had a less severe perception of epileptic seizures compared to those who were treated with two or more antiepileptic drugs. All QOLIE-31-P domains and TS correlated statistically significantly with the SSQ TS.

CONCLUSIONS

This study explored SSQ translation, evaluated preliminary results, and showed the correlation between seizure frequency and severity, clinical factors, and quality of life. This tool could be useful for measuring seizure severity in Romanian patients with epilepsy and conducting comparative studies.

Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study

We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00-55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03-3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02-3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20-4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36-5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12-6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE's therapeutic involvement.

Estimating the active and lifetime prevalence and incidence of epilepsy in Asian Countries: A systematic review and meta-analysis

OBJECTIVE

In the current era of the World Health Organization's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP), precise and updated estimates of epilepsy burden are vital in formulating policies to improve the care of persons with epilepsy, especially in Asian countries with significant treatment gap. Hence, we aimed to consolidate the available data and quantify epilepsy prevalence and incidence estimates in Asian countries.

METHODS

We systematically searched PubMed, Embase, Ovid, and Scopus databases from inception until March 2023 for studies reporting epilepsy prevalence and incidence in Asian countries. We applied random effects meta-analysis to generate the pooled prevalence and incidence using the Meta package in R. Additionally, we performed a subgroup meta-analysis to explore the potential sources of heterogeneity. A meta-regression analysis was conducted to examine the trend of epilepsy over time.

RESULTS

A total of 99 studies with 100,654,124 participants were included in the meta-analysis. The pooled prevalence was 5.6 per 1000 (95 % confidence interval (CI) 4.4-6.8) for active epilepsy and 6.7 per 1000 (95 % CI 5.7-7.9) for lifetime epilepsy. The pooled incidence rate of epilepsy was 52.5 per 100,000 person-years (95 % CI 42.7-79.4). The subgroup analysis revealed a higher prevalence of active epilepsy (6.7/1000) and lifetime epilepsy (8.6/1000) in West Asia than in other regions. The funnel plot and Egger's test (p-value =<0.0001) revealed publication bias for active epilepsy.

CONCLUSION

Our findings highlight a high prevalence of active and lifetime epilepsy in West Asia and emphasize the necessity of implementing and formulating specific strategies to tackle the epilepsy burden in this region. Furthermore, high-quality epidemiological studies incorporating economic burdens and comorbidities associated with epilepsy in Asia are still needed.

Public misconceptions and attitudes towards persons diagnosed with epilepsy in the Kingdom of Bahrain: A cross-sectional study

BACKGROUND

Despite significant advancements in the understanding and treatment of epilepsy, the quality of life for persons diagnosed with Epilepsy (PdwE) can still be negatively impacted due to prevalent misconceptions and societal attitudes. This study aimed to investigate the knowledge, misconceptions, and attitudes towards epilepsy in Bahrain.

METHODS

This cross-sectional study involved 1079 participants aged ≥ 18 years living in Bahrain. Data collection occurred between June and December 2023 through an online questionnaire. The questionnaire consisted of four sections: sociodemographic characteristics, sources of information, knowledge about epilepsy, and attitudes toward PdwE.

RESULTS

Most participants (1063 out of 1179) were familiar with epilepsy, with social media being the main source of information (56.7%). While 75.6% correctly recognized epilepsy as a nervous system disorder. About 30% of participants believed that body shaking and falling to the ground were the only types of seizures. In terms of attitudes, 47.9% believed that PdwE could achieve high levels of education, but 40% thought they might face job loss due to their condition. Additionally, 27.5% disagreed with the idea of marrying someone with epilepsy or allowing a family member to do so. Being female, young, highly educated, and having a family member with epilepsy were associated with significantly more positive attitudes compared to other groups.

CONCLUSION

The studied sample of the Bahraini public demonstrated a satisfactory level of knowledge about epilepsy. However, they still held certain misconceptions that could impact their attitudes towards PdwE. Community awareness campaigns can address this knowledge gap and reduce epilepsy stigma.

Barriers to Enrollment in a Post-Stroke Neuromodulation and Walking Study: Implications for Recruiting Women

BACKGROUND

Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization.

