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Bozorg A, Beller C, Jensen L, Arzimanoglou A, Chiron C, Dlugos D, Gaitanis J, Wheless JW, McClung C. Pitfalls of using video-EEG for a trial endpoint in children aged <4 years with focal seizures. Ann Clin Transl Neurol 2024; 11:780-790. [PMID: 38318689 DOI: 10.1002/acn3.51999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Double-blind, randomized, and placebo-controlled trial SP0967 (NCT02477839/2013-000717-20) did not demonstrate superior efficacy of lacosamide versus placebo in patients aged ≥1 month to <4 years with uncontrolled focal seizures, per ≤72 h video-electroencephalogram (video-EEG)-based primary endpoints (reduction in average daily frequency of focal seizures at end-of-maintenance [EOM] versus end-of-baseline [EOB], patients with ≥50% response). This was unexpected because randomized controlled trial SP0969 (NCT01921205) showed efficacy of lacosamide in patients aged ≥4 to <17 years with uncontrolled focal seizures. SP0969's primary endpoint was based on seizure diary instead of video-EEG, an issue with the latter being inter-reader variability. We evaluated inter-reader agreement in video-EEG interpretation in SP0967, which to our knowledge, are the first such data for very young children with focal seizures from a placebo-controlled trial. METHODS Local investigator and central reader agreement in video-EEG interpretation was analyzed post hoc. RESULTS Analysis included 105 EOB and 98 EOM video-EEGs. Local investigators and central reader showed poor agreement based on ≥2 focal seizures at EOB (Kappa = 0.01), and fair agreement based on ≥2 focal seizures at EOM (Kappa = 0.23). Local investigator and central reader seizure count interpretations varied substantially, particularly for focal seizures, but also primary generalized and unclassified epileptic seizures, at both timepoints. INTERPRETATION High inter-reader variability and low inter-reader reliability of the interpretation of seizure types and counts prevent confident conclusion regarding the lack of efficacy of lacosamide in this population. We recommend studies in very young children do not employ video-EEGs exclusively for accurate study inclusion or as an efficacy measure.
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Affiliation(s)
- Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
| | | | - Lori Jensen
- UCB Pharma, Morrisville, North Carolina, USA
| | - Alexis Arzimanoglou
- Department of Paediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, Lyon, France
- Epilepsy Unit, San Juan de Dios Children's Hospital, Member of the ERN EpiCARE, Universitat de Barcelona, Barcelona, Spain
| | | | - Dennis Dlugos
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - James W Wheless
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Auvin S, Arzimanoglou A, Brambilla I, French J, Knupp KG, Lagae L, Perucca E, Trinka E, Dlugos D. Call for the use of the ILAE terminology for seizures and epilepsies by health care professionals and regulatory agencies to benefit patients and caregivers. Epilepsia 2024; 65:283-286. [PMID: 38105624 DOI: 10.1111/epi.17868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
The International League Against Epilepsy (ILAE) introduced a classification for seizure types in 2017 and updated the classification for epilepsy syndromes in 2022. These classifications aim to improve communication among healthcare professionals and help patients better describe their condition. So far, regulatory agencies have used different terminology. This paper stresses the crucial need for consistently adopting ILAE terminology in both regulatory processes and clinical practice. It highlights how language plays a significant role in healthcare communication and how standardized terminology can enhance patient comprehension. The ongoing review of guidelines by regulatory bodies offers a timely opportunity. Aligning regulatory terminologies holds the potential to facilitate discussions on future drug development and harmonize practices across diverse regions, ultimately fostering improved care and research outcomes in epilepsy treatment.
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Affiliation(s)
- Stéphane Auvin
- Institut national de la santé et de la recherche médicale (INSERM) NeuroDiderot, Université Paris Cité, Paris, France
- Pediatric Neurology Department, APHP, CRMR Epilepsies Rares, member of European Reference Network EpiCARE, Robert Debré University Hospital, Paris, France
- Institut Universitaire de France, Paris, France
| | - Alexis Arzimanoglou
- Coordinating Member of the European Reference Network EpiCARE, Children's University Hospital San Juan de Dios, Barcelona, Spain
| | - Isabella Brambilla
- Coordinator, EPAG Patient Group, European Reference Network EpiCARE, Dravet Italia Onlus, Verona, Italy
| | - Jacqueline French
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Kelly G Knupp
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lieven Lagae
- Member of the European Reference Network EPICARE, Paediatric Neurology Section, Department of Development and Regeneration, University Hospitals KU Leuven, Leuven, Belgium
| | - Emilio Perucca
- Department of Medicine (Austin Health), University of Melbourne, Mebourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Eugen Trinka
- Member of European Reference Network EpiCARE, Department of Neurology, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Neuroscience Institute, Center for Cognitive Neuroscience, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tyrol, Austria
| | - Dennis Dlugos
- Pediatric Epilepsy Program, Division of Neurology, Department of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Pediatric Epilepsy Program, Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Perry MS, Scheffer IE, Sullivan J, Brunklaus A, Boronat S, Wheless JW, Laux L, Patel AD, Roberts CM, Dlugos D, Holder D, Knupp KG, Lallas M, Phillips S, Segal E, Smeyers P, Lal D, Wirrell E, Zuberi S, Brünger T, Wojnaroski M, Maru B, O'Donnell P, Morton M, James E, Vila MC, Huang N, Gofshteyn JS, Rico S. Severe communication delays are independent of seizure burden and persist despite contemporary treatments in SCN1A+ Dravet syndrome: Insights from the ENVISION natural history study. Epilepsia 2024; 65:322-337. [PMID: 38049202 DOI: 10.1111/epi.17850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Dravet syndrome (DS) is a developmental and epileptic encephalopathy characterized by high seizure burden, treatment-resistant epilepsy, and developmental stagnation. Family members rate communication deficits among the most impactful disease manifestations. We evaluated seizure burden and language/communication development in children with DS. METHODS ENVISION was a prospective, observational study evaluating children with DS associated with SCN1A pathogenic variants (SCN1A+ DS) enrolled at age ≤5 years. Seizure burden and antiseizure medications were assessed every 3 months and communication and language every 6 months with the Bayley Scales of Infant and Toddler Development 3rd edition and the parent-reported Vineland Adaptive Behavior Scales 3rd edition. We report data from the first year of observation, including analyses stratified by age at Baseline: 0:6-2:0 years:months (Y:M; youngest), 2:1-3:6 Y:M (middle), and 3:7-5:0 Y:M (oldest). RESULTS Between December 2020 and March 2023, 58 children with DS enrolled at 16 sites internationally. Median follow-up was 17.5 months (range = .0-24.0), with 54 of 58 (93.1%) followed for at least 6 months and 51 of 58 (87.9%) for 12 months. Monthly countable seizure frequency (MCSF) increased with age (median [minimum-maximum] = 1.0 in the youngest [1.0-70.0] and middle [1.0-242.0] age groups and 4.5 [.0-2647.0] in the oldest age group), and remained high, despite use of currently approved antiseizure medications. Language/communication delays were observed early, and developmental stagnation occurred after age 2 years with both instruments. In predictive modeling, chronologic age was the only significant covariate of seizure frequency (effect size = .52, p = .024). MCSF, number of antiseizure medications, age at first seizure, and convulsive status epilepticus were not predictors of language/communication raw scores. SIGNIFICANCE In infants and young children with SCN1A+ DS, language/communication delay and stagnation were independent of seizure burden. Our findings emphasize that the optimal therapeutic window to prevent language/communication delay is before 3 years of age.
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Affiliation(s)
- M Scott Perry
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Ingrid E Scheffer
- University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Joseph Sullivan
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Linda Laux
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Anup D Patel
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deborah Holder
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Matt Lallas
- Nicklaus Children's Hospital, Miami, Florida, USA
| | | | - Eric Segal
- Northeast Regional Epilepsy Group & Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | | | | | | | - Sameer Zuberi
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Magda Morton
- Encoded Therapeutics, South San Francisco, California, USA
| | - Emma James
- Encoded Therapeutics, South San Francisco, California, USA
| | | | - Norman Huang
- Encoded Therapeutics, South San Francisco, California, USA
| | | | - Salvador Rico
- Encoded Therapeutics, South San Francisco, California, USA
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Molisani SE, Parikh D, DiGiovine M, Dlugos D, Fitzgerald MP, Fried L, Helbig I, Kessler SK, McDonnell PP, Melamed S, Prelack MS, Sharif U, Tefft S, Tencer J, Witzman S, Shaw K, Abend NS. A quality improvement initiative to improve folic acid supplementation counseling for adolescent females with epilepsy. Epilepsia 2023; 64:2818-2826. [PMID: 37496463 DOI: 10.1111/epi.17723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We designed a quality improvement (QI) project to improve rates of documented folic acid supplementation counseling for adolescent females with epilepsy, consistent with a quality measure from the American Academy of Neurology and American Epilepsy Society. Our SMART aim was to increase the percentage of visits at which folic acid counseling was addressed from our baseline rate of 23% to 50% by July 1, 2020. METHODS This initiative was conducted in female patients ≥12 years old with epilepsy who were prescribed daily antiseizure medication and were seen by the 13 providers in our Neurology QI Program. Using provider interviews, we undertook a root cause analysis of low counseling rates and identified the following main factors: insufficient time during clinic visit to counsel, lack of provider knowledge, and forgetting to counsel. Countermeasures were designed to address these main root causes and were implemented through iterative plan-do-study-act (PDSA) cycles. Interventions included provider education and features within the electronic health record, which were introduced sequentially, culminating in the creation of a best practice advisory (BPA). We performed biweekly chart reviews of visits for applicable patients to establish baseline performance rate and track progress over time. We used a statistical process control p-chart to analyze the outcome measure of documented counseling. As a balancing measure, clinicians were surveyed using the Technology Adoption Model survey to assess acceptance of the BPA. RESULTS From September 2019 to August 2022, the QI team improved rates of documented folic acid counseling from 23% to 73% through several PDSA cycles. This level of performance has been sustained over time. The most successful and sustainable intervention was the BPA. Provider acceptance of the BPA was overall positive. SIGNIFICANCE We successfully used QI methodology to improve and sustain our rates of documented folic acid supplementation counseling for adolescent females with epilepsy.
