1
|
Anaje OD, Nwani PO, Nwosu MC, Asomugha LA, Anaje CC, Amaechi IA, Ebeogu OG, Oriji SO, Ndukwe CC, Eze LI, Morah NJ, Omaga IC, Ogunniyi A. Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria. Ann Afr Med 2024; 23:628-634. [PMID: 39138960 DOI: 10.4103/aam.aam_39_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024] Open
Abstract
CONTEXT Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. AIMS The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. SETTINGS AND DESIGN This was a cross-sectional descriptive study in a Southeast Nigeria local government area. SUBJECTS AND METHODS PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. STATISTICAL ANALYSIS USED The Statistical Package for the Social Sciences version 22.0 was used. RESULTS There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. CONCLUSIONS Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.
Collapse
Affiliation(s)
- Obiora Daniel Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Paul Osemeke Nwani
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Maduaburochukwu Cosmas Nwosu
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Lasbrey Azuoma Asomugha
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
- Department of Internal Medicine, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chetanna Chioma Anaje
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ifeoma Adaigwe Amaechi
- Department of Medical Rehabilitation, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | | | - Sunday Onyemaechi Oriji
- Department of Psychiatry, Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Chinwe Chioma Ndukwe
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Linda Ifunanya Eze
- Department of Internal Medicine, Neurology Unit, Enugu State University of Science and Technology Teaching Hospital Parklane, Enugu, Nigeria
| | | | - Imelda Chinenye Omaga
- Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Adesola Ogunniyi
- Department of Internal Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
2
|
Georgis-Yap Z, Popovic MR, Khan SS. Supervised and Unsupervised Deep Learning Approaches for EEG Seizure Prediction. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2024; 8:286-312. [PMID: 38681760 PMCID: PMC11052752 DOI: 10.1007/s41666-024-00160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 05/01/2024]
Abstract
Epilepsy affects more than 50 million people worldwide, making it one of the world's most prevalent neurological diseases. The main symptom of epilepsy is seizures, which occur abruptly and can cause serious injury or death. The ability to predict the occurrence of an epileptic seizure could alleviate many risks and stresses people with epilepsy face. We formulate the problem of detecting preictal (or pre-seizure) with reference to normal EEG as a precursor to incoming seizure. To this end, we developed several supervised deep learning approaches model to identify preictal EEG from normal EEG. We further develop novel unsupervised deep learning approaches to train the models on only normal EEG, and detecting pre-seizure EEG as an anomalous event. These deep learning models were trained and evaluated on two large EEG seizure datasets in a person-specific manner. We found that both supervised and unsupervised approaches are feasible; however, their performance varies depending on the patient, approach and architecture. This new line of research has the potential to develop therapeutic interventions and save human lives.
Collapse
Affiliation(s)
- Zakary Georgis-Yap
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| | - Milos R. Popovic
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| | - Shehroz S. Khan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, 550, University Avenue, Toronto, M5G 2A2 Ontario Canada
- Institute of Biomedical Engineering, University of Toronto, 64 College St., Toronto, M5S 3G9 Ontario Canada
| |
Collapse
|
3
|
Cucchi D, Walter SG, Baumgartner T, Menon A, Egger L, Randelli PS, Surges R, Wirtz DC, Friedrich MJ. Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations. J Shoulder Elbow Surg 2024; 33:1340-1351. [PMID: 37879597 DOI: 10.1016/j.jse.2023.09.023] [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: 04/28/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. METHODS Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. RESULTS A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. CONCLUSIONS Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.
Collapse
Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
| | - Sebastian Gottfried Walter
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany; Department of Orthopaedics, Trauma Surgery and Plastic-Reconstructive Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Scuola di Specializzazione in Statistica Sanitaria e Biometria, Università degli Studi di Milano, Milan, Italy
| | - Lisa Egger
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Pietro Simone Randelli
- U.O.C. 1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Milan, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | - Rainer Surges
- Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universita degli Studi di Milano, Milan, Italy
| | | | - Max Julian Friedrich
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| |
Collapse
|
4
|
Piwowarczyk S, Obłój P, Janicki Ł, Kowalik K, Łukaszuk A, Siemiński M. Seizure-Related Head Injuries: A Narrative Review. Brain Sci 2024; 14:473. [PMID: 38790452 PMCID: PMC11118010 DOI: 10.3390/brainsci14050473] [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: 04/10/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Epilepsy is one of the most common neurological diseases. Epileptic seizures very often result in head injuries that may lead to many adverse consequences, both acute and chronic. They contribute to the need for hospitalization, modification of treatment, and a general decline in social productivity. The objective of our review is to characterize and assess management aspects of seizure-related head injuries (SRHIs) as an important and frequent clinical problem present in emergency department settings. PubMed and other relevant databases and websites were systematically searched for articles on traumatic brain injuries connected with the occurrence of seizures published from inception to 9 April 2024; then, we reviewed the available literature. Our review showed that SRHIs can lead to various acute complications, in some cases requiring hospitalization and neurosurgical intervention. Long-term complications and cognitive decline after injury might be present, eventually implying a negative impact on a patient's quality of life. Despite being frequent and clinically important, there are still no widely accepted, uniform recommendations for the management of patients with SRHIs. As such, a concise and standardized protocol for the management of seizure-related head injuries in emergency departments is worth consideration.
Collapse
Affiliation(s)
- Sebastian Piwowarczyk
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Paweł Obłój
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Łukasz Janicki
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Kornelia Kowalik
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Adam Łukaszuk
- Edinburgh Medical School, College of Medicine And Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Mariusz Siemiński
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| |
Collapse
|
5
|
Seth EA, Watterson J, Xie J, Arulsamy A, Md Yusof HH, Ngadimon IW, Khoo CS, Kadirvelu A, Shaikh MF. Feasibility of cardiac-based seizure detection and prediction: A systematic review of non-invasive wearable sensor-based studies. Epilepsia Open 2024; 9:41-59. [PMID: 37881157 PMCID: PMC10839362 DOI: 10.1002/epi4.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
A reliable seizure detection or prediction device can potentially reduce the morbidity and mortality associated with epileptic seizures. Previous findings indicating alterations in cardiac activity during seizures suggest the usefulness of cardiac parameters for seizure detection or prediction. This study aims to examine available studies on seizure detection and prediction based on cardiac parameters using non-invasive wearable devices. The Embase, PubMed, and Scopus databases were used to systematically search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Human studies that evaluated seizure detection or prediction based on cardiac parameters collected using wearable devices were included. The QUADAS-2 tool and proposed standards for validation for seizure detection devices were used for quality assessment. Twenty-four articles were identified and included in the analysis. Twenty studies evaluated seizure detection algorithms, and four studies focused on seizure prediction. Most studies used either a wrist-worn or chest-worn device for data acquisition. Among the seizure detection studies, cardiac parameters utilized for the algorithms mainly included heart rate (HR) (n = 11) or a combination of HR and heart rate variability (HRV) (n = 6). HR-based seizure detection studies collectively reported a sensitivity range of 56%-100% and a false alarm rate (FAR) of 0.02-8/h, with most studies performing retrospective validation of the algorithms. Three of the seizure prediction studies retrospectively validated multimodal algorithms, combining cardiac features with other physiological signals. Only one study prospectively validated their seizure prediction algorithm using HRV extracted from ECG data collected from a custom wearable device. These studies have demonstrated the feasibility of using cardiac parameters for seizure detection and prediction with wearable devices, with varying algorithmic performance. Many studies are in the proof-of-principle stage, and evidence for real-time detection or prediction is currently limited. Future studies should prioritize further refinement of the algorithm performance with prospective validation using large-scale longitudinal data. PLAIN LANGUAGE SUMMARY: This systematic review highlights the potential use of wearable devices, like wristbands, for detecting and predicting seizures via the measurement of heart activity. By reviewing 24 articles, it was found that most studies focused on using heart rate and changes in heart rate for seizure detection. There was a lack of studies looking at seizure prediction. The results were promising but most studies were not conducted in real-time. Therefore, more real-time studies are needed to verify the usage of heart activity-related wearable devices to detect seizures and even predict them, which will be beneficial to people with epilepsy.
