The History of Epilepsy: From Ancient Mystery to Modern Misconception

Schiff Bases: A Captivating Scaffold with Potential Anticonvulsant Activity

One of the most important organic compounds, also known as a Schiff base, imine, or azomethine, has been associated with several biological processes. The group is a component of both natural or synthetic chemicals and functions as both a precursor and an intermediary in the synthesis of therapeutically active substances. The review highlights the various non-metal Schiff bases' structure-activity relationship (SAR) studies, general model, docking, and design approach for anticonvulsant actions. Schiff bases serve as linkers in numerous synthetic compounds with a variety of activities, according to the findings of several investigations. As a result, the current review will give readers a thorough understanding of the key ideas put forth by different researchers regarding the anticonvulsant properties of Schiff bases. It will serve as a valuable information source for those planning to synthesize new anticonvulsant molecules that contain Schiff bases as pharmacophores or biologically active moieties.

Assessment and evaluation of quality of life in epileptic patients using QOLIE-31 and QOLIE-AD-48 at tertiary care hospital

INTRODUCTION

The World Health Organization (WHO) defines quality of life as a person's assessment of their place in life in the context of the culture and value systems in which they live, as well as in connection to their objectives, expectations, standards, and worries. Physiological as well as emotional wellness both affect quality of life (QOL).

OBJECTIVE

To assess and evaluate the quality of life in epileptic patients by using Quality of life in epilepsy inventory for adolescent (QOLIE-AD-48) and Quality of life in epilepsy inventory for adults (QOLIE-31) at tertiary care hospital.

METHODS

After receiving approval from the Institution Ethics Committees (IEC) of the ISF College of Pharmacy and Guru Gobind Singh Medical College and Hospital, Faridkot. This observational and questionnaire based study was carried out for a period of six months. Quality of life in epilepsy inventory for adolescent (QOLIE-AD-48) and Quality of life in epilepsy inventory for adults (QOLIE-31) had been used for this research and got approval from Dr. Joyce A. Cramer to use the questionnaire.

RESULTS

Except for the patients who declined to participate in the study, 109 individuals who participated in the observation and questionnaire-based study was enrolled. In this study, it was discovered that adolescents made up the majority of the patients with respect to adults and quality of life was found to be good (p = 0.062). The mean score of quality of life of the patients and standard deviation (SD) was found to be (M = 61.26) and (SD = 21.10). Males (63%, 69 patients) were found higher with respect to females (37%, 40 patients). Linear regression test was found to be significant (p = 0.003) of quality of life score (dependent variable) in relation to age and weight (independent variable) of the patients it. One way ANOVA test was found significant of quality of life score in relation to educational status (p = 0.001), epilepsy from last year (p = 0.001), and drug therapy (p = 0.017).

CONCLUSION

The current study explains the relationship between quality of life and other dependent variables by using different statistical analysis techniques. The quality of life of epileptic patients must be assessed on an individual basis, taking into consideration the patient's state of physical health and psychological state. This study concludes that the quality of life of epileptic patients was found to be good as per significant results. If any of factors changes then there will also be differ in quality of life score.

Epilepsy: Mitochondrial connections to the 'Sacred' disease

Over 65 million people suffer from recurrent, unprovoked seizures. The lack of validated biomarkers specific for myriad forms of epilepsy makes diagnosis challenging. Diagnosis and monitoring of childhood epilepsy add to the need for non-invasive biomarkers, especially when evaluating antiseizure medications. Although underlying mechanisms of epileptogenesis are not fully understood, evidence for mitochondrial involvement is substantial. Seizures affect 35%-60% of patients diagnosed with mitochondrial diseases. Mitochondrial dysfunction is pathophysiological in various epilepsies, including those of non-mitochondrial origin. Decreased ATP production caused by malfunctioning brain cell mitochondria leads to altered neuronal bioenergetics, metabolism and neurological complications, including seizures. Iron-dependent lipid peroxidation initiates ferroptosis, a cell death pathway that aligns with altered mitochondrial bioenergetics, metabolism and morphology found in neurodegenerative diseases (NDDs). Studies in mouse genetic models with seizure phenotypes where the function of an essential selenoprotein (GPX4) is targeted suggest roles for ferroptosis in epilepsy. GPX4 is pivotal in NDDs, where selenium protects interneurons from ferroptosis. Selenium is an essential central nervous system micronutrient and trace element. Low serum concentrations of selenium and other trace elements and minerals, including iron, are noted in diagnosing childhood epilepsy. Selenium supplements alleviate intractable seizures in children with reduced GPX activity. Copper and cuproptosis, like iron and ferroptosis, link to mitochondria and NDDs. Connecting these mechanistic pathways to selenoproteins provides new insights into treating seizures, pointing to using medicines including prodrugs of lipoic acid to treat epilepsy and to potential alternative therapeutic approaches including transcranial magnetic stimulation (transcranial), photobiomodulation and vagus nerve stimulation.

