Prevalence of epilepsy in China between 1990 and 2015: A systematic review and meta-analysis

VPS13D affects epileptic seizures by regulating mitochondrial fission and autophagy in epileptic rats

Abnormal mitochondrial dynamics can lead to seizures, and improved mitochondrial dynamics can alleviate seizures. Vacuolar protein sorting 13D (VPS13D) is closely associated with regulating mitochondrial homeostasis and autophagy. However, further investigation is required to determine whether VPS13D affects seizures by influencing mitochondrial dynamics and autophagy. We aimed to investigate the influence of VPS13D on behavior in a rat model of acute epileptic seizures. Hence, we established an acute epileptic seizure rat model and employed the CRISPR/CAS9 technology to construct a lentivirus to silence the Vps13d gene. Furthermore, we used the HT22 mouse hippocampal neuron cell line to establish a stable strain with suppressed expression of Vps13d in vitro. Then, we performed quantitative proteomic and bioinformatics analyses to confirm the mechanism by which VPS13D influences mitochondrial dynamics and autophagy, both in vitro and in vivo using the experimental acute epileptic seizure model. We found that knockdown of Vps13d resulted in reduced seizure latency and increased seizure frequency in the experimental rats. Immunofluorescence staining and western blot analysis revealed a significant increase in mitochondrial dynamin-related protein 1 expression following Vps13d knockdown. Moreover, we observed a significant reduction in LC3II protein expression levels and the LC3II/LC3I ratio (indicators for autophagy) accompanied by a significant increase in P62 expression (an autophagy adaptor protein). The proteomic analysis confirmed the up-regulation of P62 protein expression. Therefore, we propose that VPS13D plays a role in modulating seizures by influencing mitochondrial dynamics and autophagy.

Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study

Background

The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction.

Methods

We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes.

Results

We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors.

Conclusions

Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system.

Effect of cognitive behavioral intervention on anxiety, depression, and quality of life in patients with epilepsy

OBJECTIVE

This study aimed to investigate the effect of cognitive behavioral therapy (CBT) on quality of life, anxiety, and depression in patients with epilepsy.

METHODS

Each study subject was randomly assigned to a CBT (n=46) or control (n=49) group (1:1 ratio), and the first group underwent an 8-week CBT treatment. Anxiety, depression, and quality of life (QOLIE-31) were assessed at both baseline and endpoint using the Self-Rating Anxiety Scale (SAS), Hamilton Depression Scale (HDMA) and quality of life in Epilepsy-31 (QOLIE-31) scales. The statistical analyses included between-and within-group comparisons of the effects of CBT on these measures and associations with demographic and clinical variables.

RESULTS

No differences were found between variables at baseline (P>0.05). The repeated-measures analyses found that CBT group had greater improvement in depression score compared to the control group (P<0.05). The analysis of anxiety score showed that compared to the control group, CBT intervention had no statistical significance in the total anxiety population. However, the CBT intervention decreased anxiety in women and Combined-drug group (P<0.05). The CBT group had greater improvement in overall score, medication effect, and seizure worry score than the control group (P<0.05). Stratified analysis found total and medication effects score of CBT intervention group for the combined-drug group were higher than those of the single drug group (P<0.05).

CONCLUSION

Increases in overall scores, seizure worry, cognitive functioning, and medication effect were better in the CBT group. CBT can improve anxiety, depression, and quality of life in patients with epilepsy. Women and combined-drug patients with epilepsy benefit most from CBT.

Parenting Programs That Address Physical Abuse in Childhood for Families of Children With Developmental Disabilities in Mainland China: Systematic Review and Meta-Regression