OBJECTIVE

In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population.

METHODS

A total of 335 individuals with chronic stroke were screened for a study examining how neuromodulation and high-intensity treadmill training affect walking speed and corticomotor excitability. Demographics and exclusions were retrospectively gathered as a secondary dataset. Exclusion criteria consisted of 6 categories (not target population, unable to do treadmill protocol, unable to do non-invasive brain stimulation, insufficient ankle motion and disinterest, and cognitive impairment). Incidence of each exclusion criterion was compared between women and men. The sex distribution was compared to a dataset from Chicago primary stroke centers.

RESULTS

A total of 81 individuals were enrolled and 254 were not. The percentage of women excluded was significantly greater than that of men (P = .04). No individual exclusion criterion or categories excluded women more frequently than men. Screened and enrolled individuals had a lower proportion of women and younger age than a representative stroke population (P < .001).

CONCLUSIONS

We identified exclusion criteria (ie, headaches, cognitive scores, and age) that are modifiable barriers to enrollment of women in this post-stroke neuromodulation study. Addressing underrepresentation of women in stroke research is pivotal for enhancing generalizability, achieving statistical power, and optimizing resources.

The role of cranial magnetic resonance imaging findings in pediatric epilepsy: A single-center experience

OBJECTIVE

The aim of this study was to investigate cranial magnetic resonance imaging (MRI) findings in different age groups and genders in pediatric epilepsy, to determine the percentages of etiologic factors, and to evaluate the association between MRI positivity and treatment resistance.

METHODS

Cranial MRIs of 359 patients with epilepsy aged 1 month to 18 years were retrospectively evaluated. Etiologic factors as an underlying cause of epilepsy were classified as previous parenchymal damage, hippocampal sclerosis, malformations of cortical development, tumor, neurocutaneous syndrome, myelination disorder, vascular anomaly, metabolic/genetic/neurodegenerative diseases, encephalitis, and an uncategorized "other" group. Data were transferred to IBM SPSS Statistics 25.0 (SPSS Inc., Chicago, IL, USA), and descriptive statistics, correlation analyses, chi-square, and t-tests were performed.

RESULTS

Among the patients included in the study, 141 (39.3%) had pathological findings on MRI related to the etiology. Previous parenchymal damage (39.7%) was the most common etiologic cause in all age groups. Regarding the relationship between drug resistance and MRI positivity, MRI positivity was observed in 72% of drug-resistant cases, while a complete response to therapy was found in 67.6% of MRI-negative cases.

CONCLUSION

MRI guides clinicians to determine the presence of an etiologic factor as the underlying cause of childhood epilepsy before treatment planning. MRI positivity is a remarkable indicator of response to antiseizure drug treatment and drug resistance.

The burden of epilepsy in the People's Republic of China from 1990 to 2019: epidemiological trends and comparison with the global burden of epilepsy

Background

Epilepsy is associated with a significant global burden of disease, affecting over 50 million people worldwide. The specific aim of this study is to compare the burden of epilepsy in the People's Republic of China (PRC) with the global burden, and to analyze the epidemiological trends of epilepsy, the relationship between the burden of epilepsy and social demographic index (SDI), and the relative contributions of epidemiological factors.

Methods

This is a retrospective population-based study, data were obtained from the Global Burden of Disease (GBD) study in 2019. We employed Joinpoint software and the age-period-cohort (APC) model to analyze epilepsy's epidemiological trends. Health inequality analysis was conducted to investigate the impact of SDI on epilepsy burden. Decomposition analysis was performed to examine the relative contributions of age, population, and epidemiological changes to epilepsy.

Results

Between 1990 and 2019, the incidence rate in the PRC increased by 45%, significantly surpassing the global incidence of epilepsy. However, Disability-Adjusted Life Years (DALY) decreased notably, and the proportion of Years of Life Lost (YLL) decreased from 62.73 to 39.03%. Concerning incidence, the period Rate Ratio (RR) in the PRC initially increased and then decreased, while the cohort RR in the PRC and globally exhibited a consistent upward trend. In terms of mortality, period RR and cohort RR in the PRC displayed a gradual decrease, with mortality starting higher but eventually falling below the global mortality. The net drifts of incidence were greater than 0, whereas the net drifts of mortality were less than 0, both were lower in the PRC than at the global level. Decomposition analysis indicated that the changes of incidence and mortality in the PRC were mainly attributed to epidemiological changes. Additionally, global disparities in epilepsy decreased, with the burden concentrating in low SDI countries.