Collapse
Affiliation(s)
- Eryse Amira Seth
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Jessica Watterson
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Jue Xie
- Department of Human‐Centred ComputingMonash UniversityMelbourneVictoriaAustralia
| | - Alina Arulsamy
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Hadri Hadi Md Yusof
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Irma Wati Ngadimon
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Ching Soong Khoo
- Neurology Unit, Department of MedicineUniversiti Kebangsaan Malaysia Medical CentreKuala LumpurMalaysia
| | - Amudha Kadirvelu
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
| | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
- School of Dentistry and Medical SciencesCharles Sturt UniversityOrangeNew South WalesAustralia
| |
Collapse
|
6
|
Čellár R, Sokol D. [Bilateral Dorsal Fracture-Dislocation of the Proximal Humerus]. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:123-126. [PMID: 38801669 DOI: 10.55095/achot2024/014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Fractures of the proximal humerus constitute approximately 5% of all fractures. Shoulder joint injuries without any external mechanical impact during seizures with the occurrence of spasms occur only sporadically. The occurrence rate is reported in approximately 0.4% of patients. Very rarely they occur in the form of epileptic seizure-induced dorsal fracturedislocation impacting both sides. The case report describes a case of a 48-year-old woman with no treatment for epileptic seizures in her medical history. During the first seizure she sustained a bilateral dorsal fracture-dislocation caused by a muscle spasm, without any other mechanical impact. The fractures were classified as a 3-fragment fracture on the right side and a 4-fragment fracture on the left side. After the patient's admission to the inpatient emergency department, reduction under anaesthesia was attempted. Subsequently, after preparation, open reduction and osteosynthesis using an angularly stable plate were performed as a two-stage surgery. No complications were observed postoperatively Currently, at 3 years after surgeries, the female patient has full mobility of her shoulder joints with no subjective difficulties. Key words: epilepsy, seizure, dorsal fracture-dislocation of the proximal humerus.
Collapse
Affiliation(s)
- R Čellár
- Klinika ortopédie a traumatológie pohybového ústrojenstva, Lekárskej fakulty Univerzity Pavla Jozefa Šafárika a Univerzitnej nemocnice L. Pasteura, Košice
| | - D Sokol
- Klinika ortopédie a traumatológie pohybového ústrojenstva, Lekárskej fakulty Univerzity Pavla Jozefa Šafárika a Univerzitnej nemocnice L. Pasteura, Košice
| |
Collapse
|
7
|
Rajamaki B, Braithwaite B, Hartikainen S, Tolppanen AM. Identifying Comorbidity Patterns in People with and without Alzheimer's Disease Using Latent Dirichlet Allocation. J Alzheimers Dis 2024; 101:1393-1403. [PMID: 39302369 DOI: 10.3233/jad-240490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Multimorbidity is common in older adults and complicates diagnosing and care for this population. Objective We investigated co-occurrence patterns (clustering) of medical conditions in persons with Alzheimer's disease (AD) and their matched controls. Methods The register-based Medication use and Alzheimer's disease study (MEDALZ) includes 70,718 community-dwelling persons with incident AD diagnosed during 2005-2011 in Finland and a matched comparison cohort. Latent Dirichlet Allocation was used to cluster the comorbidities (ICD-10 diagnosis codes). Modeling was performed separately for AD and control cohorts. We experimented with different numbers of clusters (also known as topics in the field of Natural Language Processing) ranging from five to 20. Results In both cohorts, 17 of the 20 most frequent diagnoses were the same. Based on a qualitative assessment by medical experts, the cluster patterns were not affected by the number of clusters, but the best interpretability was observed in the 10-cluster model. Quantitative assessment of the optimal number of clusters by log-likelihood estimate did not imply a specific optimal number of clusters. Multidimensional scaling visualized the variability in cluster size and (dis)similarity between the clusters with more overlapping of clusters and variation in group size seen in the AD cohort. Conclusions Early signs and symptoms of AD were more commonly clustered together in the AD cohort than in the comparison cohort. This study experimented with using natural language processing techniques for clustering patterns from an epidemiological study. From the computed clusters, it was possible to qualitatively identify multimorbidity that differentiates AD cases and controls.
Collapse
Affiliation(s)
- Blair Rajamaki
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | | | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
8
|
Nasir M, Abebaw E, Ahmed M, Ketema DB. Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia. Pediatric Health Med Ther 2023; 14:385-404. [PMID: 37927397 PMCID: PMC10625381 DOI: 10.2147/phmt.s436022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.
Collapse
Affiliation(s)
- Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Ermias Abebaw
- Pediatrics Department, ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | | |
Collapse
|
9
|
Cucchi D, Baumgartner T, Walter SG, Menon A, Ossendorff R, Surges R, Burger C, Wirtz DC, Friedrich MJ. Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures. Arch Orthop Trauma Surg 2023; 143:1999-2009. [PMID: 35347411 PMCID: PMC10030428 DOI: 10.1007/s00402-022-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Epileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications. METHODS All patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions' characteristics and trauma dynamics were analysed, as wells as-when carried out-the type of surgical intervention and any postoperative complications. RESULTS The average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%). CONCLUSIONS Uncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success. LEVEL OF EVIDENCE Cohort study, level III.
Collapse
Affiliation(s)
- Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Gottfried Walter
- Department for Orthopedic Surgery and Traumatology, University Hospital Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Alessandra Menon
- ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- Scuola di Specializzazione in Statistica Sanitaria e Biometria, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Robert Ossendorff
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christof Burger
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dieter Christian Wirtz
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Max Julian Friedrich
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| |
Collapse
|
10
|
Monté CPJA, Arends JBAM, Lazeron RHC, Tan IY, Boon PAJM. Seizure-related complication rate in a residential population with epilepsy and intellectual disability (ECOMRAID-trial). Epilepsy Behav 2023; 140:108995. [PMID: 36822042 DOI: 10.1016/j.yebeh.2022.108995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 02/23/2023]
Abstract
INTRODUCTION The aim of the ECOMRAID trial (Epileptic seizure related Complication RAte in residential population of persons with epilepsy and Intellectual Disability) was to study seizure-related complications (status epilepticus, respiratory complications, or other severe complications) in people with epilepsy and intellectual disability living in a residential setting. The results of the present study are a prerequisite for performing a prospective study into the effectiveness of nocturnal surveillance patients with high risk for Sudden unexpected death in epilepsy (SUDEP). MATERIAL AND METHODS A retrospective study was conducted in three general residential care institutions and one residential specialized epilepsy clinic. In this 5-year cohort, we collected the following data: age (at inclusion and in case of death), sex, type of residential care, different types of complications, rescue/emergency medication administration, transfers to another department (internal midcare / monitoring unit or general hospital) and a self-designed SUDEP risk score. Our primary research questions were to assess the number of patients who experienced seizure-related complications and their individual complication rates. The secondary research questions were to document the relationship of these complications with the SUDEP risk score, with the type of residential living, and with the frequency of interventions by caregivers. RESULTS We included 370 patients (1790 patient-years) and in 135 of them, we found 717 seizure-related complications. The following complication rates were found: all complications: at 36%, status epilepticus: at 13%, respiratory complications: at 5%, and other complications at 26%. In residential care institutions, we found fewer patients with complications compared to the specialized epilepsy clinic (all complications 24% vs 42%, OR 0.44, p < 0.01; status epilepticus 5% vs 17%, OR 0.27, p < 0.01; other: complications 19% vs 30%, OR 0.56, p < 0.05). In residential care institutions, we found more "other complications" than in the specialized epilepsy clinic (89% vs 71%, OR 3.13, p < 0.0001). The annual frequency of all complications together was higher in residential care institutions (range 0 to 21 vs 0 to 10, p < 0.05). Rescue medication was given to 75% of the patients, but more often in the specialized epilepsy clinic (median 2.6 vs 0.5 times/patient/year, p < 0.001). In the specialized epilepsy clinic, more patients were transferred to a midcare / monitoring unit or general hospital (56% vs 9%, OR 13.44, p < 0.0001) with higher yearly frequencies (median 0.2 vs 0.0, p < 0.001). There were no reported cases of SUDEP. The median SUDEP risk score was higher in the specialized epilepsy clinic (5 vs 4, p < 0.05) and was weakly correlated with the status epilepticus (ρ = 0.20, p < 0.001) and (total) complication rate (ρ = 0.18, p < 0.001). CONCLUSION We found seizure-related complications in more than one-third of the patients with epilepsy and intellectual disability living in a residential setting over a period of 5 years. The data also quantify seizure-related complications in patients with epilepsy and intellectual disability.