Millions of children in China are diagnosed with developmental disabilities (DD), many of whom are subject to physical abuse. While a significant body of research suggests that parenting interventions can reduce the incidence and risk of such abuse, there is currently limited evidence of their effectiveness for this population or from non-English-speaking countries. This review involved searches in both English and Chinese databases to identify randomized controlled trials and quasi-experimental studies of parenting interventions for families of children with DD in mainland China. Multilevel meta-analyses were undertaken to examine the effectiveness of parenting programs. Subgroup analyses and meta-regression were conducted to investigate heterogeneity and identify potential moderators with a focus on intervention and delivery components. Risk of bias was assessed for each study. Thirty-one studies were included. The results showed that parenting interventions could reduce child emotional and behavioral problems (CEBP) and improve the parent-child relationship, although only one study directly measured the actual incidence of abuse. Programs for autism and epilepsy had stronger treatment effects. Teaching knowledge about CEBP, skills to improve parental mental health, and techniques to cultivate empathy were associated with program success; however, positive reinforcement was associated with more problems. The results also supported the delivery of programs with longer duration, a combination of group and individual sessions, efforts to build rapport, ongoing communication outside the programs, and delivery in hospitals or service agencies. Further research is needed, however, in addition to improvements in the quality of research and reporting.

Epileptic disorders in Becker and Duchenne muscular dystrophies: a systematic review and meta-analysis

Dystrophin alterations in the brain have been associated with an increased risk of epilepsy in Becker and Duchenne muscular dystrophies (BMD and DMD). Moreover, an association between the mutation site and the risk of epilepsy is not ruled out. The aim of this systematic review and meta-analysis was to estimate the prevalence of epilepsy in BMD and DMD populations and to establish a possible association between the site of mutation in the dystrophin gene and the risk of epilepsy. Systematic searches of Medline, Scopus, Web of Science, and Cochrane Library were conducted to identify relevant studies published from inception to January 2022. Observational studies of participants with BMD/DMD estimating the prevalence of epilepsy were included. The main outcome was the prevalence of epilepsy, and the secondary outcome was the prevalence ratio considering genotype. A random effects meta-analysis was performed for the prevalence of epilepsy. Eight studies were included in the systematic review and meta-analysis. The prevalence of epilepsy was 7% (95% CI 3-11%) in BMD, 5% (95% CI 2-8%) in DMD, and 5% (95% CI 3-7%) in the overall estimate. No association was observed between mutation site and the prevalence of epilepsy. BMD/DMD is strongly associated with the prevalence of epilepsy, with a higher prevalence in BMD/DMD populations than in the general population, probably owing to alterations in Dp427. The current evidence does not support the hypothesis that Dp140 or Dp71 affect epilepsy risk.

Gut Microbiome Distinguishes Patients With Epilepsy From Healthy Individuals

Objective: The gut microecosystem is the largest microecosystem in the human body and has been proven to be linked to neurological diseases. The main objective of this study was to characterize the fecal microbiome, investigate the differences between epilepsy patients and healthy controls, and evaluate the potential efficacy of the fecal microbiome as a diagnostic tool for epilepsy.

Design: We collected 74 fecal samples from epilepsy patients (Eps, n = 24) and healthy controls (HCs, n = 50) in the First Affiliated Hospital of Zhengzhou University and subjected the samples to 16S rRNA MiSeq sequencing and analysis. We set up a train set and a test set, identified the optimal microbial markers for epilepsy after characterizing the gut microbiome in the former and built a diagnostic model, then validated it in the validation group.

Results: There were significant differences in microbial communities between the two groups. The α-diversity of the HCs was higher than that of the epilepsy group, but the Venn diagram showed that there were more unique operational taxonomic unit (OTU) in the epilepsy group. At the phylum level, Proteobacteria and Actinobacteriota increased significantly in Eps, while the relative abundance of Bacteroidota increased in HCs. Compared with HCs, Eps were enriched in 23 genera, including Faecalibacterium, Escherichia-Shigella, Subdoligranulum and Enterobacteriaceae-unclassified. In contrast, 59 genera including Bacteroides, Megamonas, Prevotella, Lachnospiraceae-unclassified and Blautia increased in the HCs. In Spearman correlation analysis, age, WBC, RBC, PLT, ALB, CREA, TBIL, Hb and Urea were positively correlated with most of the different OTUs. Seizure-type, course and frequency are negatively correlated with most of the different OTUs. In addition, twenty-two optimal microbial markers were identified by a fivefold cross-validation of the random forest model. In the established train set and test set, the area under the curve was 0.9771 and 0.993, respectively.