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Affiliation(s)
- Sara E Molisani
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Darshana Parikh
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marissa DiGiovine
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dennis Dlugos
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark P Fitzgerald
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lawrence Fried
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sudha Kilaru Kessler
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pamela Pojomovsky McDonnell
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Melamed
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marisa S Prelack
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Uzma Sharif
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah Tefft
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jaclyn Tencer
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Witzman
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathy Shaw
- Department of Pediatrics (Division of Emergency Medicine), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas S Abend
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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5
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Kanner AM, Saporta AS, Kim DH, Barry JJ, Altalib H, Omotola H, Jette N, O'Brien TJ, Nadkarni S, Winawer MR, Sperling M, French JA, Abou-Khalil B, Alldredge B, Bebin M, Cascino GD, Cole AJ, Cook MJ, Detyniecki K, Devinsky O, Dlugos D, Faught E, Ficker D, Fields M, Gidal B, Gelfand M, Glynn S, Halford JJ, Haut S, Hegde M, Holmes MG, Kalviainen R, Kang J, Klein P, Knowlton RC, Krishnamurthy K, Kuzniecky R, Kwan P, Lowenstein DH, Marcuse L, Meador KJ, Mintzer S, Pardoe HR, Park K, Penovich P, Singh RK, Somerville E, Szabo CA, Szaflarski JP, Lin Thio KL, Trinka E, Burneo JG. Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity. Neurology 2023; 100:e1123-e1134. [PMID: 36539302 PMCID: PMC10074468 DOI: 10.1212/wnl.0000000000201671] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mood, anxiety disorders, and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis are not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts. METHODS The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18-60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, χ2 statistics, and logistic regression analyses. RESULTS A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts. DISCUSSION In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.
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Affiliation(s)
- Andres M Kanner
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.
| | - Anita S Saporta
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dong H Kim
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - John J Barry
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hamada Altalib
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hope Omotola
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Nathalie Jette
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Terence J O'Brien
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Siddhartha Nadkarni
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Melodie R Winawer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Sperling
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jacqueline A French
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Bassel Abou-Khalil
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Brian Alldredge
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Martina Bebin
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Gregory D Cascino
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Andrew J Cole
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Mark J Cook
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kamil Detyniecki
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Orrin Devinsky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dennis Dlugos
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Edward Faught
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - David Ficker
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Madeline Fields
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Barry Gidal
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Gelfand
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Simon Glynn
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jonathan J Halford
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Sheryl Haut
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manu Hegde
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manisha G Holmes
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Reetta Kalviainen
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Joon Kang
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Pavel Klein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Robert C Knowlton
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kaarkuzhali Krishnamurthy
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ruben Kuzniecky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patrick Kwan
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Daniel H Lowenstein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Lara Marcuse
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kimford J Meador
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Scott Mintzer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Heath R Pardoe
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kristen Park
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patricia Penovich
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Rani K Singh
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ernest Somerville
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Charles A Szabo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jerzy P Szaflarski
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - K Liu Lin Thio
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Eugen Trinka
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jorge G Burneo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
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French JA, Cleary E, Dlugos D, Farfel G, Farrell K, Gidal B, Grzeskowiak CL, Gurrell R, Harden C, Stalvey TJ, Tsai J, Wirrell EC, Blum D, Fountain N. Considerations for determining the efficacy of new antiseizure medications in children age 1 month to younger than 2 years. Epilepsia 2022; 63:2664-2670. [PMID: 35835554 PMCID: PMC9804346 DOI: 10.1111/epi.17366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Drug treatment for children with epilepsy should, ideally, be governed by evidence from adequate and well-controlled clinical studies. However, these studies are difficult to conduct, and so direct evidence supporting the informed use of specific drugs is often lacking. The Research Roundtable for Epilepsy (RRE) met in 2020 to align on an approach to therapy development for focal seizures in children age 1 month <2 years of age. METHODS The RRE reviewed the regulatory landscape, epidemiology, seizure semiology, antiseizure medicine pharmacology, and safety issues applicable to this population. RESULTS After reviewing evidence, the conclusion was that pediatric efficacy trials would be impracticable to conduct but a waiver of the regulatory requirement to conduct any study would lead to an absence of information to guide dosing in a critical population. Review of available data and discussion of RRE attendees led to the conclusion that the requirements for extrapolation of efficacy from older children down to infants from age 1 month to <2 years old appeared to be met. After the RRE, the US Food and Drug Administration (FDA) approved brivaracetam for use in children with focal epilepsy above the age of 1 month in August 2021 and lacosamide in October 2021, both based on the principle of extrapolation from data in older children. SIGNIFICANCE These recommendations should result in more rapid accessibility of antiseizure medications for infants.
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Affiliation(s)
| | | | - Dennis Dlugos
- Departments of Neurology and PediatricsChildren's Hospital of Philadelphia, PerelmanPhiladelphiaPennsylvaniaUSA
| | - Gail Farfel
- Zogenix, a UCB CompanyEmeryvilleCaliforniaUSA
| | - Kathleen Farrell
- Research and New Therapies ProgramEpilepsy Foundation of AmericaMarylandUSA
| | - Barry Gidal
- University of Wisconsin School of PharmacyMadisonWisconsinUSA
| | | | | | - Cynthia Harden
- Clinical Development DivisionXenon Pharmaceuticals Inc.BurnabyBritish ColumbiaCanada
| | | | | | - Elaine C. Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - Nathan Fountain
- Department of NeurologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Hahn CD, Jiang Y, Villanueva V, Zolnowska M, Arkilo D, Hsiao S, Asgharnejad M, Dlugos D. A phase 2, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of soticlestat as adjunctive therapy in pediatric patients with Dravet syndrome or Lennox-Gastaut syndrome (ELEKTRA). Epilepsia 2022; 63:2671-2683. [PMID: 35841234 PMCID: PMC9804149 DOI: 10.1111/epi.17367] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) are rare treatment-resistant childhood epilepsies classed as developmental and epileptic encephalopathies. ELEKTRA investigated the efficacy and safety of soticlestat (TAK-935) as adjunctive therapy in children with DS or LGS (NCT03650452). METHODS ELEKTRA was a phase 2, randomized, double-blind, placebo-controlled study of soticlestat (≤300 mg twice daily, weight-adjusted) in children (aged 2-17 years) with DS, demonstrating three or more convulsive seizures/month, or with LGS, demonstrating four or more drop seizures/month at baseline. The 20-week treatment period comprised an 8-week dose-optimization period and a 12-week maintenance period. Efficacy endpoints included change from baseline in seizure frequency versus placebo. Safety assessments included incidence of treatment-emergent adverse events (TEAEs). RESULTS ELEKTRA enrolled 141 participants; 126 (89%) completed the study. The modified intent-to-treat population included 139 participants who received one or more doses of study drug and had one or more efficacy assessments (DS, n = 51; LGS, n = 88). ELEKTRA achieved its primary endpoint: the combined soticlestat-treated population demonstrated a placebo-adjusted median reduction in seizure frequency of 30.21% during the maintenance period (p = .0008, n = 139). During this period, placebo-adjusted median reductions in convulsive and drop seizure frequencies of 50.00% (p = .0002; patients with DS) and 17.08% (p = .1160; patients with LGS), respectively, were observed. TEAE incidences were similar between the soticlestat (80.3%) and placebo (74.3%) groups and were mostly mild or moderate in severity. Serious TEAEs were reported by 15.5% and 18.6% of participants receiving soticlestat and placebo, respectively. TEAEs reported in soticlestat-treated patients with ≥5% difference from placebo were lethargy and constipation. No deaths were reported. SIGNIFICANCE Soticlestat treatment resulted in statistically significant, clinically meaningful reductions from baseline in median seizure frequency (combined patient population) and in convulsive seizure frequency (DS cohort). Drop seizure frequency showed a nonstatistically significant numerical reduction in children with LGS. Soticlestat had a safety profile consistent with previous studies.