Collapse
Affiliation(s)
- C P J A Monté
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Private Practice of Neurology, Zottegem, Belgium.
| | - J B A M Arends
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands
| | - R H C Lazeron
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands
| | - I Y Tan
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands
| | - P A J M Boon
- Academic Centre for Epileptology Kempenhaeghe, Heeze, The Netherlands; Eindhoven University of Technology, The Netherlands; Department of Neurology, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
11
|
Tajdini M, Tavolinejad H, Aminorroaya A, Aryan Z, Jalali A, Alaeddini F, Sadeghian S, Yadangi S, Vasheghani‐Farahani A, Kalhor P, Bozorgi A. Clinical Associations of Injuries Caused by Vasovagal Syncope: A Cohort Study From a Tertiary Syncope Unit. J Am Heart Assoc 2022; 12:e027272. [PMID: 36565190 PMCID: PMC9973565 DOI: 10.1161/jaha.122.027272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Recent research has revealed that vasovagal syncope (VVS) leads to a high incidence of injuries; however, clinical associations of injury are not well-established. We present data from an ongoing VVS cohort and aimed to determine characteristics associated with VVS-related injury. Methods and Results Between 2017 and 2020, consecutive patients ≥18 years of age presenting to a tertiary syncope unit and diagnosed with VVS were included. Clinical characteristics relevant to syncope were obtained for the index episode. The outcome was incidence of injury during VVS, documented by clinical evaluation at the syncope clinic. Among 1115 patients (mean age, 45.9 years; 48% women), 260 injuries (23%) occurred. History of VVS-related injuries (adjusted relative risk [aRR], 1.80 [95% CI, 1.42-2.29]), standing position (aRR, 1.34 [95% CI, 1.06-1.68]), and female sex (aRR, 1.30 [95% CI, 1.06-1.60]) were associated with injury, whereas recurrent VVS (aRR, 0.63 [95% CI, 0.49-0.81]) and syncope in the noon/afternoon (aRR, 0.70 [95% CI, 0.56-0.87]) and evening/night (aRR, 0.43 [95% CI, 0.33-0.57]) compared with morning hours were associated with lower risk. There was a trend for higher rates of injury with overweight/obesity (aRR, 1.23 [95% CI, 0.99-1.54]) and syncope occurring at home (aRR, 1.22 [95% CI, 0.98-1.51]). In a per-syncope analysis considering up to 3 previous episodes (n=2518, 36% traumatic), syncope at home (aRR, 1.33 [95% CI, 1.17-1.51]) and absence of prodromes (aRR, 1.34 [95% CI, 1.09-1.61]) were associated with injury. Conclusions Patient characteristics, VVS presentations, the circumstances, and surroundings can determine the risk of injury. These associations of VVS-related injury identify at-risk individuals and high-risk situations. Future prospective studies are needed to investigate potential strategies for prevention of post-VVS injury in recurrent cases.
Collapse
Affiliation(s)
- Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Hamed Tavolinejad
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Arya Aminorroaya
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran,Noncommunicable Disease Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Zahra Aryan
- Department of MedicineRutgers New Jersey Medical SchoolNewarkNY
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Farshid Alaeddini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Somayeh Yadangi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Vasheghani‐Farahani
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran,Cardiac Primary Prevention Research Center, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Parvin Kalhor
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Ali Bozorgi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| |
Collapse
|
12
|
Self-care and Epilepsy. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00743-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
13
|
Asiri S, Al-Otaibi A, Hameed MA, Hamhom A, Al-Enizi A, Eskandrani A, AlKhrisi M, Aldosari MM. Seizure-Related Injuries in People with Epilepsy: A cohort study from Saudi Arabia. Epilepsia Open 2022; 7:422-430. [PMID: 35621396 PMCID: PMC9436392 DOI: 10.1002/epi4.12615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Patients with epilepsy have a high risk of accidents and injuries, resulting in minimized physical activity and social withdrawal. Therefore, we surveyed the prevalence and the types of injuries that patients with epilepsy may endure, and the factors that may increase the risk of injuries. Methods In this cohort study, adult and pediatric patients diagnosed with epilepsy (age ≥ 7 years) and a close family member (parents/guardian) attending the outpatient epilepsy clinics at King Fahd Medical City (Riyadh, Saudi Arabia) were interviewed by neurologists. They reviewed the patients' medical records and administered a structured questionnaire to identify and compare several variables, including injury frequency versus seizure type and seizure frequency, number of antiseizure medications used, medication compliance, and work and social limitations. Results Out of 200 patients, 86 (43%) sustained injuries during an attack of their habitual seizures. Almost half of this group showed a tendency for recurrent injuries. The most common traumas were soft tissue injury (36.5%), head injury (32%), dental injury (8.5%), burns (7%), dislocation (7%), fractures (6.5%), and submersion (2%). Two‐thirds of the patients had their injury at home. 64% of patients who had seizures for more than 10 years sustained multiple injuries (P = .003). Injury frequency was higher among patients with daily or monthly seizures (P = .03). 76% of patients who suffered injuries more than twice had generalised tonic‐clonic seizures, and genetic generalised epilepsy was encountered more in injured patients (P = .02). Also, patients on polytherapy were more likely than those on monotherapy to have an injury (P = .003). Significance Two‐fifths of the patients reported seizure‐related injuries. The most common were soft‐tissue injuries and head traumas, while homes were the most frequent site. In addition, longer epilepsy duration, generalized tonic‐clonic seizures, and polytherapy were associated with a higher prevalence of injuries. Therefore, injury prevention strategies should be developed for PWE, especially for those at higher risk.
Collapse
Affiliation(s)
- Safiyyah Asiri
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Ali Al-Otaibi
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Majed Al Hameed
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Abdulrahim Hamhom
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Asma Al-Enizi
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Alaa Eskandrani
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Munirah AlKhrisi
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Mubarak M Aldosari
- Epilepsy Program, National Neuroscience Institution, King Fahd Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Bilateral Scapular Fractures Occurring as a Result of a First-Time Seizure. Case Rep Emerg Med 2022; 2022:9186275. [PMID: 35620531 PMCID: PMC9130008 DOI: 10.1155/2022/9186275] [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] [Received: 02/21/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
The violent nature of generalized tonic-clonic seizures puts individuals at risk of a large number of potential injuries. These can occur due both to the profound muscular contractions that accompany these episodes as well as falls and other traumatic events that occur due to the period of loss of consciousness that occurs during generalized seizures. While injuries such as soft tissue contusions, tongue biting, dental injuries, and facial lacerations resulting from falls from standing predominate, bony injuries are not uncommon. We present a case of bilateral scapular fractures that occurred in an otherwise healthy 32-year male who presented with shoulder and back pain and inability to perform any significant movement of his upper arms secondary to pain after experiencing an apparent first-time generalized tonic-clonic seizure. The presence of unilateral and bilateral scapular fractures, while uncommonly described, should be considered as an additional potential orthopedic injury that may occur secondary to a generalized tonic-clonic seizure. In the absence of observed significant forceful traumatic injury, this injury is unusual, and its presence noted in a patient experiencing sudden loss of consciousness should raise heightened concern of seizures as the potential etiology.