Conclusion: Our study was the first to characterize the gut microbiome of Eps and HCs in central China and demonstrate the potential efficacy of microbial markers as a noninvasive biological diagnostic tool for epilepsy.

Treatment Outcome and Risk Factors of Adult Newly Diagnosed Epilepsy: A Prospective Hospital-Based Study in Northeast China

Objective: The study was conducted to summarize the treatment outcomes of newly diagnosed epilepsy (NDE) and analyse the risk factors for refractory epilepsy (RE) in Northeast China.

Methods: A total of 466 adult patients with NDE were consecutively enrolled in this programme. Clinical data were collected at baseline and each follow-up. Several scales concerning recognition and mood were also completed at the first visit.

Results: Seizure-free status was achieved by 52% (n = 244) of the patients; however, 15% (n = 68) manifested RE. A total of 286 (61%) patients continued with the first ASM as monotherapy, among which 186 (40%) patients became seizure-free. Fifteen (22%) patients with RE became seizure-free following ASM adjustment and 34 patients (14%) had breakthrough seizures after being classified as seizure-free. One patient developed RE after attaining seizure-free status. Breakthrough seizures during the first expected interictal interval [Odds ratio (OR) = 5.81, 95% CI: 2.70–12.50], high seizure frequency at baseline (OR = 1.24, 95% CI: 1.04–1.49), younger age of onset (OR = 1.42, 95% CI: 1.12–1.79), and male sex (OR = 2.64, 95% CI: 1.26–5.53) were risk factors for RE.

Significance: Treatment outcomes of the majority of NDE cases are good. New risk factors could help physicians more promptly and accurately identify patients who are likely to develop RE. Seizure-free state is not long enough to commence the withdrawal of ASMs. RE is not permanent and seizure-free may be achieved subsequently by appropriate drug adjustment.

Severity Grading, Risk Factors, and Prediction Model of Complications After Epilepsy Surgery: A Large-Scale and Retrospective Study

Purpose: To report complications after epilepsy surgery, grade the severity of complications, investigate risk factors, and develop a nomogram for risk prediction of complications.

Methods: Patients with epilepsy surgery performed by a single surgeon at a single center between October 1, 2003 and April 30, 2019 were retrospectively analyzed. Study outcomes included severity grading of complications occurring during the 3-month period after surgery, risk factors, and a prediction model of these complications. Multivariable logistic regression analysis was used to calculate odds ratio and 95% confidence interval to identify risk factors.

Results: In total, 2,026 surgical procedures were eligible. There were 380 patients with mild complications, 23 with moderate complications, and 82 with severe complications. Being male (odds ratio 1.29, 95% confidence interval 1.02–1.64), age at surgery (>40 years: 2.58, 1.55–4.31; ≤ 40: 2.25, 1.39–3.65; ≤ 30: 1.83, 1.18–2.84; ≤ 20: 1.71, 1.11–2.63), intracranial hemorrhage in infancy (2.28, 1.14–4.57), serial number of surgery ( ≤ 1,000: 1.41, 1.01–1.97; ≤ 1,500: 1.63, 1.18–2.25), type of surgical procedure (extratemporal resections: 2.04, 1.55–2.70; extratemporal plus temporal resections: 2.56, 1.80–3.65), surgery duration (>6 h: 1.94, 1.25–3.00; ≤ 6: 1.92, 1.39–2.65), and acute postoperative seizure (1.44, 1.06–1.97) were independent risk factors of complications. A nomogram including age at surgery, type of surgical procedure, and surgery duration was developed to predict the probability of complications.

Conclusions: Although epilepsy surgery has a potential adverse effect on the patients, most complications are mild and severe complications are few. Risk factors should be considered during the perioperative period. Patients with the above risk factors should be closely monitored to identify and treat complications timely. The prediction model is very useful for surgeons to improve postoperative management.

Agmatine Alleviates Epileptic Seizures and Hippocampal Neuronal Damage by Inhibiting Gasdermin D-Mediated Pyroptosis

Background: Epilepsy is a common neurological disease, and neuroinflammation is one of the main contributors to epileptogenesis. Pyroptosis is a type of pro-inflammatory cell death that is related to epilepsy. Agmatine, has anti-inflammatory properties and exerts neuroprotective effects against seizures. Our study investigated the effect of agmatine on the core pyroptosis protein GSDMD in the context of epilepsy.