Conclusion

The incidence of epilepsy in the PRC rose during the 30-year study period, while epilepsy mortality decreased. The improved survival rate in the PRC is predominantly attributable to epidemiological changes. The burden of epilepsy in the PRC predominantly affects males, children, and the elderly, Chinese government should focus on specific populations.

Inequities in Epilepsy: A Scoping Review

Objectives

The objective of this study was to complete a scoping review of current literature surrounding health inequities in epilepsy while providing recommendations for future research.

Methods

During July 2022, we searched MEDLINE and Ovid Embase to find published articles pertaining to epilepsy and health inequities. Initially, authors received training. Authors then screened, and data were extracted in a masked duplicate manner. Studies published within the time frame of 2011-2021 in all countries were deemed appropriate. We screened 5,325 studies for titles and abstracts and then 56 studies for full text. We evaluated the inequities of race/ethnicity, sex or gender, income, occupation status, education level, under-resourced/rural population, and LGBTQ+. To summarize the data and descriptive statistics of our study, we used Stata 17.0 (StataCorp, LLC, College Station, TX).

Results

We obtained a sample size of 45 studies for study inclusion. The most reported health inequities were income (18/45, 40.0%), under-resourced/rural population (15/45, 33.3%), and race/ethnicity (15/45, 33.3%). The least reported health inequity was LGBTQ+ (0/45, 0.0%).

Discussion

The findings of our study suggest that gaps exist in literature concerning epilepsy and inequities. The inequities of income status, under-resourced/rural population, and race/ethnicity were examined the most, while LGBTQ+, occupation status, and sex or gender were examined the least. With the ultimate goal of more equitable and patient-centered care in mind, it is vital that future studies endeavor to fill in these determined gaps.

Alterations in salivary biochemical composition and redox state disruption induced by the anticonvulsant valproic acid in male rat salivary glands

OBJECTIVE

To investigate the effects of the anticonvulsant valproic acid (VPA) on salivary glands in male rat using biochemical, functional, histomorphometric, and redox state parameters.

MATERIALS AND METHODS

Twenty-four male Wistar rats were randomly distributed into three groups (n = 8 per group): Control (0.9% saline solution), VPA100 (100 mg/kg), and VPA400 (400 mg/kg). After 21 consecutive days of treatment with by intragastric gavage. Pilocarpine-induced saliva was collected to determine salivary flow rate, pH, buffering capacity, and biochemical composition. Analyses of histomorphometric parameters and redox balance markers were performed on the parotid and submandibular glands.

RESULTS

Salivary flow rate, pH, buffering capacity, total protein, potassium, sodium, and chloride were similar between groups. However, phosphate and calcium were reduced in VPA400, while amylase was increased in both VPA100 and VPA400. We did not detect significant differences in the areas of acini, ducts, and connective tissue in the salivary glands between the groups. There were no significant changes in the redox status of the submandibular glands. In turn, in the parotid glands we detected reduced total oxidizing capacity and lipid peroxidation, measured as thiobarbituric acid reactive substances (TBARs) and higher uric acid concentration in both the VPA100 and VPA400 groups, and increased superoxide dismutase (SOD) in the VPA400 group.

CONCLUSION

Chronic treatment with VPA modified the salivary biochemical composition and caused disruption in the redox state of the parotid gland in rats.