Collapse
|
15
|
A 10-day mild treadmill exercise performed before an epileptic seizure alleviates oxidative injury in the skeletal muscle and brain tissues of the rats. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1056192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
16
|
Watson GDR, Afra P, Bartolini L, Graf DA, Kothare SV, McGoldrick P, Thomas BJ, Saxena AR, Tomycz LD, Wolf SM, Yan PZ, Hagen EC. A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States. Epilepsy Behav 2021; 124:108319. [PMID: 34563807 DOI: 10.1016/j.yebeh.2021.108319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Patients often recognize unmet needs that can improve patient-provider experiences in disease treatment management. These needs are rarely captured and may be hard to quantify in difficult-to-treat disease states such as drug-resistant epilepsy (DRE). To further understand challenges living with and managing DRE, a team of medical anthropologists conducted ethnographic field assessments with patients to qualitatively understand their experience with DRE across the United States. In addition, healthcare provider assessments were conducted in community clinics and Comprehensive Epilepsy Centers to further uncover patient-provider treatment gaps. We identified four distinct stages of the treatment and management journey defined by patients' perceived control over their epilepsy: Gripped in the Panic Zone, Diligently Tracking to Plan, Riding a Rollercoaster in the Dark, and Reframing Priorities to Redefine Treatment Success. We found that patients sought resources to streamline communication with their care team, enhanced education on treatment options beyond medications, and long-term resources to protect against a decline in control over managing their epilepsy once drug-resistant. Likewise, treatment management optimization strategies are provided to improve current DRE standard of care with respect to identified patient-provider gaps. These include the use of digital disease management tools, standardizing neuropsychiatrists into patients' initial care team, and introducing surgical and non-pharmacological treatment options upon epilepsy and DRE diagnoses, respectively. This ethnographic study uncovers numerous patient-provider gaps, thereby presenting a conceptual framework to advance DRE treatment. Further Incentivization from professional societies and healthcare systems to support standardization of the treatment optimization strategies provided herein into clinical practice is needed.
Collapse
Affiliation(s)
| | - Pegah Afra
- Department of Neurology, Weill-Cornell Medicine, New York, NY 10065, USA
| | - Luca Bartolini
- Division of Pediatric Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daniel A Graf
- Department of Neurology, Geisinger Health System, Danville, PA 17822, USA
| | - Sanjeev V Kothare
- Department of Pediatric Neurology, Northwell Health, New York, NY 10011, USA
| | - Patricia McGoldrick
- Boston Children's Health Physicians and Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY 10595, USA
| | - Bethany J Thomas
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aneeta R Saxena
- Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA, USA
| | | | - Steven M Wolf
- Boston Children's Health Physicians and Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY 10595, USA
| | - Peter Z Yan
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Eliza C Hagen
- LivaNova, Neuromodulation Unit, Houston, TX 77058, USA; Department of Neurology, Alameda County Medical Center, Oakland, CA 94602, USA
| |
Collapse
|
17
|
Anwar MJ, Alenezi SK, Mahmood D, Azam F, Alharbi KS. An insight into the implications of estrogen deficiency and transforming growth factor β in antiepileptic drugs-induced bone loss. Eur J Pharmacol 2021; 907:174313. [PMID: 34245750 DOI: 10.1016/j.ejphar.2021.174313] [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: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
There have been a number of reports that chronic antiepileptic drug (AEDs) therapy is associated with abnormal bone and calcium metabolism, osteoporosis/osteomalacia, and increased risk of fractures. Bony adverse effects of long term antiepileptic drug therapy have been reported for more than four decades but the exact molecular mechanism is still lacking. Several mechanisms have been proposed regarding AEDs induced bone loss; Hypovitaminosis D, hyperparathyroidism, estrogen deficiency, calcitonin deficiency. Transforming growth factor-β (TGF- β) is abundant in bone matrix and has been shown to regulate the activity of osteoblasts and osteoclasts in vitro. All isoforms of TGF- β are expressed in bone and intricately play role in bone homeostasis by modulating estrogen level. Ovariectomised animal have shown down regulation of TGF- β in bone that could also be a probable target of AEDs therapy associated bone loss. One of the widely accepted hypotheses regarding the conventional drugs induced bone loss is hypovitaminosis D which is by virtue of their microsomal enzyme inducing effect. However, despite of the lack of enzyme inducing effect of certain newer antiepileptic drugs, reduced bone mineral density with these drugs have also been reported. Thus an understanding of bone biology, pathophysiology of AEDs induced bone loss at molecular level can aid in the better management of bone loss in patients on chronic AEDs therapy. This review focuses mainly on certain new molecular targets of AEDs induced bone loss.
Collapse
Affiliation(s)
- Md Jamir Anwar
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia.
| | - Sattam K Alenezi
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Danish Mahmood
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Faizul Azam
- Department of Pharmaceutical Chemistry & Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakakah, Saudi Arabia
| |
Collapse
|
18
|
Wali AR, Rennert RC, Wang SG, Chen CC. Evidence-Based Recommendations for Seizure Prophylaxis in Patients with Brain Metastases Undergoing Stereotactic Radiosurgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 128:51-55. [PMID: 34191061 DOI: 10.1007/978-3-030-69217-9_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Symptomatic epilepsy is frequently encountered in patients with brain metastases (BM), affecting up to 25% of them. However, it generally remains unknown whether the risk of seizures in such cases is affected by stereotactic radiosurgery (SRS), which involves highly conformal delivery of high-dose irradiation to the tumor with a minimal effect on adjacent brain tissue. Thus, the role of prophylactic administration of antiepileptic drugs (AED) after SRS remains controversial. A comprehensive review and analysis of the available literature reveals that according to prospective studies, the incidence of seizures after SRS for BM varies from 8% to 22%, and there is no evidence that SRS increases the incidence of symptomatic epilepsy. Therefore, routine prophylactic administration of AED prior to, during, or after SRS in the absence of a seizure history is not recommended. Nevertheless, short-course administration of an AED may be judiciously considered (on the basis of class III evidence) for selected high-risk individuals.
Collapse
Affiliation(s)
- Arvin R Wali
- Department of Neurosurgery, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Sonya G Wang
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN, USA.
| |
Collapse
|
19
|
Dghaies A, Mokline A, Messadi A. [Not Available]. ANNALS OF BURNS AND FIRE DISASTERS 2020; 33:288-292. [PMID: 33708017 PMCID: PMC7894848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 06/12/2023]
Abstract
Patients with epilepsy are a high-risk population for severe burns. A retrospective study was conducted to assess burns during epileptic seizure in epileptic patients. The study was conducted in a 20- bed burn ICU in Tunis over the period 01/01/2011 to 30/06/2019. Fifty cases combining burns and epilepsy were reviewed. Twenty patients (11 women and 9 men, sex-ratio 0.6) suffering a burn following an epileptic seizure were included. The average age was 46. Epileptic disease was uncontrolled in 75% of our patients and 35% were not receiving any antiepileptic treatment. Burns were related to domestic accident in 95% of cases, 2/3 of which were related to a fall on a brazier. Lesions were deep in 70% of cases, requiring excision of necrotic tissue. Only two patients benefited from a dermal-epidermal graft. Amputation was necessary in 5 patients. Mortality was 25%, related to refractory septic shock.