Methods: A chronic epilepsy model and BV2 microglial cellular inflammation model were established by pentylenetetrazole (PTZ)-induced kindling or lipopolysaccharide (LPS) stimulation. H&E and Nissl staining were used to evaluate hippocampal neuronal damage. The expression of pyroptosis and inflammasome factors was examined by western blotting, quantitative real-time PCR, immunofluorescence and enzyme-linked immunosorbent assay (ELISA).

Results: Agmatine disrupted the kindling acquisition process, which decreased seizure scores and the incidence of full kindling and blocked hippocampal neuronal damage. In addition, agmatine increased BV2 microglial cell survival in vitro and alleviated seizures in vivo by suppressing the levels of PTZ-induced pyroptosis. Finally, the expression of TLR4, MYD88, phospho-IκBα, phospho-NF-κB and the NLRP3 inflammasome was significantly upregulated in LPS-induced BV2 microglial cells, while agmatine suppressed the expression of these proteins.

Conclusions: Our results indicate that agmatine affects epileptogenesis and exerts neuroprotective effects by inhibiting neuroinflammation, GSDMD activation, and pyroptosis. The inhibitory effect of agmatine on pyroptosis was mediated by the suppression of the TLR4/MYD88/NF-κB/NLRP3 inflammasome pathway. Therefore, agmatine may be a potential treatment option for epilepsy.

Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis

Introduction: China has ~6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures. Perampanel (PER) is a novel anti-epileptic drug for partial-onset seizures. PER has been included in the latest Chinese National Reimbursement Drug List (NRDL) in 2020. However, there is still a lack of evaluation evidence on the value of PER in China. Methods: This study selected a health system perspective. A Markov model was established to simulate the lifelong transition of different response levels and calculate the number of seizures in Chinese patients. Based on the utility value and mortality risk, the life years and quality-adjusted life years (QALYs) of patients using PER vs. lacosamide (LCM) were estimated. Efficacy data were derived from clinical trials and the literature. Cost data (in US dollars) included drug costs and medical service costs. A lifetime horizon was adopted. Health outcomes and costs were discounted at an annual discount rate of 5%. Deterministic sensitivity analysis, probability sensitivity analysis, and scenario analysis were performed. The impact of the inclusion of PER in the NRDL on the medical insurance budget over 3 years (2021-2023) was also estimated. Results: Cost-effectiveness analysis indicates that 8 mg/day of PER increases QALYs by 0.054 and saves costs by $2,390 compared with 400 mg/day of LCM. 4 mg/day of PER increases QALYs by 0.010 and saves costs by $860 compared with 200 mg/day of LCM. Deterministic sensitivity analysis reveals that utility value and the extreme discount rate are the factors with the greatest impact on the incremental cost-effectiveness ratio. Probabilistic sensitivity analysis and scenario analysis show that the results are robust. Budget impact analysis indicates that after inclusion of PER in the NRDL, the incremental budget would be $1.28, $2.83, and $4.56 million from 2021 to 2023, respectively, but covering more eligible epileptic patients in the same time (1,918, 4,287, and 8,983, respectively). Conclusion: PER (8 or 4 mg/day) is of relatively high value as an add-on therapeutic regimen for partial-onset seizures in China because of its dominate advantage of cost-effectiveness over LCM and acceptable budget impact.

Cytisine Exerts an Anti-Epileptic Effect via α7nAChRs in a Rat Model of Temporal Lobe Epilepsy

Background and Purpose: Temporal lobe epilepsy (TLE) is a common chronic neurological disease that is often invulnerable to anti-epileptic drugs. Increasing data have demonstrated that acetylcholine (ACh) and cholinergic neurotransmission are involved in the pathophysiology of epilepsy. Cytisine, a full agonist of α7 nicotinic acetylcholine receptors (α7nAChRs) and a partial agonist of α4β2nAChRs, has been widely applied for smoking cessation and has shown neuroprotection in neurological diseases. However, whether cytisine plays a role in treating TLE has not yet been determined.