Ceftriaxone and selenium mitigate seizures and neuronal injury in pentylenetetrazole-kindled rats: Oxidative stress and inflammatory pathway

Epilepsy is one of the most serious worldwide neurological disorders that lead to the cognitive-psychosocial insults in recurrent seizures. About one third of the patients are drug-resistant, so innovative drugs are needed to manage seizures to improve the quality of life. Ceftriaxone is a cephalosporin antibiotic that increases the expression of glutamate transporters-1 and improves the neurobehavioral effects caused by increased glutamate level in the CNS. Selenium is well known antioxidant. The present study aimed to investigate ceftriaxone and selenium therapeutic effects against epilepsy in rats. Epilepsy was induced by PTZ given at a dose (50 mg/kg I.P) on alternative days for 13 days. Eighty rats were randomly divided into 8 groups: Group1-2; normal and vehicle control, Group 3; PTZ group, Group 4-8; kindled rats received selenium, ceftriaxone100, ceftriaxone200, selenium + ceftriaxone100 and selenium + ceftriaxone200 mg/kg/day respectively for a week. At the end of the study, behavioral tests were performed. Oxidative stress, inflammatory markers, neurotransmitters and GLT-1 were measured in brain tissue homogenate. Brain histopathological investigation was also done. PTZ-kindled rats exhibited increased Racine score, besides behavioral tests and histopathological changes, significant elevation in oxidative stress and inflammatory markers, with decrease in serotonin, dopamine, GABA levels and GLT-1 expressions. Selenium and Ceftriaxone alone or combined treatment decreased Racine score with remarkable improvement in behavioral and histopathological changes. The antioxidant enzymes, neurotransmitters and GLT-1 expressions were increased, along with reduced TNF-α, IL-1 levels. Current study showed that selenium + ceftriaxone100 group represents a possible approach to improve epilepsy particularly through inhibiting oxidative stress and inflammation.

Gender and socioeconomic disparities in global burden of chronic kidney disease due to glomerulonephritis: A global analysis

AIM

To investigate the gender and socioeconomic disparities in the global burden of chronic kidney disease (CKD) due to glomerulonephritis from 1990 to 2019.

METHODS

Data were extracted from the global burden of diseases (GBD) 2019 study, including incidence, prevalence and disability-adjusted life-years (DALYs). Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in age-standardized rate (ASR) of CKD due to glomerulonephritis. Paired t-test, paired Wilcoxon signed-rank test and Spearman correlation were performed to analyse the association and gender disparity in CKD due to glomerulonephritis.

RESULTS

Globally, incident cases of CKD due to glomerulonephritis increased 81% from 9 557 397 in 1990 to 17 308 071 in 2019. The age-standardized incidence rate increased by 1.47 compared with 1990 and DALYs increased by 1.35 compared with 1990 (per 100 000). The number of patients with CKD due to glomerulonephritis in low-middle SDI (3829917) and middle SDI (6268817) regions accounts for more than 55% of the total cases. CKD due to glomerulonephritis caused a higher burden including the incidence rate (p < .0001) and DALY rate (p < .0001) in men compared to women. The age-standardized DALY rate was negatively correlated with SDI (ρ = -0.64, p < .001). In the analysis of risk factors for DALYs, male individuals had a larger burden of hypertension, high BMI and high sodium diet in the DALY rates than female subjects.

CONCLUSION

The burden of CKD due to glomerulonephritis was more skewed towards developing and less developed economies and differed by gender, so certain nations should implement far more focused and targeted policies.

Turkish validity and reliability study of disease-related fear scale in patients with epilepsy

OBJECTIVE

This study was conducted to examine the validity and reliability of the Turkish disease-related fear scale (D-RFS) for adult patients with epilepsy.

METHODS

This methodological study was conducted with 154 patients with epilepsy who were referred to the neurology clinic and outpatient clinic of Firat University Hospital between December 2021 and March 2022. Content and construct validity were evaluated after the scale was translated into Turkish. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted for construct validity. Item analyses and internal consistency analyses were conducted for reliability. Convergent validity was also evaluated.

RESULTS

As a result of the evaluations and analyses, the content validity index of the scale was found to be 0.97. Exploratory factor analysis showed that the value of total variance explained by two factors was 74.77%. Factor loading of all items was found to be between 0.60 and 0.93. Cronbach's alpha values of the factors were found to be 0.97, while the total Cronbach's alpha value was found to be 0.95. As a result of the EFA and CFA, the 27-item, 2-factor disease-related fear scale was confirmed without changes to the original form of the scale. Good fit index values were obtained as a result of CFA.