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Affiliation(s)
- Cecil D. Hahn
- Division of Neurology, Hospital for Sick Children and Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - Yuwu Jiang
- Department of PediatricsPeking University First HospitalBeijingChina
| | - Vicente Villanueva
- Refractory Epilepsy UnitLa Fe University and Polytechnic HospitalValenciaSpain
| | | | | | - Samuel Hsiao
- Takeda Pharmaceutical Company LimitedCambridgeMassachusettsUSA
| | | | - Dennis Dlugos
- Division of Neurology, Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Buchhalter J, Neuray C, Cheng JY, D’Cruz O, Datta AN, Dlugos D, French J, Haubenberger D, Hulihan J, Klein P, Komorowski RW, Kramer L, Lothe A, Nabbout R, Perucca E, der Ark PV. EEG Parameters as Endpoints in Epilepsy Clinical Trials- An Expert Panel Opinion Paper. Epilepsy Res 2022; 187:107028. [DOI: 10.1016/j.eplepsyres.2022.107028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022]
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Knupp KG, Coryell J, Singh RK, Gaillard WD, Shellhaas RA, Koh S, Mitchell WG, Harini C, Millichap JJ, May A, Dlugos D, Nickels K, Mytinger JR, Keator C, Yozawitz E, Singhal N, Lockrow J, Thomas JF, Juarez-Colunga E. Comparison of Cosyntropin, Vigabatrin, and Combination Therapy in New-Onset Infantile Spasms in a Prospective Randomized Trial. J Child Neurol 2022; 37:186-193. [PMID: 35044272 DOI: 10.1177/08830738211073400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: In a randomized trial, we aimed to evaluate the efficacy of cosyntropin injectable suspension, 1 mg/mL, compared to vigabatrin for infantile spasms syndrome. An additional arm was included to assess the efficacy of combination therapy (cosyntropin and vigabatrin) compared with cosyntropin monotherapy. Methods: Children (2 months to 2 years) with new-onset infantile spasms syndrome and hypsarhythmia were randomized into 3 arms: cosyntropin, vigabatrin, and cosyntropin and vigabatrin combined. Daily seizures and adverse events were recorded, and EEG was repeated at day 14 to assess for resolution of hypsarhythmia. The primary outcome measure was the composite of resolution of hypsarhythmia and absence of clinical spasms at day 14. Fisher exact test was used to compare outcomes. Results: 37 children were enrolled and 34 were included in the final efficacy analysis (1 withdrew prior to treatment and 2 did not return seizure diaries). Resolution of both hypsarhythmia and clinical spasms was achieved in in 9 of 12 participants (75%) treated with cosyntropin, 1/9 (11%) vigabatrin, and 5/13 (38%) cosyntropin and vigabatrin combined. The primary comparison of cosyntropin versus vigabatrin was significant (64% [95% confidence interval 21, 82], P < .01). Adverse events were reported in all 3 treatment arms: 31 (86%) had an adverse event, 7 (19%) had a serious adverse event, and 15 (42%) had an adverse event of special interest with no difference between treatment arms. Significance: This randomized trial was underpowered because of incomplete enrollment, yet it demonstrated that cosyntropin was more effective for short-term outcomes than vigabatrin as initial treatment for infantile spasms.
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Affiliation(s)
- Kelly G Knupp
- Pediatrics and Neurology, 12225University of Colorado, Anschutz Campus, Aurora, CO, USA
| | - Jason Coryell
- Department of Pediatrics and Neurology, 89020Oregon Health and Sciences University, Portland, Oregon, USA
| | - Rani K Singh
- Department of Pediatrics, Division of Pediatric Neurology, Atrium Health/Levine Children's Hospital, Charlotte, NC, USA
| | - William D Gaillard
- Department of Pediatrics and Neurology, George Washington University, Washington, DC, USA
| | - Renée A Shellhaas
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sookyong Koh
- Department of Pediatrics, Children's Hospital, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Wendy G Mitchell
- Neurology Division, Keck School of Medicine, 8785University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - John J Millichap
- Department of Pediatrics and Neurology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Alison May
- Department of Neurology, Morgan Stanley Children's Hospital, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Dennis Dlugos
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Cynthia Keator
- Jane and John Justin Neurosciences, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Department of Pediatrics, 550033Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Nilika Singhal
- Department of Neurology, Division of Epilepsy, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jason Lockrow
- Division of Pediatric Neurology, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jacob F Thomas
- School of Medicine, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Sperling MR, Wheless JW, Hogan RE, Dlugos D, Cascino GD, Liow K, Rabinowicz AL, Carrazana E. Use of second doses of Valtoco® (diazepam nasal spray) across 24 hours after the initial dose for out-of-hospital seizure clusters: Results from a phase 3, open-label, repeat-dose safety study. Epilepsia 2022; 63:836-843. [PMID: 35112342 PMCID: PMC9305147 DOI: 10.1111/epi.17177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 11/29/2022]
Abstract
Objective An exploratory analysis from a long‐term, phase 3, open‐label, repeat‐dose safety study of diazepam nasal spray for acute treatment of seizure clusters assessed the use of a second dose up to 24 hours after the initial dose and effectiveness in potentially reducing the number of seizures. Methods Seizures and doses were recorded in diaries. Results Of 175 patients enrolled, 163 received ≥1 dose of diazepam nasal spray and were included in the safety population; those patients received a total of 4390 doses for a total of 3853 seizure clusters. Less than half of these patients used a second dose a least once during the study (79 patients [48.5%]), with a total of 485 second doses for seizure clusters (12.6% of all seizure clusters). Among these 79 patients, 33 (41.8%) used only one second dose during the study (range: 1–82). The proportion of seizure clusters treated with a second dose over time was consistently low across 24 h: 0–4 h, 152 (3.9%); 4–6 h, 72 (1.9%); 6–8 h, 39 (1.0%); 8–12 h, 55 (1.4%); 12–16 h, 42 (1.1%); 16–20 h, 42 (1.1%); 20–24 h, 83 (2.2%). Rates of treatment‐emergent adverse events (TEAEs) and treatment‐related TEAEs occurring within 1 day of a second dose were low (15.2% and 5.1%, respectively). Significance Patients with epilepsy may experience seizure clusters lasting up to 24 hours, and little is known about the effectiveness of rescue therapies for that duration. The current labeling of the US Food and Drug Administration (FDA)–approved outpatient treatments for seizure clusters (rectal diazepam, intranasal midazolam, and diazepam nasal spray) allows for a second dose, if needed, for control. These findings support the safety profile of second doses, and the low use supports the effectiveness of diazepam nasal spray across 24 hours.
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Affiliation(s)
| | - James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - R Edward Hogan
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Kore Liow
- Hawaii Pacific Neuroscience, Honolulu, Hawaii, USA
| | | | - Enrique Carrazana
- Neurelis, Inc., San Diego, California, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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Steriade C, Sperling MR, DiVentura B, Lozano M, Shellhaas RA, Kessler SK, Dlugos D, French J. Proposal for an updated seizure classification framework in clinical trials. Epilepsia 2022; 63:565-572. [PMID: 34997581 PMCID: PMC9302660 DOI: 10.1111/epi.17120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
The International League Against Epilepsy (ILAE) seizure classification scheme has been periodically updated to improve its reliability and applicability to clinicians and researchers alike. Here, members of the Epilepsy Study Consortium propose a pragmatic seizure classification, based on the ILAE scheme, designed for use in clinical trials with a focus on outcome measures that have high reliability, broad interpretability across stakeholders, and clinical relevance in the context of the development of novel antiseizure medications. Controversies around the current ILAE classification scheme are discussed in the context of clinical trials, and pragmatic simplifications to the existing scheme are proposed, for intended use by investigators, industry sponsors, and regulatory agencies.
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Affiliation(s)
- Claude Steriade
- New York University Comprehensive Epilepsy Center, New York, New York, USA.,Epilepsy Study Consortium, Reston, Virginia, USA
| | - Michael R Sperling
- Epilepsy Study Consortium, Reston, Virginia, USA.,Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Meryl Lozano
- Epilepsy Study Consortium, Reston, Virginia, USA
| | - Renée A Shellhaas
- Epilepsy Study Consortium, Reston, Virginia, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Sudha Kilaru Kessler
- Epilepsy Study Consortium, Reston, Virginia, USA.,Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dennis Dlugos
- Epilepsy Study Consortium, Reston, Virginia, USA.,Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline French
- New York University Comprehensive Epilepsy Center, New York, New York, USA.,Epilepsy Study Consortium, Reston, Virginia, USA
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12
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Wheless JW, Miller I, Hogan RE, Dlugos D, Biton V, Cascino GD, Sperling MR, Liow K, Vazquez B, Segal EB, Tarquinio D, Mauney W, Desai J, Rabinowicz AL, Carrazana E. Final results from a Phase 3, long-term, open-label, repeat-dose safety study of diazepam nasal spray for seizure clusters in patients with epilepsy. Epilepsia 2021; 62:2485-2495. [PMID: 34418086 PMCID: PMC9290500 DOI: 10.1111/epi.17041] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
Objective A Phase 3 open‐label safety study (NCT02721069) evaluated long‐term safety of diazepam nasal spray (Valtoco) in patients with epilepsy and frequent seizure clusters. Methods Patients were 6–65 years old with diagnosed epilepsy and seizure clusters despite stable antiseizure medications. The treatment period was 12 months, with study visits at Day 30 and every 60 days thereafter, after which patients could elect to continue. Doses were based on age and weight. Seizure and treatment information was recorded in diaries. Treatment‐emergent adverse events (TEAEs), nasal irritation, and olfactory changes were recorded. Results Of 163 patients in the safety population, 117 (71.8%) completed the study. Duration of exposure was ≥12 months for 81.6% of patients. There was one death (sudden unexpected death in epilepsy) and one withdrawal owing to a TEAE (major depression), both considered unlikely to be related to treatment. Diazepam nasal spray was administered 4390 times for 3853 seizure clusters, with 485 clusters treated with a second dose within 24 h; 53.4% of patients had monthly average usage of one to two doses, 41.7% two to five doses, and 4.9% more than five doses. No serious TEAEs were considered to be treatment related. TEAEs possibly or probably related to treatment (n = 30) were most commonly nasal discomfort (6.1%); headache (2.5%); and dysgeusia, epistaxis, and somnolence (1.8% each). Only 13 patients (7.9%) showed nasal irritation, and there were no relevant olfactory changes. The safety profile of diazepam nasal spray was generally similar across subgroups based on age, monthly usage, concomitant benzodiazepine therapy, or seasonal allergy/rhinitis. Significance In this large open‐label safety study, the safety profile of diazepam nasal spray was consistent with the established profile of rectal diazepam, and the high retention rate supports effectiveness in this population. A second dose was used in only 12.6% of seizure clusters.