Experimental Approach: In this study, cytisine was injected intraperitoneally into pilocarpine-induced epileptic rats for three weeks. Alpha-bungarotoxin (α-bgt), a specific α7nAChR antagonist, was used to evaluate the mechanism of action of cytisine. Rats were assayed for the occurrence of seizures and cognitive function by video surveillance and Morris water maze. Hippocampal injuries and synaptic structure were assessed by Nissl staining and Golgi staining. Furthermore, levels of glutamate, γ-aminobutyric acid (GABA), ACh, and α7nAChRs were measured.

Results: Cytisine significantly reduced seizures and hippocampal damage while improving cognition and inhibiting synaptic remodeling in TLE rats. Additionally, cytisine decreased glutamate levels without altering GABA levels, and increased ACh levels and α7nAChR expression in the hippocampi of TLE rats. α-bgt antagonized the above-mentioned effects of cytisine treatment.

Conclusion and Implications: Taken together, these findings indicate that cytisine exerted an anti-epileptic and neuroprotective effect in TLE rats via activation of α7nAChRs, which was associated with a decrease in glutamate levels, inhibition of synaptic remodeling, and improvement of cholinergic transmission in the hippocampus. Hence, our findings not only suggest that cytisine represents a promising anti-epileptic drug, but provides evidence of α7nAChRs as a novel therapeutic target for TLE.

Anti-seizure Medication Prescription in Adult Outpatients With Epilepsy in China, 2013-2018

This study aimed to assess the national trends in anti-seizure medication (ASM) prescription in Chinese adult outpatients with epilepsy over a 6-year period from 2013 to 2018. Prescriptions for adult outpatients with epilepsy from hospitals in six major cities were extracted from the database of the Hospital Prescription Analysis Cooperative Project. Trends in the annual prescriptions and expenditure of ASM were analyzed. Prescription patterns (monotherapy or combination therapy) were also assessed. A total of 225,767 prescriptions from 60 hospitals were eligible and extracted for analysis. The number of ASM prescriptions increased from 28,360 in 2013 to 44,110 in 2018, and the corresponding cost increased from 9,452,990 Chinese Yuan (CNY) in 2013 to 14,627,865 CNY in 2018. The share of newer ASM use increased continuously, accounting for 56.75% of prescriptions and 85.03% of expenditure in 2018. The most frequently prescribed ASMs were sodium valproate and levetiracetam. The proportion of sodium valproate use decreased, while the proportion of levetiracetam use increased dramatically in terms of both ASM prescriptions and expenditure. Monotherapy was more frequent than combination therapy. The three most common combination therapies were sodium valproate/lamotrigine, levetiracetam/oxcarbazepine, and sodium valproate/levetiracetam. In summary, ASM use increased rapidly in terms of the number of ASM prescriptions and cost during the 6-year period, which raises concern regarding the rational use and pharma-economic profiles of ASMs. In place of valproate, levetiracetam became the most frequently used ASM. The development of ASM prescription is in line with therapy guidelines and reflects the current state of research in China.

miR-485 inhibits histone deacetylase HDAC5, HIF1α and PFKFB3 expression to alleviate epilepsy in cellular and rodent models

We investigated the role of microRNA (miR)-485 and its downstream signaling molecules on mediating epilepsy in cellular and rat models. We established a cellular epilepsy model by exposing hippocampal neurons to magnesium and a rat model by treating ICR mice with lithium chloride (127 mg/kg) and pilocarpine (30 mg/kg). We confirmed that miR-485 could bind and inhibit histone deacetylase 5 (HDAC5) and then measured expression of miR-485 and in mice and cells. Cells were transfected with overexpression or knockdown of miR-485, HDAC5, hypoxia-inducible factor-1alpha (HIF1α), or 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 enzyme (PFKFB3) to verify their roles in apoptosis, oxidative stress, and inflammation in epileptic hippocampal neurons. Binding relationship between miR-485, HDAC5, HIF1α, and PFKFB3 was verified. Oxidative stress and inflammation marker levels in epilepsy model mice were assessed. miR-485 was downregulated and HDAC5 was upregulated in cell and animal model of epilepsy. Seizure, neuronal apoptosis, oxidative stress (increased SOD and GSH-Px expression and decreased MDA and 8-OHdG expression) and inflammation (reduced IL-1β, TNF-α, and IL-6 expression) were reduced by miR-485 in epileptic cells. HIF1α and PFKFB3 expression was reduced by HDAC5 knockdown in cells, which was recapitulated in vivo. Thus, miR-485 alleviates neuronal damage and epilepsy by inhibiting HDAC5, HIF1α, and PFKFB3.