CONCLUSION

The Turkish version of the disease-related fear scale for adult patients with epilepsy is a valid and reliable measurement tool to evaluate the disease-related fear of adult patients with epilepsy and to use in clinical practice.

Role of Neurogenesis and Oxidative Stress in Epilepsy (Study on Plasma Brain Derived Neurotrophic Factor and Malondialdehyde Level)

BACKGROUND: Epilepsy is a neurological disorder. Its incidence in Indonesia was 700,000–1,400,000 cases and 40–50% occurred in children. About 30–40% of cases in children had uncontrolled seizures. Biomarkers are needed to assess the prognostic value of patients with uncontrolled epilepsy. Malondialdehyde (MDA) and brain-derived neurotrophic factor (BDNF) are one of the prognostic biomarkers related to uncontrolled epilepsy to see the effect of oxidative stress and neuroplasticity. AIM: The objective of the study was to examine cut off value of plasma BDNF and MDA level; and to compare plasma BDNF and MDA levels in uncontrolled and controlled epilepsy patients. METHODS: The research usedanalytic observational with cross-sectional approach. Number of respondents was 30 patients of epilepsy who came to Ulin Hospital Banjarmasin. Respondents were divided into two groups (controlled and uncontrolled epilepsy). Blood plasma was examined for MDA with a spectrophotometer and BDNF with ELISA. Data were analyzed by t-test with 95% confidence level. RESULTS: 11 children were found in the uncontrolled epilepsy group and 19 children with controlled epilepsy. The result showed that there were significant differences between type of therapy and developmental disorders/other diseases with epilepsy status. There was no significant differences of plasma BDNF in epilepsy status (controlled and uncontrolled epilepsy), and there was also no significant differences of plasma MDA in epilepsy status (controlled and uncontrolled epilepsy). CONCLUSION: There were no significant differences of plasma BDNF and MDA in epilepsy status.

The Global Burden of Appendicitis in 204 Countries and Territories from 1990 to 2019

OBJECTIVE

Appendicitis is a common surgical emergency. This study aimed to estimate the worldwide burden and trends of appendicitis from 1990 to 2019.

METHODS

Data on appendicitis were derived from the Global Burden of Disease 2019. Incidence and disability-adjusted life-years (DALYs) data were analyzed at global, regional, and national levels and stratified by sex, age, and socio-demographic index. The estimated annual percentage change and relative change were used to assess changing trends. Pearson's correlation test was used to assess the correlation between different measures.

RESULTS

Global incidence grew by 63.55% between 1990 and 2019, age-standardized incidence rate climbed by an estimated percentage change of 0.58 per year, whereas the number of DALY declined by 31.93% during the same period, with an estimated annual percentage change of -2.77. In 2019, the areas of Andean Latin America and the Caribbean had the highest age-standardized rates of incidence and DALYs. While South Asia saw the largest increase in age-standardized incidence rates, Andean Latin America saw the biggest decline in age-standardized rates of incidence and DALYs. At the national level, Bangladesh, Bhutan, and Peru were the top three countries in terms of age-standardized incidence rates in 2019, and Honduras, Haiti, and the Central African Republic held the highest age-standardized DALY rates. Ethiopia experienced the most age-standardized incidence rate increase, and Peru saw the largest decline in age-standardized rate of incidence and DALYs. Significant negative correlations between age-standardized DALY rates and socio-demographic index, between estimated annual percentage change and age-standardized incidence rates, were observed at the national level.

CONCLUSION

Appendicitis remains a major global health concern. Although the trends in DALYs decreased, the burden of incidence increased from 1990 to 2019. Policymakers should create health policies adapted to local conditions to manage the burden of appendicitis globally.