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Affiliation(s)
- James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ian Miller
- Formerly Nicklaus Children's Hospital, Miami, Florida, USA
| | - R Edward Hogan
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Victor Biton
- Arkansas Epilepsy Program, Little Rock, Arkansas, USA
| | | | | | - Kore Liow
- Hawaii Pacific Neuroscience, Honolulu, Hawaii, USA
| | - Blanca Vazquez
- New York University, Comprehensive Epilepsy Center, New York, New York, USA
| | - Eric B Segal
- Hackensack University Medical Center and Northeast Regional Epilepsy Group, Hackensack, New Jersey, USA
| | | | - Weldon Mauney
- Northwest Florida Clinical Research Group, Gulf Breeze, Florida, USA
| | - Jay Desai
- Children's Hospital of Los Angeles, Los Angeles, California, USA
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13
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Fitzgerald MP, Kaufman MC, Massey SL, Fridinger S, Prelack M, Ellis C, Ortiz-Gonzalez X, Fried LE, DiGiovine MP, Melamed S, Malcolm M, Banwell B, Stephenson D, Witzman SM, Gonzalez A, Dlugos D, Kessler SK, Goldberg EM, Abend NS, Helbig I. Assessing seizure burden in pediatric epilepsy using an electronic medical record-based tool through a common data element approach. Epilepsia 2021; 62:1617-1628. [PMID: 34075580 DOI: 10.1111/epi.16934] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Improvement in epilepsy care requires standardized methods to assess disease severity. We report the results of implementing common data elements (CDEs) to document epilepsy history data in the electronic medical record (EMR) after 12 months of clinical use in outpatient encounters. METHODS Data regarding seizure frequency were collected during routine clinical encounters using a CDE-based form within our EMR. We extracted CDE data from the EMR and developed measurements for seizure severity and seizure improvement scores. Seizure burden and improvement was evaluated by patient demographic and encounter variables for in-person and telemedicine encounters. RESULTS We assessed a total of 1696 encounters in 1038 individuals with childhood epilepsies between September 6, 2019 and September 11, 2020 contributed by 32 distinct providers. Childhood absence epilepsy (n = 121), Lennox-Gastaut syndrome (n = 86), and Dravet syndrome (n = 42) were the most common epilepsy syndromes. Overall, 43% (737/1696) of individuals had at least monthly seizures, 17% (296/1696) had a least daily seizures, and 18% (311/1696) were seizure-free for >12 months. Quantification of absolute seizure burden and changes in seizure burden over time differed between epilepsy syndromes, including high and persistent seizure burden in patients with Lennox-Gastaut syndrome. Individuals seen via telemedicine or in-person encounters had comparable seizure frequencies. Individuals identifying as Hispanic/Latino, particularly from postal codes with lower median household incomes, were more likely to have ongoing seizures that worsened over time. SIGNIFICANCE Standardized documentation of clinical data in childhood epilepsies through CDE can be implemented in routine clinical care at scale and enables assessment of disease burden, including characterization of seizure burden over time. Our data provide insights into heterogeneous patterns of seizure control in common pediatric epilepsy syndromes and will inform future initiatives focusing on patient-centered outcomes in childhood epilepsies, including the impact of telemedicine and health care disparities.
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Affiliation(s)
- Mark P Fitzgerald
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Kaufman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shavonne L Massey
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sara Fridinger
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marisa Prelack
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin Ellis
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xilma Ortiz-Gonzalez
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence E Fried
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marissa P DiGiovine
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Melamed
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marissa Malcolm
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Stephenson
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie M Witzman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander Gonzalez
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sudha Kilaru Kessler
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ethan M Goldberg
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicholas S Abend
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
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14
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Miller I, Wheless JW, Hogan RE, Dlugos D, Biton V, Cascino GD, Sperling MR, Liow K, Vazquez B, Segal EB, Tarquinio D, Mauney W, Desai J, Rabinowicz AL, Carrazana E. Consistent safety and tolerability of Valtoco ® (diazepam nasal spray) in relationship to usage frequency in patients with seizure clusters: Interim results from a phase 3, long-term, open-label, repeat-dose safety study. Epilepsia Open 2021; 6:504-512. [PMID: 34033266 PMCID: PMC8408590 DOI: 10.1002/epi4.12494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Need for rescue therapy differs among patients with seizure clusters. Diazepam nasal spray is approved to treat seizure clusters in patients with epilepsy ≥6 years of age. This analysis used interim data from a phase 3 safety study to assess safety profile and effectiveness of diazepam nasal spray using average number of doses/month as a proxy measurement. Methods This phase 3, open‐label, repeat‐dose, safety study of diazepam nasal spray enrolled patients (6‐65 years) with epilepsy and need of benzodiazepine rescue. Patients were stratified by average number of doses/month (<2, moderate frequency; 2‐5, high frequency; >5, very‐high frequency). Safety was evaluated based on treatment‐emergent adverse events (TEAEs), assessed nasal irritation, and olfaction. The proportion of treatments given as a second dose was used as an exploratory proxy for effectiveness. Results Of 175 enrolled patients (data cutoff, October 31, 2019), 158 received ≥1 dose of diazepam nasal spray. Frequency of use was moderate in 43.7% of patients, high in 50.6% of patients, and very high in 5.7% of patients. Patients treated 3397 seizure episodes (moderate frequency, 14.2%; high frequency, 59.9%; very high frequency, 25.8%). Nasal discomfort was the most common treatment‐related TEAE in all groups. No notable changes in nasal irritation or olfaction were observed. Second doses represented only 2.5%, 7.5%, and 17.2% of all doses in the moderate‐, high‐, and very‐high‐frequency groups, respectively. Overall retention rate was 82.9%, without an observed relationship to frequency of use. Significance Frequency of dosing diazepam nasal spray had little impact on the safety/tolerability profile across a range of <2 to >5 doses/month. Effectiveness was suggested for all dosing frequencies by the high proportion of seizure clusters not treated with a second dose. These results support the utility, safety profile, and effectiveness of diazepam nasal spray across frequencies of seizure cluster burden.
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Affiliation(s)
- Ian Miller
- Formerly Nicklaus Children's Hospital, Miami, FL, USA
| | - James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Kore Liow
- Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Blanca Vazquez
- Comprehensive Epilepsy Center, New York University, New York, NY, USA
| | - Eric B Segal
- Hackensack University Medical Center and Northeast Regional Epilepsy Group, Hackensack, NJ, USA
| | | | - Weldon Mauney
- Northwest Florida Clinical Research Group, Gulf Breeze, FL, USA
| | - Jay Desai
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
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15
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Segal EB, Tarquinio D, Miller I, Wheless JW, Dlugos D, Biton V, Cascino GD, Desai J, Hogan RE, Liow K, Sperling MR, Vazquez B, Cook DF, Rabinowicz AL, Carrazana E. Evaluation of diazepam nasal spray in patients with epilepsy concomitantly using maintenance benzodiazepines: An interim subgroup analysis from a phase 3, long-term, open-label safety study. Epilepsia 2021; 62:1442-1450. [PMID: 33942315 PMCID: PMC8252651 DOI: 10.1111/epi.16901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Objective Diazepam nasal spray (Valtoco), indicated for acute treatment of frequent seizure activity (seizure clusters) in patients with epilepsy ≥6 years of age, is designed to be a rapid, noninvasive, socially acceptable route of administration. This interim analysis evaluated the safety profile of diazepam nasal spray in patients with and without concomitant use of benzodiazepines, with use of a second dose for a seizure cluster as a proxy for effectiveness. Methods A long‐term, phase 3, open‐label safety study enrolled patients with epilepsy who had seizures despite a stable antiseizure medication regimen. Results Among 175 patients enrolled by October 31, 2019, a total of 158 were treated with diazepam nasal spray (aged 6–65 years; 53.8% female). Of those, 119 (75.3%) received concomitant benzodiazepines (60, chronic; 59, intermittent); 39 (24.7%) did not. Use of a second dose was similar in patients using chronic concomitant benzodiazepines (second dose in 11.1% [144/1299]) and those with no concomitant benzodiazepines (second dose in 10.3% [41/398]). Treatment emergent adverse events (TEAEs) occurred for 80.0% with chronic use of concomitant benzodiazepines and 61.5% without. Cardiorespiratory depression was not reported, and no serious TEAEs were treatment related. Study retention was high: 83.3% in the chronic benzodiazepine group and 76.9% in the no‐benzodiazepine group. Findings were similar in a sub‐analysis of patients who were (n = 44) or were not (n = 75) taking clobazam. Significance This analysis of patients from a long‐term study shows a similar safety profile of diazepam nasal spray in patients with and without concomitant benzodiazepines, and consistent with the established profile for diazepam. Use of a single dose of diazepam nasal spray and high study retention rates suggest the effectiveness of diazepam nasal spray in patients irrespective of chronic daily benzodiazepine use. Results were similar in the clobazam sub‐analysis. These results support the safety and effectiveness of diazepam nasal spray in patients with concomitant benzodiazepine use.