Zebrafish as a robust preclinical platform for screening plant-derived drugs with anticonvulsant properties-a review

Traditionally, selected plant sources have been explored for medicines to treat convulsions. This continues today, especially in countries with low-income rates and poor medical systems. However, in the low-income countries, plant extracts and isolated drugs are in high demand due to their good safety profiles. Preclinical studies on animal models of seizures/epilepsy have revealed the anticonvulsant and/or antiepileptogenic properties of, at least some, herb preparations or plant metabolites. Still, there is a significant number of plants known in traditional medicine that exert anticonvulsant activity but have not been evaluated on animal models. Zebrafish is recognized as a suitable in vivo model of epilepsy research and is increasingly used as a screening platform. In this review, the results of selected preclinical studies are summarized to provide credible information for the future development of effective screening methods for plant-derived antiseizure/antiepileptic therapeutics using zebrafish models. We compared zebrafish vs. rodent data to show the translational value of the former in epilepsy research. We also surveyed caveats in methodology. Finally, we proposed a pipeline for screening new anticonvulsant plant-derived drugs in zebrafish ("from tank to bedside and back again").

Whole exome sequencing identified five novel variants in CNTN2, CARS2, ARSA, and CLCN4 leading to epilepsy in consanguineous families

Introduction: Epilepsy is a group of neurological disorders characterized by recurring seizures and fits. The Epilepsy genes can be classified into four distinct groups, based on involvement of these genes in different pathways leading to Epilepsy as a phenotype. Genetically the disease has been associated with various pathways, leading to pure epilepsy-related disorders caused by CNTN2 variations, or involving physical or systemic issues along with epilepsy caused by CARS2 and ARSA, or developed by genes that are putatively involved in epilepsy lead by CLCN4 variations. Methods: In this study, five families of Pakistani origin (EP-01, EP-02, EP-04, EP-09, and EP-11) were included for molecular diagnosis. Results: Clinical presentations of these patients included neurological symptoms such as delayed development, seizures, regression, myoclonic epilepsy, progressive spastic tetraparesis, vision and hearing impairment, speech problems, muscle fibrillation, tremors, and cognitive decline. Whole exome sequencing in index patients and Sanger sequencing in all available individuals in each family identified four novel homozygous variants in genes CARS2: c.655G>A p.Ala219Thr (EP-01), ARSA: c.338T>C: p.Leu113Pro (EP-02), c.938G>T p.Arg313Leu (EP-11), CNTN2: c.1699G>T p.Glu567Ter (EP-04), and one novel hemizygous variant in gene CLCN4: c.2167C>T p.Arg723Trp (EP-09). Conclusion: To the best of our knowledge these variants were novel and had not been reported in familial epilepsy. These variants were absent in 200 ethnically matched healthy control chromosomes. Three dimensional protein analyses revealed drastic changes in the normal functions of the variant proteins. Furthermore, these variants were designated as "pathogenic" as per guidelines of American College of Medical Genetics 2015. Due to overlapping phenotypes, among the patients, clinical subtyping was not possible. However, whole exome sequencing successfully pinpointed the molecular diagnosis which could be helpful for better management of these patients. Therefore, we recommend that exome sequencing be performed as a first-line molecular diagnostic test in familial cases.

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Presently, at least 60 million people are suffering from epilepsy worldwide. Although multiple pharmacological options for treatment exist, about 30% to 40% of these patients are estimated to have drug-resistant epilepsy (DRE), which is associated with severe disability and morbidity. The surgical treatment options are restricted to either open surgical procedures or laser ablations. When a resective option is not favorable, then neuromodulation options such as vagal nerve stimulation and deep brain stimulation are considered. A relatively recent and more commonly used clinical application is the deep brain stimulation (DBS) of the anterior thalamic nucleus, FDA approval for which was obtained in 2018. Furthermore, new technological advances in DBS technology are expected to positively impact the treatment options of these patients.