The global prevalence of essential tremor, with emphasis on age and sex: A meta-analysis

Background

Essential tremor (ET) is one of the most common neurological disorders that impairs quality of life and leads to disability and social handicap. It was estimated that approximate 0.9% of people worldwide were affected by ET. The last decade has seen new investigations on the epidemiology of ET, enabling us to provide an up-to-date estimation of ET prevalence, with emphasis on age and sex.

Methods

We searched PubMed, Medline, Embase and Global Health for studies that reported the prevalence of ET in the general population. Potential sources of heterogeneity were examined by age-adjusted meta-regression. The age- and sex-specific prevalence of ET was constructed with a multilevel mixed-effects meta-regression.

Results

A total of 29 articles were included in our systematic review and meta-analysis. The prevalence of ET increased dramatically with advancing age, where the prevalence estimate in people aged under 20 years was 0.04% (95% confidence interval [CI] = 0.00-0.29) and that in elderly aged 80 years and above was 2.87% (95% CI = 1.07-7.49). ET was consistently more common in males than in females. In 2020, the overall prevalence of ET in the general population was 0.32% (95% CI = 0.12-0.91), and the prevalence was higher in males (0.36%, 95% CI = 0.14-1.03) than in females (0.28%, 95% CI = 0.11-0.79). In 2020, the number of people affected by ET was 24.91million (95% CI = 9.51-70.92), among whom 56% were males.

Conclusions

This study provides an up-to-date estimation of ET prevalence in the general population throughout the whole life span, with emphasis on age and sex. The adoption of an internationally acknowledged diagnostic strategy is prompted in future epidemiological investigations.

Protocol registration

PROSPERO (CRD42020203979)

Risk factors for suicidal tendency in people with epilepsy in China: a case-control study

People with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.

Patient Preference for Antiepileptic Drugs Treatment in China: Evidence From the Discrete Choice Experiment

Objective: Explore Chinese patients' risk-benefit preferences and willingness-to-pay (WTP) for antiepileptic drugs (AEDs) treatment through the discrete choice experiment (DCE).

Method: Six attributes including the efficacy of AEDs, adverse reactions (digestive system, neuropsychic systems, and the effects on the fetus), dosing frequency and drug costs (to estimate patient WTP) were included in the DCE questionnaire based on results collected from literature reviews, expert consultation, and patient survey. The alternative-specific conditional logit model was used to analyze patient preference and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics.

Results: A total of 151 valid questionnaires were collected. The result shows that five out of the six attributes are significant, except the dosing frequency. Among the six attributes, the efficacy of AEDs (10.0; 95% CI 8.9–11.1) is mostly concerned by patients, followed by the effects of AEDs on the fetus (8.9; 95% CI 7.7–10.1), duration of side effects in the neuropsychic system (4.9; 95% CI 3.7–6.0) and adverse reactions of the digestive system (3.2; 95% CI 1.5–4.2). The patients surveyed are willing to spend ¥ 1,246 (95% CI, ¥ 632- ¥ 1,861) per month to ensure 100% seizure control, and ¥ 1,112 (95% CI, ¥ 586–¥ 1,658) to reduce the risk of the drug affecting the fetus to 3%. Besides, it was found that personal characteristics including the intention for conception and AEDs treatment regimens have statistical significance.

Conclusion: Improving the drug's efficacy and reducing its side effects are predominant considerations for patients with epilepsy in China, especially for those who are concerned about the seizure control and the drug effect on the fetus. This finding is useful to physicians and can encourage shared decision-making between the patients and their doctors in the clinic.