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Affiliation(s)
- Eric B Segal
- Hackensack University Medical Center, Hackensack Meridian School of Health, and Northeast Regional Epilepsy Group, Hackensack, NJ, USA
| | | | - Ian Miller
- Nicklaus Children's Hospital, Miami, FL, USA
| | - James W Wheless
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Jay Desai
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | - Kore Liow
- Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | | | - Blanca Vazquez
- Comprehensive Epilepsy Center, New York University, New York, NY, USA
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16
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Blackmon K, Waechter R, Landon B, Noël T, Macpherson C, Donald T, Cudjoe N, Evans R, Burgen KS, Jayatilake P, Oyegunle V, Pedraza O, Abdel Baki S, Thesen T, Dlugos D, Chari G, Patel AA, Grossi-Soyster EN, Krystosik AR, LaBeaud AD. Epilepsy surveillance in normocephalic children with and without prenatal Zika virus exposure. PLoS Negl Trop Dis 2020; 14:e0008874. [PMID: 33253174 PMCID: PMC7728266 DOI: 10.1371/journal.pntd.0008874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/10/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Children with Congenital Zika Syndrome and microcephaly are at high risk for epilepsy; however, the risk is unclear in normocephalic children with prenatal Zika virus (ZIKV) exposure [Exposed Children (EC)]. In this prospective cohort study, we performed epilepsy screening in normocephalic EC alongside a parallel group of normocephalic unexposed children [Unexposed Children (UC)]. We compared the incidence rate of epilepsy among EC and UC at one year of life to global incidence rates. Pregnant women were recruited from public health centers during the ZIKV outbreak in Grenada, West Indies and assessed for prior ZIKV infection using a plasmonic-gold platform that measures IgG antibodies in serum. Normocephalic children born to mothers with positive ZIKV results during pregnancy were classified as EC and those born to mothers with negative ZIKV results during and after pregnancy were classified as UC. Epilepsy screening procedures included a pediatric epilepsy screening questionnaire and video electroencephalography (vEEG). vEEG was collected using a multi-channel microEEG® system for a minimum of 20 minutes along with video recording of participant behavior time-locked to the EEG. vEEGs were interpreted independently by two pediatric epileptologists, who were blinded to ZIKV status, via telemedicine platform. Positive screening cases were referred to a local pediatrician for an epilepsy diagnostic evaluation. Epilepsy screens were positive in 2/71 EC (IR: 0.028; 95% CI: 0.003-0.098) and 0/71 UC. In both epilepsy-positive cases, questionnaire responses and interictal vEEGs were consistent with focal, rather than generalized, seizures. Both children met criteria for a clinical diagnosis of epilepsy and good seizure control was achieved with carbamazepine. Our results indicate that epilepsy rates are modestly elevated in EC. Given our small sample size, results should be considered preliminary. They support the use of epilepsy screening procedures in larger epidemiological studies of children with congenital ZIKV exposure, even in the absence of microcephaly, and provide guidance for conducting epilepsy surveillance in resource limited settings.
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Affiliation(s)
- Karen Blackmon
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- * E-mail:
| | - Randall Waechter
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | | | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Kemi S. Burgen
- Windward Islands Research and Education Foundation, St George’s University, St George’s, Grenada, West Indies
| | - Piumi Jayatilake
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Vivian Oyegunle
- St George’s University School of Medicine, Department of Physiology, Neuroscience, and Behavioral Sciences, St. George’s, Grenada, West Indies
| | - Otto Pedraza
- Mayo Clinic, Department of Psychiatry and Psychology, Jacksonville, Florida, United States of America
| | - Samah Abdel Baki
- Biosignal Group Inc., Boston, Massachusetts, United States of America
| | - Thomas Thesen
- New York University School of Medicine, Department of Neurology, New York, New York, United States of America
- Department of Biomedical Sciences, University of Houston College of Medicine, USA
| | - Dennis Dlugos
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Archana A. Patel
- Boston Children’s Hospital, Department of Neurology, Boston, Massachusetts, United States of America
| | - Elysse N. Grossi-Soyster
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - Amy R. Krystosik
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
| | - A. Desiree LaBeaud
- Stanford University School of Medicine, Department of Pediatrics, Stanford, California, United States of America
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17
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Jayatilake P, Oyegunle V, Waechter R, Landon B, Fernandes M, Cudjoe N, Evans R, Noël T, Macpherson C, Donald T, Abdelbaki SG, Mandalaneni K, Dlugos D, Chari G, Patel AA, Grossi-Soyster EN, Desiree LaBeaud A, Blackmon K. Focal epilepsy features in a child with Congenital Zika Syndrome. Epilepsy Behav Rep 2020; 14:100411. [PMID: 33313503 PMCID: PMC7720018 DOI: 10.1016/j.ebr.2020.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
Congenital Zika Syndrome with microcephaly can present with focal seizures. TeleEEG can augment epilepsy care in Zika-endemic resource limited settings. A seizure questionnaire can prompt caregiver report of relevant seizure features.
Zika virus (ZIKV) is a mosquito-borne, single-stranded DNA flavivirus that is teratogenic and neurotropic. Similar to the teratogenic effects of other TORCH infections, ZIKV infection during pregnancy can have an adverse impact on fetal and neonatal development. Epilepsy is detected in 48–96% of children with Congenital Zika Syndrome (CZS) and microcephaly. Early epilepsy surveillance is needed in children with prenatal ZIKV exposure; yet, most ZIKV-endemic regions do not have specialist epilepsy care. Here, we describe the demographic, clinical, imaging, and EEG characteristics of a 2-year-old child with CZS and microcephaly who presented with focal epileptiform activity, suboptimal growth, and severe neurodevelopmental delays. Administration of a brief seizure questionnaire by allied health professionals to the patient’s caregiver helped to characterize the child’s seizure semiology and differentiate focal from generalized seizure features. A telemedicine EEG interpretation platform provided valuable diagnostic information for the patient’s local pediatrician to integrate into her treatment plan. This case illustrates that CZS can present with focal epilepsy features and that a telemedicine approach can be used to bridge the gap between epilepsy specialists and local care providers in resource limited ZIKV-endemic regions to achieve better seizure control in children with CZS.
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Affiliation(s)
| | | | - Randall Waechter
- St. George's University, St. George's, West Indies, Grenada.,Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Barbara Landon
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Michelle Fernandes
- Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
| | - Nikita Cudjoe
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Roberta Evans
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Trevor Noël
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Calum Macpherson
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada
| | - Tyhiesia Donald
- Ministry of Health, Government of Grenada, West Indies, Grenada
| | | | | | - Dennis Dlugos
- Children's Hospital of Pennsylvania, Philadelphia, PA, USA
| | - Geetha Chari
- SUNY Downstate Health Sciences University, New York, NY, USA
| | - Archana A Patel
- Boston Children's Hospital, Division of Epilepsy and Clinical Neurophysiology, Boston, MA, USA
| | | | - A Desiree LaBeaud
- Stanford University School of Medicine, Department of Pediatrics, CA, USA
| | - Karen Blackmon
- Windward Islands Research and Education Foundation, St George's University, West Indies, Grenada.,Mayo Clinic, Jacksonville, FL, USA
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Correa DJ, Milano L, Kwon CS, Jetté N, Dlugos D, Harte-Hargrove L, Pugh MJ, Smith JK, Moshé SL. Quantitative readability analysis of websites providing information on traumatic brain injury and epilepsy: A need for clear communication. Epilepsia 2020; 61:528-538. [PMID: 32096225 DOI: 10.1111/epi.16446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The use of the Internet for health-related questions is increasing, but it is not clear whether individuals can understand the information available online. Most health organizations recommend that health educational materials (HEMs) be written below the sixth grade reading level. This study was designed to evaluate the readability level of available online HEMs pertaining to traumatic brain injury (TBI), epilepsy, and posttraumatic epilepsy (PTE). METHODS This cross-sectional readability assessment included HEMs from TBI and epilepsy stakeholder organizations and those obtained from four Internet searches. The search strategy was designed to replicate a nonmedical individual's keyword searches. Each HEM was assessed with an online automated readability tool using three indices (Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Simple Measure of Gobbledygook). Findings were compared as a function of organization type (journalistic news or health organization), targeted medical condition (TBI, epilepsy, or PTE), or content topic (patient health education, clinical research education, or both). RESULTS Readability analysis of 405 identified HEMs revealed scores above the sixth grade reading level recommendation. Only 6.2% of individual HEMs met the sixth grade recommendation. Journalistic news organizations' HEMs had similar readability levels to health organizations' HEMs. PTE-related HEMs required the highest readability level, >11th grade (P < .001). There were significant differences in the readability scores (P < .01 for all indices) among HEMs with information on health education, research education, or both topics. The highest required readability level (>12 grade level) was for HEMs that included both health and research education. SIGNIFICANCE The majority of TBI-, epilepsy-, and PTE-related online HEMs do not meet the sixth grade reading recommendation. Improving the readability of HEMs may advance health literacy around TBI, epilepsy, and PTE, leading to more effective participant recruitment/retention strategies for future antiepileptogenesis trials in persons with TBI and perhaps better patient-centered outcomes.