Collapse
Affiliation(s)
- A. Dghaies
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - A. Mokline
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| | - A.A. Messadi
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunisie
- Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie
| |
Collapse
|
20
|
Barone V, van Putten MJAM, Visser GH. Absence epilepsy: Characteristics, pathophysiology, attention impairments, and the related risk of accidents. A narrative review. Epilepsy Behav 2020; 112:107342. [PMID: 32861896 DOI: 10.1016/j.yebeh.2020.107342] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Absence epilepsy (AE) is related to both cognitive and physical impairments. In this narrative review, we critically discuss the pathophysiology of AE and the impairment of attention in children and adolescents with AE. In particular, we contextualize the attentive dysfunctions of AE with the associated risks, such as accidental injuries. DATA SOURCE An extensive literature search on attention deficits and the rate of accidental injuries in AE was run. The search was conducted on Scopus, Pubmed, and the online libraries of the University of Twente and Maastricht University. Relevant references of the included articles were added. Retrospective and prospective studies, case reports, meta-analysis, and narrative reviews were included. Only studies written in English were considered. Date of last search is February 2020. The keywords used were "absence epilepsy" AND "attention"/"awareness", "absence epilepsy" AND "accidental injuries"/"accident*"/"injuries". RESULTS Ten retrospective and two prospective studies on cognition and AE were fully screened. Seventeen papers explicitly referring to attention in AE were reviewed. Just one paper was found to specifically focus on accidental injuries and AE, while twelve studies generally referring to epilepsy syndromes - among which AE - and related accidents were included. CONCLUSION Absence epilepsy and attention deficits show some patterns of pathophysiological association. This relation may account for dysfunctions in everyday activities in the pediatric population. Particular metrics, such as the risk related to biking in children with AE, should be used in future studies to address the problem in a novel way and to impact clinical indications.
Collapse
Affiliation(s)
- Valentina Barone
- Twente Medical System International B.V. (TMSi), Zutphenstraat 57, 7575EJ Oldenzaal, the Netherlands; Clinical Neurophysiology (CNPH), Technohal Univeristy of Twente, Hallenweg 5, 7522 NH, the Netherlands.
| | - Michel J A M van Putten
- Clinical Neurophysiology (CNPH), Technohal Univeristy of Twente, Hallenweg 5, 7522 NH, the Netherlands; Department of Clinical Neurophysiology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, the Netherlands..
| | - Gerhard H Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 2, 2103 SW Heemstede, the Netherlands.
| |
Collapse
|
21
|
Nishida T, Terada K, Ikeda H, Inoue Y. Seizures, accidental injuries at work, and reasons for resignation in people with epilepsy. Epilepsy Behav 2020; 111:107237. [PMID: 32575014 DOI: 10.1016/j.yebeh.2020.107237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Few studies have examined seizures, accidental injuries at work, and reasons for resignation in people with epilepsy (PWE). We performed a questionnaire survey of PWE to identify the risk of injury at work, its relationship to different seizure characteristics, and reasons for resignation. METHODS We distributed a questionnaire survey in the outpatient clinic of a single epilepsy center. Medical information was obtained retrospectively from medical records. RESULTS Of 200 patients who received the questionnaire, 172 responded. Two-fifths of PWE had experienced seizures at work, but the risk of accidental injuries due to epileptic seizures was only 0.01 person/year (1.0%) and 0.018 injuries/year, whereas the risk of accidental injuries not related to seizures was 0.039 person/year (3.9%) and 0.083 injuries/year. All accidental injuries due to seizures at work were caused by seizures characterized by a fall and inappropriate behavior with impaired awareness. Most accidental injuries due to seizures at work were caused by seizures that occurred at least once a year. The types of injuries reported were bruising, abrasion, laceration, fracture, burn, and submersion injuries. A quarter of PWE had left previous jobs because of epilepsy, of these, about four-fifths reported that seizures at the workplace had interfered with their own or others' tasks. SIGNIFICANCE The risk of seizure-related injury is not high compared to the risk of injury not related to seizures, and most injuries due to seizures are not severe. The features of seizures with a fall, impaired awareness, and inappropriate behavior, as well as seizure frequency, should be considered when evaluating the risks associated with seizures in the workplace. Most PWE who had left their previous job because of epilepsy had experienced seizures at the workplace interfering with their own or others' tasks.
Collapse
Affiliation(s)
- Takuji Nishida
- National Epilepsy Center, NHO, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan.
| | - Kiyohito Terada
- National Epilepsy Center, NHO, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan
| | - Hitoshi Ikeda
- National Epilepsy Center, NHO, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan
| | - Yushi Inoue
- National Epilepsy Center, NHO, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Aoi-ku, Shizuoka 420-8688, Japan
| |
Collapse
|
22
|
Miller D, Felker M, Ciccarelli M. Transitioning Ambulatory Medicine from Pediatrics to Adult Care for Patients with Epilepsy and Intellectual Disability. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1717135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractConsensus statements and clinical reports exist to guide the transition of youth from pediatric to adult healthcare services. Across the range of youth with no chronic health conditions to those with the most complex disabilities, the standards of practice continue to vary broadly across the country and internationally. Youth and young adults with combined conditions of epilepsy with intellectual disability are a small subset of the total population of young adults who share common needs. These include a system of supports that supplement each person's limitations in autonomy and self-management. Caregivers play significant roles in their lives, whether they are family members or paid direct service providers. Medical decision making and treatment adherence require specific adaptations for patients whose independence due to disability is unlikely. Key issues related to tuberous sclerosis complex, neurofibromatosis, and Rett and Sturge–Weber syndromes will be highlighted.
Collapse
Affiliation(s)
- Derryl Miller
- Department of Pediatrics and Child Neurology, Indiana University Graduate Medical Education, Indianapolis, Indiana, United States
| | - Marcia Felker
- Department of Child Neurology, Indiana University Child Neurology, Indianapolis, Indiana, United States
| | - Mary Ciccarelli
- Department of Medicine and Pediatrics, Indiana University Medicine and Pediatrics, Indianapolis, Indiana, United States
| |
Collapse
|
23
|
Thompson NJ, McGee RE, Garcia-Williams A, Selwa LM, Stoll SC, Johnson EK, Fraser RT. The impact of a depression self-management intervention on seizure activity. Epilepsy Behav 2020; 103:106504. [PMID: 31648928 PMCID: PMC7002270 DOI: 10.1016/j.yebeh.2019.106504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE Seizures have a variety of significant physical, cognitive, and social effects upon the individual. Depression has been linked to an increase in seizure activity, and Project Using Practice and Learning to Increase Favorable Thoughts (UPLIFT) was shown to reduce depressive symptoms. Project UPLIFT, based upon mindfulness-based cognitive therapy (MBCT), provides distance delivery of depression management skills to groups of people with epilepsy. Because Project UPLIFT reduces depression and depression is linked to seizure activity, the current analysis was designed to determine the impact of Project UPLIFT upon seizure frequency and severity. METHOD Participants (n = 107) were adults ages 21-70 with epilepsy and mild-to-moderate depressive symptoms from the states of Georgia, Michigan, Texas, and Washington. The eight-session Project UPLIFT intervention was group-delivered weekly via the web or telephone. Participants were randomly assigned to condition (i.e., Project UPLIFT or a treatment-as-usual [TAU] waitlist) and assessed at baseline, and after intervening in the Project UPLIFT group (~10 weeks). Assessments included valid self-report measures of seizure frequency and severity and depression. RESULTS Mediation analysis found that there was a significant negative direct relationship between condition and number of seizures at posttest; the mean number of seizures decreased by 3.2 in the Project UPLIFT group, but increased by 2.3 in the TAU group. The indirect path from condition to number of seizures through change in depression was not significant. Conversely, there was no significant negative direct relationship between condition and seizure severity at posttest, although the seizure severity decreased by 2.2 points in the UPLIFT group and increased by 2.7 points in the TAU group. The indirect path from condition to seizure severity through depression was significant, however, demonstrating that change in depression mediated the effect of Project UPLIFT on seizure severity. CONCLUSIONS This study found that participating in Project UPLIFT directly reduced the number of seizures experienced by participants with epilepsy. This was not mediated by the change in depression. Participation in Project UPLIFT also reduced their perceived seizure severity indirectly, through reducing their depressive symptoms. This suggests Project UPLIFT may have the potential to impact the health, healthcare costs, and well-being of people with epilepsy.