Epilepsy Occurrence and Circadian Rhythm: A Bibliometrics Study and Visualization Analysis via CiteSpace

Objective: This study aimed to review the research status and to demonstrate the hot spots and frontiers of epilepsy and circadian rhythm via CiteSpace.

Method: We searched Web of Science (WoS) for studies related to epilepsy and circadian rhythm from inception to 2020. CiteSpace was used to generate network maps about the collaborations between authors, countries, and institutions and reveal hot spots and frontiers of epilepsy and circadian rhythm.

Results: A total of 704 studies related to epilepsy and circadian rhythm from the WoS were retrieved. Sanchez-Vazquez FJ was the most prolific author (17 articles). The USA and University of Murcia were the leading country and institution in this field with 219 and 22 publications, respectively. There were active collaborations among the authors, countries, and institutions. Hot topics focused on the interaction between epilepsy and circadian rhythm, as well as possible novel treatments.

Conclusions: Based on the results of CiteSpace, the current study suggested active cooperation between authors, countries, and institutions. Major ongoing research trends include the circadian rhythm of epilepsy based on different epileptic focus and the interaction between epilepsy and circadian rhythm, especially through melatonin, sleep–wake cycles, and clock genes, which may implicate possible treatments (such as chronotherapy, neural stem cells transplantation) for epilepsy in the future.

Comparison of Psychological Difficulties in Patients with Migraine and Epilepsy Using PARADISE-24 Questionnaire

BACKGROUND

Patients with migraine or epilepsy suffer from a wide range of psychological difficulties, and various instruments are needed to separately assess each difficulty. However, the PARADISE-24 questionnaire is a comprehensive questionnaire for evaluating different psychological difficulties in cases with neurological disorders.

OBJECTIVE

The aim of this study was to compare psychological difficulties in patients with migraine and those with epilepsy by using the PARADISE-24 questionnaire.

METHODS

Overall, 240 migraineurs and 210 patients with epilepsy were enrolled. All the participants were asked to fill the Persian version of the PARADISE-24 questionnaire.

RESULTS

In migraineurs, the mean age and mean headache severity (by means of visual analogue scale, VAS) were 38.6±11.6 and 6.8±2.8, respectively. In patients with epilepsy, the mean age and mean duration of the disease were 33.6±13.4 and 12±10.3 years, respectively. The mean PARADISE score was significantly higher in migraineurs than in epileptic cases (57.9±12 vs 50.7±15.1) (p<0.001).

CONCLUSION

Patients with migraine suffer more from psychological difficulties than epileptic cases. This finding could help physicians to pay more attention to psychological well-being.

Ambient air pollution and its influence on human health and welfare: an overview

Human health is closely related to his environment. The influence of exposure to air pollutants on human health and well-being has been an interesting subject and gained much volume of research over the last 50 years. In general, polluted air is considered one of the major factors leading to many diseases such as cardiovascular and respiratory disease and lung cancer for the people. Besides, air pollution adversely affects the animals and deteriorates the plant environment. The overarching objective of this review is to explore the previous researches regarding the causes and sources of air pollution, how to control it and its detrimental effects on human health. The definition of air pollution and its sources were introduced extensively. Major air pollutants and their noxious effects were detailed. Detrimental impacts of air pollution on human health and well-being were also presented.

MiR-206 inhibits epilepsy and seizure-induced brain injury by targeting CCL2

To determine the function of miR-206 in epilepsy. Epileptic rat model was established by intra-amygdala injection of kainic acid (KA). Expression levels of miR-206, C-C Motif Chemokine Ligand 2 (CCL2) and interleukin-1β (Il-1β) in hippocampus tissues was measured by reverse transcription-quantitative PCR (RT-qPCR) and western blot. Dual luciferase reporter assay was performed to determine the binding of miR-206 to 3' untranslated region (UTR) of CCL2. Finally, brain waves were recorded and Hematoxylin and eosin (HE) staining and Nissl's staining were performed on the epileptic rat injected with LPS, miR-206 agomir, adeno-associated virus (AAV) expressed CCL2 alone or in combination. Expression of miR-206 was specially decreased in hippocampus tissues compared to cortex in response to KA induced pathologic brain activity. Enforced expression of miR-206 by injection miR-206 agomir not only decreased seizure activity, but also protected KA-induced neuronal loss. And enforced expression of miR-206 suppressed increase of C-C Motif Chemokine Ligand 2 (CCL2) and interleukin-1β (Il-1β) which were induced by injection of KA or KA combined with lipopolysaccharide (LPS). Further more, results of dual luciferase reporter assay confirmed CCL2 was a target of miR-206. Finally, co-injection adeno-associated virus (AAV) expressed CCL2 with miR-206 agomir abolished the function of miR-206 agomir. Taken together, our results showed that expression of miR-206 could inhibit seizure-induced brain injury by targeting CCL2. Our results showed that expression of miR-206 could inhibit seizure-induced brain injury by targeting CCL2.