Targeting NMDA Receptors at the Neurovascular Unit: Past and Future Treatments for Central Nervous System Diseases

The excitatory neurotransmission of the central nervous system (CNS) mainly involves glutamate and its receptors, especially N-methyl-D-Aspartate receptors (NMDARs). These receptors have been extensively described on neurons and, more recently, also on other cell types. Nowadays, the study of their differential expression and function is taking a growing place in preclinical and clinical research. The diversity of NMDAR subtypes and their signaling pathways give rise to pleiotropic functions such as brain development, neuronal plasticity, maturation along with excitotoxicity, blood-brain barrier integrity, and inflammation. NMDARs have thus emerged as key targets for the treatment of neurological disorders. By their large extracellular regions and complex intracellular structures, NMDARs are modulated by a variety of endogenous and pharmacological compounds. Here, we will present an overview of NMDAR functions on neurons and other important cell types involved in the pathophysiology of neurodegenerative, neurovascular, mental, autoimmune, and neurodevelopmental diseases. We will then discuss past and future development of NMDAR targeting drugs, including innovative and promising new approaches.

Medical Admissions in a Rural Teaching Hospital in Southern Nigeria: A Retrospective Review

Background

Hospital-based morbidity and mortality records reflect the health status of host communities. This helps policymakers and industry actors plan and allocate resources for health services, research, training, and development. This study aimed to determine the pattern and outcome of medical admissions in a Nigerian teaching hospital.

Methodology

This was a three-year retrospective review from 2019 to 2021.Data on morbidity and mortality were extracted from ward registers. The relevant data was analysed using the IBM SPSS software. Tests were considered significant at p values of less than 0.05.

Results

A total of 2544 patients were admitted during the study period. There were 1420 females (55.8%) and 1124 males (44.2%), and the majority (36.9%) of patients were middle-aged. The mean age was 53.81 ± 18.81 years, and the mean duration of hospital stay was 9.07 ± 8.41 days, with 97.2% of the patients spending less than 30 days on admission. Non-communicable diseases (70.6%) were the most common causes of admissions. The top disease-specific causes of admissions were diabetes mellitus with its complications (14.9%), renal failure (11.8%), heart failure (9.2%), hypertension and its emergencies (9.2%), stroke (7.8%) and tuberculosis (7.0%). Cardiology (15.5%), endocrinology (15.1%), nephrology (15.0%), pulmonology (14.8%), and neurology (13.3%) accounted for the majority (86.4%) of the admissions. The major causes of death were renal failure (16.2%), stroke (15.8%), diabetes mellitus and its complications (12.5%) and HIV/AIDS (8.7%). The majority (86.7%) of patients were discharged, 10.4% died, 2.2% were discharged against medical advice, and 0.7% were referred.

Conclusion

The study found an increased burden of non-communicable diseases relative to communicable diseases. Effective health education and promotion initiatives must be implemented to combat the impact of the increasing prevalence of these diseases.

Third-wave psychotherapies to promote mental health in epilepsy: An updated systematic review

PURPOSE/OBJECTIVE

Research on third-wave cognitive behavioral therapies has burgeoned over the last ten years. However, questions remain about the effectiveness of these therapies for people with epilepsy. This article provides an up-to-date review of the current evidence-base.

METHODS

Following protocol registration (PROSPERO CRD42021269882), two reviewers searched six databases (from inception until 1 March 2022) for mindfulness and acceptance interventions targeted at mental health in adults with epilepsy. The reporting quality of included studies was rated (QualSyst tool) and standardized mean group differences (Hedges' g) with 95% confidence intervals and p values calculated. Results were narratively synthesized based on therapy characteristics and mental health outcome.

RESULTS

Eleven randomized controlled trials, involving 941 adults with chronic epilepsy, were included. All studies were of sound methodological quality. Third-wave therapies were typically delivered in a group format although varied in their face-to-face, telephone, and online learning options. Programs evaluating Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, or elements of both, outperformed wait-listed controls or usual care, although individual variability in treatment response was evident (g_range = -0.11-2.28).

CONCLUSIONS

Acceptance techniques and mindfulness practice may bring mental health benefits for some people living with epilepsy, but do not have consistent results for everyone. Patient diversity and preferences need to be factored into effective third-wave approaches for this cohort.

Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany

OBJECTIVE

Epilepsy is a chronic condition that can affect patients of all ages. Women with epilepsy (WWE) require access to specific counseling and information regarding issues related to contraception, pregnancy, and hormonal effects on seizure control and bone mineral density. This study investigated the knowledge among WWE regarding their condition, and whether epilepsy-specific knowledge has improved over the last 15 years.