Collapse
Affiliation(s)
| | - Robin E McGee
- Emory University, Atlanta, GA 30322, United States of America
| | | | - Linda M Selwa
- University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Shelley C Stoll
- University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Erica K Johnson
- University of Washington, Seattle, WA 98195, United States of America
| | - Robert T Fraser
- University of Washington, Seattle, WA 98195, United States of America
| |
Collapse
|
24
|
Risk of readmission for injury in patients with epilepsy in the United States - A population-based study. Epilepsy Behav 2020; 102:106651. [PMID: 31778877 DOI: 10.1016/j.yebeh.2019.106651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to determine the 30-day injury readmission risk among persons with epilepsy vs. without epilepsy using a nationally representative US database. Secondary objectives were to examine the factors associated with injury-related readmissions among those with epilepsy and identify specific causes of readmissions within 30 days of index admission. METHODS Hospitalized individuals of all ages with epilepsy as the primary diagnosis were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the 2014 Nationwide Readmission Database (NRD). Primary outcome was 30-day readmission for an injury defined by ICD-9-CM diagnosis codes following discharge from index hospitalization. Subgroup differences in the groups with epilepsy and without epilepsy were estimated using standardized mean difference scores that are calculated with means and variances of the covariates. Multinomial logistic regressions were conducted to determine the 30-day injury readmission risk and examine the factors associated with injury-related readmissions. RESULTS There were 60,074 unique persons with epilepsy (mean age: 42.53 years, female: 49.32%) and 9,282,952 without epilepsy (mean age: 44.46 years, female: 59.43%). A higher proportion of persons with epilepsy (n = 215, 0.34%) vs. without epilepsy (n = 22,783, 0.22%) had a 30-day readmission due to an injury. After adjusting for covariates, persons with epilepsy had higher odds of 30-day readmission due to an injury (adjusted OR: 1.40, 95% CI: 1.20-1.62, p < 0.0001). Factors associated with an injury-related readmission in persons with epilepsy include the following: increasing age (OR: 1.01, 95% CI: 1.00-1.02, p = 0.02), transfer to short term hospital/other facility (OR: 1.50, 95% CI: 1.00-2.27, p = 0.05), discharged against medical advice/discharge destination unknown (OR: 2.26, 95% CI: 1.40-4.45, p = 0.02), and higher Elixhauser comorbidity index (OR: 1.02, 95% CI: 1.01-1.03, p < 0.0001). CONCLUSIONS Higher odds of 30-day injury readmissions were observed in persons with epilepsy vs. without epilepsy. Optimizing the management of comorbid conditions during the patient's index admission for epilepsy, minimizing discharges against medical advice, and fostering outreach programs to those who have been transferred to short-term hospitals or facilities may reduce 30-day readmissions due to an injury.
Collapse
|
25
|
Delayed unrelated presentation of a lumbar burst fracture consequent to a remote episode of a single convulsive seizure: A diagnostic challenge. J Clin Orthop Trauma 2020; 11:952-955. [PMID: 32879586 PMCID: PMC7452183 DOI: 10.1016/j.jcot.2020.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED Non-traumatic vertebral fractures occurring as a sole consequence of the violent muscle forces generated during the first episode of a GTCS(generalized tonic clonic seizure) in a previously healthy non-epileptic individual are very rare. Being clinically asymptomatic they are easily overseen at the time of initial presentation due to their rarity of occurrence and the presence of potentially distracting factors in the post-ictal phase. We present a 52-year-old healthy non-epileptic male who presented with unrelenting back pain and neurodeficit secondary to a four-month-old unstable burst fracture of the first lumbar vertebra sustained during an isolated single episode of a witnessed GTCS. A detailed inquiry revealed no history of a significant traumatic event either during the convulsive episode or thereafter. A meticulous history taking, a thorough clinical and neurological examination combined with a comprehensive radiological evaluation established the unusual etiology of the fracture and the presence of a thoracolumbar kyphotic deformity with compression of conus medullaris. A detailed neurological, and laboratory work-up, confirmed no attributable organic or metabolic cause for the seizure. His BMD(Bone Mineral Density) was normal. Patient was managed with posterior instrumented deformity correction by a posterior column shortening osteotomy, neural decompression and fusion of D12-L1 facets. Patient had complete neurological recovery with good clinical and functional outcomes at 28-months follow-up. A few cases of seizure-induced non-traumatic spinal fractures have been published in literature. A majority of these fractures occurred in individuals with either seizure-provoking risk factors (epileptics with recurrent seizures, brain tumors, drug overdose/withdrawal, metabolic disorders, or electrolyte imbalance) or in those with an increased susceptibility to fracture due to decreased BMD. This case demonstrates the rare occurrence of a non-traumatic vertebral fracture during the first episode of a GTCS in an otherwise healthy non-epileptic individual with normal BMD and no seizure-provoking risk factors. This is the first case report of a delayed unrelated presentation of a non-traumatic lumbar vertebral fracture with complications (spinal deformity and neurodeficit) consequent to a remote episode of a single convulsive seizure. It emphasizes the need for a high index of clinical suspicion,a meticulous history taking, thorough musculoskeletal and neurological examination in any individual presenting with a seemingly benign back pain following a remote isolated episode of seizure, even in the absence of overt trauma. A detailed radiological evaluation guided by a meticulous history taking and detailed clinical examination is essential to rule out a fracture unless proven otherwise. It also shows that a single convulsive seizure can result in a potentially unstable fracture that when neglected, can result in devastating complications like spinal deformity and neurodeficit. LEVEL OF EVIDENCE Level IV.
Collapse
|
26
|
Robichaud AS, Barry TK, Barry SP. Seizure-induced thoracolumbar burst fractures - Not to be missed. Epilepsy Behav Rep 2019; 13:100352. [PMID: 32021969 PMCID: PMC6994300 DOI: 10.1016/j.ebr.2019.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/03/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022] Open
Abstract
While rare, post-ictal thoracolumbar burst fractures are commonly missed due to confounding factors, resulting in delayed treatment and the potential for serious neurological deficits. This paper serves as a call for a high-degree of clinical suspicion when treating post-ictal patients to ensure they undergo a focused neurological examination of the lower extremities. If unresponsive/uncooperative, spinal precautions should be maintained until the spine can be cleared clinically or radiographically. In all events, if the patient is complaining of musculoskeletal pain possibly originating from the spine, radiographic evaluations are warranted to prevent possible deficits caused by a missed thoracolumbar fracture.
Collapse
Affiliation(s)
| | | | - Sean P. Barry
- Division of Neurosurgery, Dalhousie University, Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Halifax, NS, Canada, B3H 3A7
| |
Collapse
|
27
|
Atwell K, Bartley C, Cairns B, Charles A. The Effect of Pre-existing Seizure Disorders on Mortality and Hospital Length of Stay Following Burn Injury. J Burn Care Res 2019; 40:979-982. [PMID: 31420660 PMCID: PMC6939827 DOI: 10.1093/jbcr/irz141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Patients with a seizure disorder have a higher incidence of burn injury; however, there are limited studies that examine the association between pre-existing seizure disorders (PSD) and burn outcomes. This is a retrospective study of admitted burn patients. Variables analyzed include patient demographics, clinical characteristics, associated PSD, hospital length of stay (LOS), and mortality. Multivariate logistic regression was performed to analyze the impact of PSD on burn mortality and LOS. Seven thousand six hundred and forty patients met the inclusion criteria and 1.31% (n = 100) patients had a PSD. There was no difference in mortality rate between patients with or without PSD (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 0.87 to 5.93). Multivariate logistic regression showed that patients with PSD had significantly increased odds of longer hospital LOS (OR = 2.85, 95% CI = 1.73 to 4.67). Seizure disorder management is mandatory in reducing burn injury and decreasing the costs associated with increased hospital LOS.
Collapse
Affiliation(s)
- Kenisha Atwell
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center
| | - Colleen Bartley
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, North Carolina Jaycee Burn Center
| |
Collapse
|
28
|
Mohamed N, Makaranka S, Cheema K, Harnett P. Bilateral acetabular fractures induced by an epileptic seizure in a paediatric patient: a unique case and its management. BMJ Case Rep 2019; 12:12/8/e230143. [PMID: 31439552 DOI: 10.1136/bcr-2019-230143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic-clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra-pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.