Medication Belief and Adherence among Patients with Epilepsy

BACKGROUND

Medication adherence and belief are crucial to achieving the desired goal of therapy in epileptic patients. However, there is a lack of study regarding medication adherence and belief in our setting. Therefore, the purpose of this study was to investigate medication adherence and belief and associated factors among ambulatory patients with epilepsy.

METHOD

A cross-sectional study was conducted on randomly selected epileptic patients at the neurologic clinic of Ayder Comprehensive Specialized Hospital, Ethiopia. Medication adherence and belief were assessed using self-reported questionnaires which were developed based on the review of different literatures. Data were analyzed using binary logistic regression analysis.

RESULT

We included a total of 292 patients. Almost two-thirds (65.4%) of the patients were nonadherent to their medications. The most common cause of nonadherence was forgetfulness (48.7%) followed by inability to get medicine (28.8) and safety concern (23.5%). The majority (78.4%) of the patients had high medication necessity belief while 44.1% had high concern belief about the potential adverse effect of their medications. Overall, 39.4% of the patients had a negative belief toward their medications. Comorbidity (AOR: 3.51, 95% CI: 1.20-10.31), seizure encounter within the last 3 months (AOR: 5.45, 95% CI: 2.48-12.00), low medication necessity belief (AOR: 3.38, 95% CI: 1.14-10.00), high medication concern belief (AOR: 4.23, 95% CI: 2.07-8.63), and negative medication belief (AOR: 4.17, 95% CI: 1.74-10.02) were predictors of medication nonadherence.

CONCLUSION

Majority of the epileptic patients were nonadherent to their medications, and more than one-third of the patients had a negative medication belief. Low medication necessity belief, high medication concern belief, negative medication belief, comorbidity, and seizure encounter were predictors of medication nonadherence. Therefore, healthcare providers should design educational programs to enhance the patients' believe about their medication in order to improve medication adherence and overall treatment outcome.

Stereotypical patterns of epileptiform calcium signal in hippocampal CA1, CA3, dentate gyrus and entorhinal cortex in freely moving mice

Epilepsy is a multi-etiological brain dysfunction syndrome. Hippocampal neuronal damage induced by seizures may be one of the causes leading to cognitive impairment, but the underlying mechanism remains to be further elucidated. The kainic acid (KA) model of temporal lobe epilepsy is widely used in understanding of the epileptogenesis. Fiber photometry is a signal detection technology suitable for recording calcium activity of neurons in the deep brain of freely moving animal. Here, we used the optical fiber-based method to monitor the real-time neuronal population activities of freely moving mice after subcutaneous injection of KA. We observed that KA administration led to one to three kinds of stereotypical patterns of epileptiform calcium activity in CA1, CA3, and dentate gyrus (DG) of the hippocampus, as well as the entorhinal cortex (EC). There were three kinds of waves in the hippocampal CA1, which we named wave 1, wave 2 and slow flash. Wave 1 and wave 2 appeared in both the CA3 and DG regions, but the EC only showed wave 1. In these epileptiform calcium signals, we observed a high amplitude and long duration calcium wave as a part of wave 2, which resembled cortical spreading depression (CSD) and always appeared at or after the end of seizure. Because the same characteristic of epileptiform calcium signal appeared in different brain regions, calcium signal may not exist with region specificity, but may exhibit a cell type specific manner. Thus, our work provides a support for the pathogenesis of epilepsy and epileptiform signal transmission research.