METHODS

A total of 280 WWE aged 18 to 82 years participated in this multicenter, questionnaire-based study. The study was conducted at four epilepsy centers in Germany, between October 2020 and December 2020. Sociodemographic and epilepsy-specific data for participating women were analyzed and compared with the results of a similar survey performed in 2003-2005 among 365 WWE in Germany.

RESULTS

The questionnaire-based survey revealed considerable knowledge deficits without significant improvements over the last 15 years, particularly among those with less education and with regards to information on the more pronounced effects of epilepsy in older WWE (>50 years), including interactions with menopause and osteoporosis. In WWE ≤29 years, a significant increase in the knowledge score was observed in 2020 compared with this age group in 2005 (mean 7.42 vs. 6.5, p = .036). Mothers frequently reported epilepsy-related concerns regarding childrearing, particularly of seizures scaring their child and the need to rely on other people.

CONCLUSION

WWE continue to demonstrate inadequate epilepsy-related knowledge. Despite increasing information availability and the aspiration toward better awareness among medical professionals, overall knowledge has not increased sufficiently compared with the levels observed in recent studies.

Considering social determinants of health in the relationship between physical activity and exercise engagement and cognitive impairment among persons with epilepsy

Many persons with epilepsy (PWE) are not as active or physically fit as compared to the general population. This lack of engagement in physical activity has been attributed to a number of factors, few of which take into consideration the social determinants of health (SDH). In this perspective, we highlight how SDH are considered in explaining lower levels of physical activity engagement among PWE, particularly for those experiencing cognitive impairment. We also discuss how these data can be applied in research to yield a greater impact on the quality of life among PWE. Consideration of SDH allows for increased understanding of how cognition can be both a determinant of physical activity and an outcome of environments conducive to physical activity in PWE.

Seizure medication and planned pregnancy: balancing the risks and outcomes

INTRODUCTION

The therapeutic management of women with epilepsy (WWE) of childbearing age can be complicated by the need to balance maternal/fetal risks related to seizure occurrence during gestation with the potential teratogenic risks related to the use of anti-seizure medications (ASMs).

AREAS COVERED

The authors review clinical evidence on seizure-related and ASM-related risks during pregnancy. Current regulatory indications are discussed, evaluating their impact on clinical practice, and ethical implications of pharmacological decisions are debated.

EXPERT OPINION

If properly informed about the maternal/fetal risks carried by different pharmacological choices, WWE can become the final decision makers regarding their care in every phase of their life. Over the coming years, analysis of aggregated pregnancy registry data on the structural impact, on the fetus, of low doses of valproate and of newer ASMs, together with analysis of the main population study data on functional (cognitive and behavioral) outcomes, could lead to huge advances, making choosing an ASM a less complex process for the clinician and a less painful decision for the woman. Future objectives should include identification of the potential role of the pharmacogenomic profile of WWE in determining the risk of fetal malformations.

Language is brain: Improving neurologic health equity for linguistically diverse populations

Neurologic clinical care requires that clinicians gather and synthesize complex information, including a thorough, precise history and a detailed physical examination that maximizes the patient's cooperation. Yet, for patients who do not speak the dominant language in the country or region where they live, effective communication with their clinician may not always occur. In this article, we discuss the impact of language on neurologic care, focusing on access to care and on the diagnosis and treatment of two common and potentially life-threatening conditions: stroke and epilepsy. We then review implications for clinical neurologic care as well as medical education and present evidence-based recommendations for improving neurologic health equity for linguistically diverse populations. Strategies should integrate professional medical interpreters (for oral communication) and translators (for written materials) into the neurologic team, account for families and caregivers in a culturally humble manner, and teach learners to apply clinical neurologic skills in both language-concordant and discordant situations.

Gender differences in concerns about planning to have children and child-rearing among patients with epilepsy: A prospective, multicenter study with 477 patients from Germany

OBJECTIVE

To analyze the concerns and worries about planning to have children and being a parent as a person with epilepsy and investigate gender differences in these perceptions.