Collapse
Affiliation(s)
- Nusrat Mohamed
- Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Stanislau Makaranka
- Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kamalpreet Cheema
- Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Harnett
- Trauma & Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
29
|
Ghoddusi Johari M, Mohammadi AA, Dastgerdi V. Burn: A Predictable but Preventable Tragedy in Epileptic Patients. World J Plast Surg 2019; 8:254-258. [PMID: 31309065 PMCID: PMC6620804 DOI: 10.29252/wjps.8.2.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Epilepsy, the world's most common neurological brain dysfunction, affects more than 50 million people worldwide. Burn injuries can be the leading cause of morbidity and mortality in the patients. This study assessed the predictable but preventable tragedy in epileptic burn patients. METHODS From January 2001 to January 2011, data included patient's demographic, burn cause, Total Body Surface Area (TBSA) of the burn injury, patient's risk awareness, the type of treatment required as well as the treatment outcome were collected from burn admissions. Totally, 39 patients who sustained burn injuries due to epileptic seizures w were enrolled. RESULTS Totally, 39 (1.7%) were epileptic with mean age of 30±11 years, 51.3% were female, 41.2% were single and 53.84% were rural residents and 12.8% had academic education. The majority of the thermal injuries occurred at home (82.1%). Flame was the most common cause of burn (66.7%). The mean Total Body Surface Area was 19.69±18.25. Finally, 38 patients were discharged with mortality rate of 2.6%. Thirty patients underwent split or full thickness graft as the most common surgery. Only 5 patients were aware of the burn injury risk during seizure attack. CONCLUSION Despite reduction in burn injuries secondary to seizure, still such injuries lead to significant morbidity and mortality. Since these patients should adhere to specific medication, controlling it remains to be difficult. So preparation for preventive strategies is consisted of life style modification along with patients' education that is further warranted.
Collapse
Affiliation(s)
| | - Ali Akbar Mohammadi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| | - Vahid Dastgerdi
- Burn and Wound Healing Research Center, Plastic and Reconstructive Surgery Ward, Shiraz University of Medical Science, Shiraz, Iran
| |
Collapse
|
30
|
Praxis-induced myoclonia: From the neurophysiologist to the patient perspective. Seizure 2018; 60:184-189. [DOI: 10.1016/j.seizure.2018.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
|
31
|
Impact of poorly controlled epilepsy in the Republic of Guinea. Seizure 2018; 61:71-77. [PMID: 30114675 DOI: 10.1016/j.seizure.2018.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea. METHODS Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs. RESULTS Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 72% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures, and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p = 0.048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p < 0.001). Burns were more likely to occur among females (p = 0.02). CONCLUSIONS There is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.
Collapse
|
32
|
Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, Rosenow F, Strzelczyk A. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study. Front Neurol 2018; 9:414. [PMID: 29963000 PMCID: PMC6013746 DOI: 10.3389/fneur.2018.00414] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18-86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
Collapse
Affiliation(s)
- Laurent M Willems
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Watermann
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Saskia Richter
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Lara Kay
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Anke M Hermsen
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
33
|
Kemp S, Graham CD, Chan R, Kitchingman H, Vickerman K, Reuber M. The frequency and management of seizures during psychological treatment among patients with psychogenic nonepileptic seizures and epilepsy. Epilepsia 2018; 59:844-853. [DOI: 10.1111/epi.14040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Steven Kemp
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Christopher D. Graham
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
- Leeds Institute of Health Sciences; University of Leeds; Leeds UK
| | - Rebecca Chan
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Hayley Kitchingman
- Department of Clinical and Health Psychology; St James's University Hospital; Leeds UK
| | - Kirsty Vickerman
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
| | - Markus Reuber
- Academic Neurology Unit; Royal Hallamshire Hospital; University of Sheffield; Sheffield UK
| |
Collapse
|
34
|
Mahler B, Carlsson S, Andersson T, Tomson T. Risk for injuries and accidents in epilepsy. Neurology 2018; 90:e779-e789. [DOI: 10.1212/wnl.0000000000005035] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo study the risk for injuries/accidents in people with newly diagnosed epileptic seizures in relation to comorbidities.MethodsBetween September 1, 2001, and August 31, 2008, individuals in northern Stockholm with incident unprovoked seizures (epilepsy; n = 2,130) were included in a registry. For every epilepsy patient, 8 individuals matched for sex and inclusion year (n = 16,992) were randomly selected as references from the population of the catchment area. Occurrence of injuries/accidents was monitored through the national patient and cause of death registers until December 31, 2013. These registers also provided information on comorbidities (e.g., brain tumor, stroke, psychiatric disease, diabetes mellitus).ResultsInjury/accident was demonstrated in 1,033 epilepsy cases and 6,202 references (hazard ratio [HR] 1.71, 95% confidence interval 1.60–1.83). The excess risk was seen mainly during the first 2 years after diagnosis. Sex and educational status had no significant effect on HR. The risk was normal in children but increased in adults. Highest HR was seen for drowning, poisoning, adverse effect of medication, and severe traumatic brain injury. Compared to references without comorbidities, HR was 1.17 (1.07–1.28) in epilepsy without comorbidities, 4.52 (4.18–4.88) in references with comorbidities, and 7.15 (6.49–7.87) in epilepsy with comorbidities.ConclusionPresence of comorbidities should be considered when counseling patients with newly diagnosed epilepsy concerning risk for injuries/accidents. Early information is important, as the risk is highest during the first 2 years following seizure onset.
Collapse
|
35
|
Seizure-Related Injuries among People with Epilepsy at the Outpatient Department of the University of Gondar Hospital, Northwest Ethiopia: Cross-Sectional Institutional-Based Study. Neurol Res Int 2017; 2017:4970691. [PMID: 29375913 PMCID: PMC5742466 DOI: 10.1155/2017/4970691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/04/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background The characteristics of epilepsy such as the episodic nature of impairment of consciousness and motor control, psychomotor comorbidity, seizure frequency, and side effects of antiepileptic drugs impact negatively on the physical safety of the patients. Physical injuries such as burn, fracture, dental loss, and hemorrhage affect the quality of patients' life to the extent of death. Thus, the main purpose of this study was to assess the prevalence of physical injury and associated factors among people with epilepsy. Methods The study was carried out among 409 people with epilepsy. Cross-sectional study design was utilized to enroll the selected study participants using systematic random sampling technique. Binary and multivariable logistic regression were fitted to identify associated factors using an odds ratio and 95% CI. Results The overall estimated prevalence of seizure-related physical injury was found to be 27.9%. Of the 27.9% seizure-related physical injuries, 12.5% had abrasions, 5.9% had burns, 4.4% had dental injuries, 2.2% had fractures, and 1.5% had head injuries and dislocations, respectively. Employment, 2-3 years duration of illness, seizure frequencies, and frequencies of drug taken were factors associated with physical injury. Conclusion More than a quarter of the study participants experienced physical injury. Designing/strengthening injury prevention strategies is suggested especially for those who had uncontrolled seizure frequency for longer period of time.
Collapse
|
36
|
Braun A, Kendall S, Cole C, Smeeton N, Angus-Leppan H. Development of the Epilepsy Risk Awareness scale (ERA scale) for people with epilepsy. Seizure 2017; 46:13-18. [PMID: 28214711 DOI: 10.1016/j.seizure.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Quality of life in people with epilepsy depends on balancing protection from risks and avoiding unnecessary restrictions. The Epilepsy Risk Awareness Checklist (ERAC) was developed to summarise an individual's safety, health care and quality of life and to facilitate communication between professionals. Although effective, the existing Checklist required quantification and shortening to increase its utility, particularly as a longitudinal tool for measuring and communicating changes over time. METHODS 5 clinical experts, 3 people with epilepsy and 5 carers assessed the importance of each item on the ERAC questionnaire in a two-round Delphi survey. The refined Epilepsy Risk Awareness scale (ERA scale) was piloted in 30 patients to obtain an overall and sub-scale score for personal safety, health care, and quality of life domains, and was compared with the validated Seizure Severity Scale and Epilepsy Self-Management Scale. RESULTS ERAC was shortened from 69 to 48 items to take 15-20min for completion. Pilot results showed good internal consistency for the overall ERA scale, for the Personal Safety and Health Care subscales, but less for the Quality of Life subscale. There was strong association between ERA scale and the Epilepsy Self-Management Scale, but little relationship with Seizure Severity Scale scores, which focus on individual seizures. User ratings were high. CONCLUSIONS The ERA scale has been shortened and quantified to provide an objective measure of the risks and safety profile in people with epilepsy. The scale will be further tested for intra-rater variability and utility.