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Affiliation(s)
- Daniel José Correa
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Lindsey Milano
- University of North Carolina Wilmington, Wilmington, North Carolina
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mary Jo Pugh
- VA Salt Lake City Health Care System and the University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Solomon L Moshé
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, and Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
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19
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Traynelis SF, Dlugos D, Henshall D, Mefford HC, Rogawski MA, Staley KJ, Dacks PA, Whittemore V, Poduri A. Epilepsy Benchmarks Area III: Improved Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. Epilepsy Curr 2020; 20:23S-30S. [PMID: 31965829 PMCID: PMC7031805 DOI: 10.1177/1535759719895279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The goals of Epilepsy Benchmark Area III involve identifying areas that are ripe for progress in terms of controlling seizures and patient symptoms in light of the most recent advances in both basic and clinical research. These goals were developed with an emphasis on potential new therapeutic strategies that will reduce seizure burden and improve quality of life for patients with epilepsy. In particular, we continue to support the proposition that a better understanding of how seizures are initiated, propagated, and terminated in different forms of epilepsy is central to enabling new approaches to treatment, including pharmacological as well as surgical and device-oriented approaches. The stubbornly high rate of treatment-resistant epilepsy—one-third of patients—emphasizes the urgent need for new therapeutic strategies, including pharmacological, procedural, device linked, and genetic. The development of new approaches can be advanced by better animal models of seizure initiation that represent salient features of human epilepsy, as well as humanized models such as induced pluripotent stem cells and organoids. The rapid advances in genetic understanding of a subset of epilepsies provide a path to new and direct patient-relevant cellular and animal models, which could catalyze conceptualization of new treatments that may be broadly applicable across multiple forms of epilepsies beyond those arising from variation in a single gene. Remarkable advances in machine learning algorithms and miniaturization of devices and increases in computational power together provide an enhanced opportunity to detect and mitigate seizures in real time via devices that interrupt electrical activity directly or administer effective pharmaceuticals. Each of these potential areas for advance will be discussed in turn.
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Affiliation(s)
- Stephen F Traynelis
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| | - Dennis Dlugos
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Henshall
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Heather C Mefford
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael A Rogawski
- Departments of Neurology and Pharmacology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Kevin J Staley
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Almoguera B, McGinnis E, Abrams D, Vazquez L, Cederquist A, Sleiman PM, Dlugos D, Hakonarson H, Cagan A, Connolly J, Gainer VS, Garifallou J, Kaminski C, Lee YC, Mafra F, Mentch F, Pellegrino R, Qiu H, Snyder J, Tian L, Wang F, Manolio TA, Manzi S, Holm IA, Karlson EW. Drug-resistant epilepsy classified by a phenotyping algorithm associates with NTRK2. Acta Neurol Scand 2019; 140:169-176. [PMID: 31070779 DOI: 10.1111/ane.13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Up to 40% of patients with epilepsy become drug resistant (DRE). Genetic factors are likely to play a role. While efforts have focused on the transporter and target hypotheses, neither of them fully explains the pan-pharmacoresistance seen in DRE. MATERIALS AND METHODS In this study, we developed and used a phenotyping algorithm for the identification of DRE, responders, and epilepsy-free controls that were sequenced using a gene panel developed by the Pharmacogenomics Research Network (PGRN), which includes 82 genes involved in drug response. We tested the transporter hypothesis of DRE, the association between drug resistance and variants in the ATP-binding cassette family of genes previously associated with DRE, and also investigated potential new genetic factors. RESULTS In the analysis of DRE vs controls, NTRK2 was significantly associated with DRE (rs76950094; P = 1.19 × 10-7 and gene-based P-value = 1.67 × 10-4 ). NTRK2 encodes TrkB, which is involved in the development and maturation of the central nervous system, and increased activation of TrkB signaling is suggested to promote epilepsy. CONCLUSION Although the role of NTRK2 in DRE needs to be elucidated, these results support alternative mechanisms underlying DRE, complementary to the existing hypotheses, that should be evaluated.
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Affiliation(s)
- Berta Almoguera
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Emily McGinnis
- Department of Neurology Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Debra Abrams
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Lyam Vazquez
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Anna Cederquist
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Patrick M. Sleiman
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Dennis Dlugos
- Department of Neurology Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Hakon Hakonarson
- Center for Applied Genomics Children's Hospital of Philadelphia Philadelphia Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
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21
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Fitzgerald MP, Fiannacca M, Smith DM, Gertler TS, Gunning B, Syrbe S, Verbeek N, Stamberger H, Weckhuysen S, Ceulemans B, Schoonjans AS, Rossi M, Demarquay G, Lesca G, Olofsson K, Koolen DA, Hornemann F, Baulac S, Rubboli G, Minks KQ, Lee B, Helbig I, Dlugos D, Møller RS, Bearden D. Treatment Responsiveness in KCNT1-Related Epilepsy. Neurotherapeutics 2019; 16:848-857. [PMID: 31054119 PMCID: PMC6694367 DOI: 10.1007/s13311-019-00739-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Pathogenic variants in KCNT1 represent an important cause of treatment-resistant epilepsy, for which an effective therapy has been elusive. Reports about the effectiveness of quinidine, a candidate precision therapy, have been mixed. We sought to evaluate the treatment responsiveness of patients with KCNT1-related epilepsy. We performed an observational study of 43 patients using a collaborative KCNT1 patient registry. We assessed treatment efficacy based upon clinical seizure reduction, side effects of quinidine therapy, and variant-specific responsiveness to treatment. Quinidine treatment resulted in a > 50% seizure reduction in 20% of patients, with rare patients achieving transient seizure freedom. Multiple other therapies demonstrated some success in reducing seizure frequency, including the ketogenic diet and vigabatrin, the latter particularly in patients with epileptic spasms. Patients with the best quinidine response had variants that clustered distal to the NADP domain within the RCK2 domain of the protein. Half of patients did not receive a quinidine trial. In those who did, nearly half did not achieve therapeutic blood levels. More favorable response to quinidine in patients with KCNT1 variants distal to the NADP domain within the RCK2 domain may suggest a variant-specific response.
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Affiliation(s)
- Mark P Fitzgerald
- Division of Neurology, Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | | | | | - Tracy S Gertler
- Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Boudewijn Gunning
- Stichting Epilepsie Instellingen Nederland, Zwolle, 8025 BV, Netherlands
| | - Steffen Syrbe
- Division of Child Neurology and Inherited Metabolic Diseases, Department of General Paediatrics, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Nienke Verbeek
- Department of Genetics, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Hannah Stamberger
- Neurogenetics group, Center for Molecular Neurology, Vlaams Instituut voor Biotechnologie, and Institute Born Bunge, University of Antwerp, Antwerp, 2000, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, 2650, Belgium
| | - Sarah Weckhuysen
- Neurogenetics group, Center for Molecular Neurology, Vlaams Instituut voor Biotechnologie, and Institute Born Bunge, University of Antwerp, Antwerp, 2000, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, 2650, Belgium
| | - Berten Ceulemans
- Department of Paediatric Neurology, Antwerp University Hospital, University of Antwerp, Antwerp, 2650, Belgium
| | - An-Sofie Schoonjans
- Neurogenetics Research Group, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Massimiliano Rossi
- Genetics department, Hospices Civils de Lyon, and Institut National de la Santé et de la Recherche Médicale U1028, Centre national de la recherche scientifique Unité Mixte de Recherche 5292, Lyon Neuroscience Research Center, GENDEV Team, Claude Bernard Lyon 1 University, Bron, 69500, France
| | - Geneviève Demarquay
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and Centre national de la recherche scientifique, Unité Mixte de Recherche 5292, Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics Team, Lyon, 69003, France
| | - Gaetan Lesca
- Genetics department, Hospices Civils de Lyon, and Institut National de la Santé et de la Recherche Médicale U1028, Centre national de la recherche scientifique Unité Mixte de Recherche 5292, Lyon Neuroscience Research Center, GENDEV Team, Claude Bernard Lyon 1 University, Bron, 69500, France
| | - Kern Olofsson
- Danish Epilepsy Centre, Filadelfia, Dianalund,, DK 4293, Denmark
| | - D A Koolen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, 6525 GA, The Netherlands
| | - Frauke Hornemann
- Centre of Pediatric Research, Hospital for Children and Adolescents, 04103, Leipzig, Germany
| | - Stephanie Baulac
- Sorbonne Université, UPMC Univ Paris 06, Unité Mixte de Recherche S 1127, F-75013, Paris, France
- Institut National de la Santé et de la Recherche Médicale, U1127, F-75013, Paris, France
- Centre national de la recherche scientifique, Unité Mixte de Recherche 7225, F-75013, Paris, France
- Institut du Cerveau et de la Moelle épinière (ICM), Hôpital Pitié-Salpêtrière, F-75013, Paris, France
- Department of Genetics, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Guido Rubboli
- Danish Epilepsy Centre, Filadelfia, Dianalund,, DK 4293, Denmark
- University of Copenhagen, Copenhagen, 1165, Denmark
| | - Kelly Q Minks
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Bohoon Lee
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Ingo Helbig
- Division of Neurology, Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Dennis Dlugos
- Division of Neurology, Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rikke S Møller
- Danish Epilepsy Centre, Filadelfia, Dianalund,, DK 4293, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, 5230, Denmark
| | - David Bearden
- Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, NY, USA
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22
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Wheless JW, Dlugos D, Miller I, Oh DA, Parikh N, Phillips S, Renfroe JB, Roberts CM, Saeed I, Sparagana SP, Yu J, Cilio MR. Pharmacokinetics and Tolerability of Multiple Doses of Pharmaceutical-Grade Synthetic Cannabidiol in Pediatric Patients with Treatment-Resistant Epilepsy. CNS Drugs 2019; 33:593-604. [PMID: 31049885 PMCID: PMC6534520 DOI: 10.1007/s40263-019-00624-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior studies have evaluated the use of various constituents of cannabis for their anti-seizure effects. Specifically, cannabidiol, a non-psychoactive component of cannabis, has been investigated for treatment-resistant epilepsy, but more information is needed particularly on its use in a pediatric population. OBJECTIVE The objective of this study was to evaluate the pharmacokinetics and safety of a synthetic pharmaceutical-grade cannabidiol oral solution in pediatric patients with treatment-resistant epilepsy. METHODS In this open-label study, pediatric patients (aged 1 to ≤ 17 years) with treatment-resistant epilepsy received cannabidiol oral solution administered as add-on to their current antiepileptic drug regimen. Patients received a single dose (5, 10, or 20 mg/kg) on day 1 and twice-daily dosing on days 4 through 10 (10-mg/kg [cohort 1], 20-mg/kg [cohort 2], or 40-mg/kg [cohort 3] total daily dose). Serial blood samples were collected on day 1 before dosing and up to 72 h post-dose, and on day 10 before dosing and up to 24 h post-dose. Blood samples to assess trough concentrations of cannabidiol were collected on day 6 (for patients aged 12 to ≤ 17 years), day 8 (for patients aged 2 to ≤ 17 years), and day 9 (for patients aged 6 to ≤ 17 years). RESULTS Overall, 61 patients across three cohorts received one of three doses of cannabidiol oral solution (mean age, 7.6 years). The age composition was similar in the three cohorts. There was a trend for increased cannabidiol exposure with increased cannabidiol oral solution dosing, but overall exposure varied. Approximately 2-6 days of twice-daily dosing provided steady-state concentrations of cannabidiol. A bi-directional drug interaction occurred with cannabidiol and clobazam. Concomitant administration of clobazam with 40 mg/kg/day of cannabidiol oral solution resulted in a 2.5-fold increase in mean cannabidiol exposure. Mean plasma clobazam concentrations were 1.7- and 2.2-fold greater in patients receiving clobazam concomitantly with 40 mg/kg/day of cannabidiol oral solution compared with 10 mg/kg/day and 20 mg/kg/day. Mean plasma norclobazam values were 1.3- and 1.9-fold higher for patients taking clobazam plus 40 mg/kg/day of cannabidiol oral solution compared with the 10-mg/kg/day and 20-mg/kg/day groups. All doses were generally well tolerated, and common adverse events that occurred at > 10% were somnolence (21.3%), anemia (18.0%), and diarrhea (16.4%). CONCLUSIONS Inter-individual variability in systemic cannabidiol exposure after pediatric patient treatment with cannabidiol oral solution was observed but decreased with multiple doses. Short-term administration was generally safe and well tolerated. TRIAL REGISTRATION ClinicalTrials.gov (NCT02324673).