METHODS

The Epi2020 study was a large multicenter study focusing on different healthcare aspects of adult patients with epilepsy in Germany. In addition to basic clinical and demographic characteristics, patients were asked to answer a questionnaire regarding their plan to have children, if they had children, and concerns about their children's health. Data were analyzed to detect differences between men and women with epilepsy according to age group.

RESULTS

In total, 477 patients with epilepsy with a mean age of 40.5 years (SD = 15.5, range: 18-83 years) participated in this study; 280 (58.7%) were female and 197 (41.3%) were male. Both women and men frequently reported concerns and worries about having children: In the age group below 45 years of age, 72.5% of women and 58.2% of men described being worried to some extent that their children may also suffer from epilepsy (p = .006). Furthermore, 67.3% of women and 54.2% of men below the age of 45 years reported being worried that their children may be disabled (p = .003). Women were more likely to have family members who are reluctant to support their desire to have children (p = .048).

CONCLUSION

Women with epilepsy of childbearing age are significantly more likely to report major concerns that their children might be disabled or also have epilepsy than men with epilepsy and, therefore, express more concerns about choosing to have a child. However, men also report frequent concerns and worries, and this should be addressed not only on request but should be included in the provision of general information on epilepsy.

Socioeconomic disparities in epilepsy care

PURPOSE OF REVIEW

Epilepsy is a common, chronic neurologic disease with continued disparities in care. The COVID-19 pandemic and recent social movements have drawn greater attention to social determinants of health and our progress (or lack thereof) toward delivering more equitable care.

RECENT FINDINGS

Recent studies continue to document racial and economic disparities in diagnosis, treatment, and overall care of epilepsy and associated conditions. Notably, an increasing number of studies are attempting to design healthcare pathways and other interventions to improve access and equity in epilepsy care.

SUMMARY

The present literature highlights the importance of identifying and addressing the particular needs of vulnerable persons with epilepsy. Practitioners and researchers should continue to develop interventions aimed at improving care for all patients and, crucially, measure the impact of their changes to ensure that any interventions are truly advancing health equity.

Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990 - 2019

Background

The epilepsy prevalence in Latin America and the Caribbean (LAC) had remained high over the last 20 years. Data on the burden of epilepsy are needed for healthcare planning and resource allocation. However, no systematic analysis had been performed for epilepsy burden in LAC.

Methods

We extracted data of all LAC countries from the Global Burden of Disease (GBD) study from 1990 to 2019. Epilepsy burden was measured as prevalence, mortality, and disability-adjusted life-years (DALYs; defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability [YLDs]), by age, sex, year, and country. Absolute numbers, rates, and 95% uncertainty intervals were reported. We performed correlational analyses among burden metrics and Socio-demographic Index (SDI).

Findings

The burden of epilepsy decreased around 20% in LAC, led by YLLs reduction. In 2019, 6·3 million people were living with active epilepsy of all causes (95% UI 5·3 - 7·4), with 3·22 million (95% UI 2·21 - 4·03) and 3·11 million (95% UI 2·21 to 4·03) cases of epilepsy with identifiable aetiology and idiopathic epilepsy, respectively. The number of DALYs represented the 9·51% (1.37 million, 95% UI 0·99 -1·86) of the global epilepsy burden in 2019. The age-standardized burden was 175·9 per 100 000 population (95% UI 119·4 - 253·3), which tend to have a bimodal age distribution (higher in the youth and elderly) and was driven by high YLDs estimates. The burden was higher in men and older adults, primarily due to high YLLs and mortality. Alcohol use was associated with 17% of the reported DALYs. The SDI estimates significantly influenced this burden (countries with high SDI have less epilepsy burden and mortality, but not prevalence or disability).

Interpretation

The epilepsy burden has decreased in LAC over the past 30 years. Even though, LAC is still ranked as the third region with the highest global epilepsy burden. This reduction was higher in children, but burden and mortality increased for older adults. The epilepsy burden is disability predominant; however, the mortality-related estimates are still higher than in other regions. Alcohol consumption and countries' development are important determinants of this burden. There is an urgent need to improve access to epilepsy care in LAC, particularly for older adults. Strengthening primary care with online learning and telemedicine tools, and promoting risk factors modification should be prioritized in the region.

Funding

This research was self-funded by the authors.