Collapse
Affiliation(s)
- Andreas Braun
- Centre for Research in Primary and Community Care, University of Hertfordshire, UK
| | | | | | - Nigel Smeeton
- Centre for Research in Primary and Community Care, University of Hertfordshire, UK
| | - Heather Angus-Leppan
- Epilepsy Initiative Group, Royal Free London NHS Foundation Trust and University College London, UK.
| |
Collapse
|
37
|
Leppik IE, Yang H, Williams B, Zhou S, Fain R, Patten A, Bibbiani F, Laurenza A. Analysis of falls in patients with epilepsy enrolled in the perampanel phase III randomized double-blind studies. Epilepsia 2016; 58:51-59. [DOI: 10.1111/epi.13600] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Ilo E. Leppik
- Department of Neurology and College of Pharmacy; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Haichen Yang
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Betsy Williams
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Sharon Zhou
- Eisai Medical and Scientific Affairs; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Randi Fain
- Formerly of Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | | | - Francesco Bibbiani
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| | - Antonio Laurenza
- Eisai Neuroscience and General Medicine PCU; Eisai Inc.; Woodcliff Lake New Jersey U.S.A
| |
Collapse
|
38
|
Eseigbe EE, Nuhu FT, Sheikh TL, Oguizu OJ. Physical trauma in epilepsy: Characteristics and implications in a Nigerian adolescent with severe generalized epilepsy. J Emerg Trauma Shock 2015; 8:240-2. [PMID: 26604535 PMCID: PMC4626946 DOI: 10.4103/0974-2700.161661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Edwin E Eseigbe
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Folorunsho T Nuhu
- Child and Adolescent Mental Health Unit, Federal Neuro Psychiatric Hospital, Kaduna, Nigeria E-mail:
| | - Taiwo L Sheikh
- Child and Adolescent Mental Health Unit, Federal Neuro Psychiatric Hospital, Kaduna, Nigeria E-mail:
| | - Okechukwu J Oguizu
- Child and Adolescent Mental Health Unit, Federal Neuro Psychiatric Hospital, Kaduna, Nigeria E-mail:
| |
Collapse
|
39
|
Chang CY, Lu TH, Cheng TJ. Trends in reporting injury as a cause of death among people with epilepsy in the U.S., 1981–2010. Seizure 2014; 23:836-43. [DOI: 10.1016/j.seizure.2014.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022] Open
|
40
|
Shuryak I, Lubin JH, Brenner DJ. Potential for adult-based epidemiological studies to characterize overall cancer risks associated with a lifetime of CT scans. Radiat Res 2014; 181:584-91. [PMID: 24828111 DOI: 10.1667/rr13622.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Recent epidemiological studies have suggested that radiation exposure from pediatric CT scanning is associated with small excess cancer risks. However, the majority of CT scans are performed on adults, and most radiation-induced cancers appear during middle or old age, in the same age range as background cancers. Consequently, a logical next step is to investigate the effects of CT scanning in adulthood on lifetime cancer risks by conducting adult-based, appropriately designed epidemiological studies. Here we estimate the sample size required for such studies to detect CT-associated risks. This was achieved by incorporating different age-, sex-, time- and cancer type-dependent models of radiation carcinogenesis into an in silico simulation of a population-based cohort study. This approach simulated individual histories of chest and abdominal CT exposures, deaths and cancer diagnoses. The resultant sample sizes suggest that epidemiological studies of realistically sized cohorts can detect excess lifetime cancer risks from adult CT exposures. For example, retrospective analysis of CT exposure and cancer incidence data from a population-based cohort of 0.4 to 1.3 million (depending on the carcinogenic model) CT-exposed UK adults, aged 25-65 in 1980 and followed until 2015, provides 80% power for detecting cancer risks from chest and abdominal CT scans.
Collapse
Affiliation(s)
- Igor Shuryak
- a Center for Radiological Research, Columbia University Medical Center, New York, New York; and
| | | | | |
Collapse
|
41
|
Wu JJS, Chang WP, Shih HC, Yen CT, Shyu BC. Cingulate seizure-like activity reveals neuronal avalanche regulated by network excitability and thalamic inputs. BMC Neurosci 2014; 15:3. [PMID: 24387299 PMCID: PMC3893465 DOI: 10.1186/1471-2202-15-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 12/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cortical neurons display network-level dynamics with unique spatiotemporal patterns that construct the backbone of processing information signals and contribute to higher functions. Recent years have seen a wealth of research on the characteristics of neuronal networks that are sufficient conditions to activate or cease network functions. Local field potentials (LFPs) exhibit a scale-free and unique event size distribution (i.e., a neuronal avalanche) that has been proven in the cortex across species, including mice, rats, and humans, and may be used as an index of cortical excitability. In the present study, we induced seizure activity in the anterior cingulate cortex (ACC) with medial thalamic inputs and evaluated the impact of cortical excitability and thalamic inputs on network-level dynamics. We measured LFPs from multi-electrode recordings in mouse cortical slices and isoflurane-anesthetized rats. RESULTS The ACC activity exhibited a neuronal avalanche with regard to avalanche size distribution, and the slope of the power-law distribution of the neuronal avalanche reflected network excitability in vitro and in vivo. We found that the slope of the neuronal avalanche in seizure-like activity significantly correlated with cortical excitability induced by γ-aminobutyric acid system manipulation. The thalamic inputs desynchronized cingulate seizures and affected the level of cortical excitability, the modulation of which could be determined by the slope of the avalanche size. CONCLUSIONS We propose that the neuronal avalanche may be a tool for analyzing cortical activity through LFPs to determine alterations in network dynamics.
Collapse
Affiliation(s)
| | | | | | | | - Bai Chuang Shyu
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan.
| |
Collapse
|
42
|
Abstract
The impact of epilepsy is multifaceted and extensive on its effects. The occurrence of seizures is unpredictable and often dangerous, increasing the risk of injury, hospitalization and mortality, and adversely affecting a patient's mental health, often resulting in anxiety, depression or cognitive impairment. Seizures can also result in stigmatization and social exclusion, with detrimental effects on an individual's confidence and self-esteem. However, the burden of epilepsy extends beyond the effects of seizures themselves. In particular, individuals with epilepsy are significantly more likely to have medical or psychiatric comorbidities than those without epilepsy, and comorbidity in patients with epilepsy has been shown to be strongly correlated with negative impacts on subjective health status and quality of life (QoL). In addition, antiepileptic drug (AED) treatment is commonly associated with side effects, which further impair patients' QoL. Patient surveys provide valuable insights into what matters to patients in their daily lives and highlight important discrepancies between the perceptions of patients and their physicians. For example, survey data show that physicians underestimate the number of patients experiencing AED side effects and the impact of these on patients. Screening questionnaires can help physicians to quickly identify problems with treatment side effects; also, to recognize comorbidities such as depression that are otherwise difficult to identify in a time-limited consultation. Ultimately, successful management of epilepsy requires a holistic approach to care, with treatment tailored to the individual patient's needs; this can only be achieved through effective doctor-patient communication and the full involvement of a multidisciplinary care team.
Collapse
Affiliation(s)
- M. P. Kerr
- Welsh Centre for Learning Disabilities, Cardiff University; Cardiff; Wales; UK
| |
Collapse
|