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Affiliation(s)
- James W. Wheless
- University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Memphis, TN USA
| | - Dennis Dlugos
- Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Ian Miller
- Nicklaus Children’s Hospital, Miami, FL USA
| | - D. Alexander Oh
- INSYS Development Company, Inc., Chandler, AZ USA ,Present Address: Arena Pharmaceuticals, San Diego, CA USA
| | - Neha Parikh
- INSYS Development Company, Inc., Chandler, AZ USA
| | | | - J. Ben Renfroe
- Child Neurology Center of Northwest Florida, Gulf Breeze, FL USA
| | - Colin M. Roberts
- Doernbecher Childhood Epilepsy Program, Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Isra Saeed
- UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA USA
| | | | - Jin Yu
- INSYS Development Company, Inc., Chandler, AZ USA
| | - Maria Roberta Cilio
- UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA. .,Saint-Luc University Hospital, University of Louvain, Brussels, Belgium.
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Anttila V, Bulik-Sullivan B, Finucane HK, Walters RK, Bras J, Duncan L, Escott-Price V, Falcone GJ, Gormley P, Malik R, Patsopoulos NA, Ripke S, Wei Z, Yu D, Lee PH, Turley P, Grenier-Boley B, Chouraki V, Kamatani Y, Berr C, Letenneur L, Hannequin D, Amouyel P, Boland A, Deleuze JF, Duron E, Vardarajan BN, Reitz C, Goate AM, Huentelman MJ, Kamboh MI, Larson EB, Rogaeva E, St George-Hyslop P, Hakonarson H, Kukull WA, Farrer LA, Barnes LL, Beach TG, Demirci FY, Head E, Hulette CM, Jicha GA, Kauwe JSK, Kaye JA, Leverenz JB, Levey AI, Lieberman AP, Pankratz VS, Poon WW, Quinn JF, Saykin AJ, Schneider LS, Smith AG, Sonnen JA, Stern RA, Van Deerlin VM, Van Eldik LJ, Harold D, Russo G, Rubinsztein DC, Bayer A, Tsolaki M, Proitsi P, Fox NC, Hampel H, Owen MJ, Mead S, Passmore P, Morgan K, Nöthen MM, Rossor M, Lupton MK, Hoffmann P, Kornhuber J, Lawlor B, McQuillin A, Al-Chalabi A, Bis JC, Ruiz A, Boada M, Seshadri S, Beiser A, Rice K, van der Lee SJ, De Jager PL, Geschwind DH, Riemenschneider M, Riedel-Heller S, Rotter JI, Ransmayr G, Hyman BT, Cruchaga C, Alegret M, Winsvold B, Palta P, Farh KH, Cuenca-Leon E, Furlotte N, Kurth T, Ligthart L, Terwindt GM, Freilinger T, Ran C, Gordon SD, Borck G, Adams HHH, Lehtimäki T, Wedenoja J, Buring JE, Schürks M, Hrafnsdottir M, Hottenga JJ, Penninx B, Artto V, Kaunisto M, Vepsäläinen S, Martin NG, Montgomery GW, Kurki MI, Hämäläinen E, Huang H, Huang J, Sandor C, Webber C, Muller-Myhsok B, Schreiber S, Salomaa V, Loehrer E, Göbel H, Macaya A, Pozo-Rosich P, Hansen T, Werge T, Kaprio J, Metspalu A, Kubisch C, Ferrari MD, Belin AC, van den Maagdenberg AMJM, Zwart JA, Boomsma D, Eriksson N, Olesen J, Chasman DI, Nyholt DR, Avbersek A, Baum L, Berkovic S, Bradfield J, Buono RJ, Catarino CB, Cossette P, De Jonghe P, Depondt C, Dlugos D, Ferraro TN, French J, Hjalgrim H, Jamnadas-Khoda J, Kälviäinen R, Kunz WS, Lerche H, Leu C, Lindhout D, Lo W, Lowenstein D, McCormack M, Møller RS, Molloy A, Ng PW, Oliver K, Privitera M, Radtke R, Ruppert AK, Sander T, Schachter S, Schankin C, Scheffer I, Schoch S, Sisodiya SM, Smith P, Sperling M, Striano P, Surges R, Thomas GN, Visscher F, Whelan CD, Zara F, Heinzen EL, Marson A, Becker F, Stroink H, Zimprich F, Gasser T, Gibbs R, Heutink P, Martinez M, Morris HR, Sharma M, Ryten M, Mok KY, Pulit S, Bevan S, Holliday E, Attia J, Battey T, Boncoraglio G, Thijs V, Chen WM, Mitchell B, Rothwell P, Sharma P, Sudlow C, Vicente A, Markus H, Kourkoulis C, Pera J, Raffeld M, Silliman S, Boraska Perica V, Thornton LM, Huckins LM, William Rayner N, Lewis CM, Gratacos M, Rybakowski F, Keski-Rahkonen A, Raevuori A, Hudson JI, Reichborn-Kjennerud T, Monteleone P, Karwautz A, Mannik K, Baker JH, O'Toole JK, Trace SE, Davis OSP, Helder SG, Ehrlich S, Herpertz-Dahlmann B, Danner UN, van Elburg AA, Clementi M, Forzan M, Docampo E, Lissowska J, Hauser J, Tortorella A, Maj M, Gonidakis F, Tziouvas K, Papezova H, Yilmaz Z, Wagner G, Cohen-Woods S, Herms S, Julià A, Rabionet R, Dick DM, Ripatti S, Andreassen OA, Espeseth T, Lundervold AJ, Steen VM, Pinto D, Scherer SW, Aschauer H, Schosser A, Alfredsson L, Padyukov L, Halmi KA, Mitchell J, Strober M, Bergen AW, Kaye W, Szatkiewicz JP, Cormand B, Ramos-Quiroga JA, Sánchez-Mora C, Ribasés M, Casas M, Hervas A, Arranz MJ, Haavik J, Zayats T, Johansson S, Williams N, Dempfle A, Rothenberger A, Kuntsi J, Oades RD, Banaschewski T, Franke B, Buitelaar JK, Arias Vasquez A, Doyle AE, Reif A, Lesch KP, Freitag C, Rivero O, Palmason H, Romanos M, Langley K, Rietschel M, Witt SH, Dalsgaard S, Børglum AD, Waldman I, Wilmot B, Molly N, Bau CHD, Crosbie J, Schachar R, Loo SK, McGough JJ, Grevet EH, Medland SE, Robinson E, Weiss LA, Bacchelli E, Bailey A, Bal V, Battaglia A, Betancur C, Bolton P, Cantor R, Celestino-Soper P, Dawson G, De Rubeis S, Duque F, Green A, Klauck SM, Leboyer M, Levitt P, Maestrini E, Mane S, De-Luca DM, Parr J, Regan R, Reichenberg A, Sandin S, Vorstman J, Wassink T, Wijsman E, Cook E, Santangelo S, Delorme R, Rogé B, Magalhaes T, Arking D, Schulze TG, Thompson RC, Strohmaier J, Matthews K, Melle I, Morris D, Blackwood D, McIntosh A, Bergen SE, Schalling M, Jamain S, Maaser A, Fischer SB, Reinbold CS, Fullerton JM, Guzman-Parra J, Mayoral F, Schofield PR, Cichon S, Mühleisen TW, Degenhardt F, Schumacher J, Bauer M, Mitchell PB, Gershon ES, Rice J, Potash JB, Zandi PP, Craddock N, Ferrier IN, Alda M, Rouleau GA, Turecki G, Ophoff R, Pato C, Anjorin A, Stahl E, Leber M, Czerski PM, Cruceanu C, Jones IR, Posthuma D, Andlauer TFM, Forstner AJ, Streit F, Baune BT, Air T, Sinnamon G, Wray NR, MacIntyre DJ, Porteous D, Homuth G, Rivera M, Grove J, Middeldorp CM, Hickie I, Pergadia M, Mehta D, Smit JH, Jansen R, de Geus E, Dunn E, Li QS, Nauck M, Schoevers RA, Beekman AT, Knowles JA, Viktorin A, Arnold P, Barr CL, Bedoya-Berrio G, Bienvenu OJ, Brentani H, Burton C, Camarena B, Cappi C, Cath D, Cavallini M, Cusi D, Darrow S, Denys D, Derks EM, Dietrich A, Fernandez T, Figee M, Freimer N, Gerber G, Grados M, 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Analysis of shared heritability in common disorders of the brain. Science 2018; 360:eaap8757. [PMID: 29930110 PMCID: PMC6097237 DOI: 10.1126/science.aap8757] [Citation(s) in RCA: 847] [Impact Index Per Article: 141.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 02/07/2017] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Abstract
Disorders of the brain can exhibit considerable epidemiological comorbidity and often share symptoms, provoking debate about their etiologic overlap. We quantified the genetic sharing of 25 brain disorders from genome-wide association studies of 265,218 patients and 784,643 control participants and assessed their relationship to 17 phenotypes from 1,191,588 individuals. Psychiatric disorders share common variant risk, whereas neurological disorders appear more distinct from one another and from the psychiatric disorders. We also identified significant sharing between disorders and a number of brain phenotypes, including cognitive measures. Further, we conducted simulations to explore how statistical power, diagnostic misclassification, and phenotypic heterogeneity affect genetic correlations. These results highlight the importance of common genetic variation as a risk factor for brain disorders and the value of heritability-based methods in understanding their etiology.
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Affiliation(s)
- Verneri Anttila
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Brendan Bulik-Sullivan
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Hilary K Finucane
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Mathematics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Raymond K Walters
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jose Bras
- UK Dementia Research Institute, University College London, London, UK
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Laramie Duncan
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, California, USA
| | - Valentina Escott-Price
- Cardiff University, Medical Research Council Center for Neuropsychiatric Genetics & Genomics, Institute of Psychology, Medicine & Clinical Neuroscience, Cardiff, UK
- Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Guido J Falcone
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Padhraig Gormley
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Nikolaos A Patsopoulos
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephan Ripke
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Zhi Wei
- Department of Computer Science, New Jersey Institute of Technology, New Jersey, USA
| | - Dongmei Yu
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Phil H Lee
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Turley
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Benjamin Grenier-Boley
- INSERM U1167 LabEx DISTALZ, Lille, France
- Institut Pasteur de Lille, U1167, Lille, France
- Université de Lille, U1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
| | - Vincent Chouraki
- INSERM U1167 LabEx DISTALZ, Lille, France
- Institut Pasteur de Lille, U1167, Lille, France
- Université de Lille, U1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
- Centre Hosp. Univ Lille, Lille, France
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Claudine Berr
- INSERM U1061 - Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
- University of Montpellier, Montpellier, France
- Memory Research and Resources Center, Department of Neurology, Montpellier University Hospital Gui de Chauliac, Montpellier, France
| | - Luc Letenneur
- INSERM, UMR 1219, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Didier Hannequin
- Rouen University Hospital, Rouen, France
- Inserm U1245, Rouen, France
| | - Philippe Amouyel
- INSERM U1167 LabEx DISTALZ, Lille, France
- Institut Pasteur de Lille, U1167, Lille, France
- Université de Lille, U1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Lille, France
- Centre Hosp. Univ Lille, Lille, France
| | - Anne Boland
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de biologie François Jacob, CEA, Evry, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de biologie François Jacob, CEA, Evry, France
| | - Emmanuelle Duron
- Department of Gerontology, Hôpital Broca, AH-HP, Paris, France
- Hôpital Paul Brousse Université Paris Sud XI, Le Kremlin-Bicêtre, Paris, France
| | - Badri N Vardarajan
- Gertrude H. Sergievsky Center and Dept of Neurology, Columbia University, New York, NY, USA
| | | | - Alison M Goate
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew J Huentelman
- Translational Genomics Research Institute, Neurogenomics Division, Phoenix, AZ, USA
| | | | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Medicine, University of Washington, WA, USA
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
| | - Peter St George-Hyslop
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Canada
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Hakon Hakonarson
- Center for Applied Genomics of The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Walter A Kukull
- National Alzheimer Coordinating Center (NACC), Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lindsay A Farrer
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Lisa L Barnes
- Rush Alzheimers Disease Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
- Department of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | | | | | - Elizabeth Head
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Christine M Hulette
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Gregory A Jicha
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - John S K Kauwe
- Department of Biology, Brigham Young University, Provo, UT, USA
| | - Jeffrey A Kaye
- Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - James B Leverenz
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan I Levey
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Andrew P Lieberman
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Vernon S Pankratz
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Wayne W Poon
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Joseph F Quinn
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
- Department of Neurology and Parkinson's Disease Research Education and Clinical Care Center (PADRECC), Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Andrew J Saykin
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lon S Schneider
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Amanda G Smith
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Joshua A Sonnen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | - Vivianna M Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Denise Harold
- School of Biotechnology, Dublin City University, Glasnevin, Dublin, Ireland
| | - Giancarlo Russo
- Functional Genomics Center Zurich, ETH/UZH-Zurich, Zurich, Switzerland
| | - David C Rubinsztein
- Department of Medical Genetics, Cambridge Institute for Medical Research, Cambridge, UK
- UK Dementia Research Institute, Cambridge, UK
| | | | - Magda Tsolaki
- 1st and 3rd Departments of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Petra Proitsi
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute, University College London, London, UK
| | - Harald Hampel
- Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
- Brain & Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Paris, France
- AXA Research Fund & Sorbonne University Chair, Paris, France
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Simon Mead
- Institute of Prion Diseases and MRC Prion Unit, University College London, London, UK
| | - Peter Passmore
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Kevin Morgan
- Human Genetics, School of Life Sciences, University of Nottingham, Nottingham UK
| | - Markus M Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Human Genetics, School of Medicine, University of Bonn & University Hospital Bonn, Bonn, Germany
| | - Martin Rossor
- Department of Neurodegeneration, UCL Institute of Neurology, London, UK
| | - Michelle K Lupton
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Institute of Psychiatry Psychology and Neuroscience, Kings College London, UK
| | - Per Hoffmann
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Human Genetics, School of Medicine, University of Bonn & University Hospital Bonn, Bonn, Germany
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg University Hospital, Erlangen, Germany
| | - Brian Lawlor
- Department of Psychiatry and Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Andrew McQuillin
- Division of Psychiatry, Molecular Psychiatry Laboratory,University College London, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- King's College Hospital, London, UK
| | - Joshua C Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Agustin Ruiz
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain and Universitat Internacional de Catalunya, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Mercè Boada
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain and Universitat Internacional de Catalunya, Barcelona, Spain
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
- Neurology and Neurogenetics Core, Framingham Heart Study, Framingham, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Alexa Beiser
- School of Public Health, Boston University, Boston, MA, USA
- Framingham Heart Study, Framingham, MA, USA
- School of Medicine, Boston University, Boston, MA, USA
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Sven J van der Lee
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Philip L De Jager
- Center for Translational & Computational Neuroimmunology, Columbia University Medical Center, New York, NY, USA
| | - Daniel H Geschwind
- Neurogenetics Program, Departments of Neurology and Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center For Autism Research and Treatment, Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Departments of Pediatrics and Medicine, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gerhard Ransmayr
- Department of Neurology II, Kepler University Clinic, Johannes Kepler University, Linz, Austria
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carlos Cruchaga
- Washington University School of Medicine, St. Louis, MO, USA
| | - Montserrat Alegret
- Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain and Universitat Internacional de Catalunya, Barcelona, Spain
| | - Bendik Winsvold
- Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Kai-How Farh
- Illumina Inc., San Diego, CA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ester Cuenca-Leon
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lannie Ligthart
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias Freilinger
- Institute for Stroke and Dementia Research, Klinikum der Universitaet Muenchen, Munich, Germany
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Scott D Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Guntram Borck
- Institute of Human Genetics, University of Ulm, Ulm, Germany
| | - Hieab H H Adams
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Juho Wedenoja
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Markus Schürks
- Department of Neurology, University Hospital Essen, Germany
| | | | - Jouke-Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Avera Institute for Human Genetics, Sioux Falls, SD, USA
| | - Brenda Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Ville Artto
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Mari Kaunisto
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Salli Vepsäläinen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Grant W Montgomery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Mitja I Kurki
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Eija Hämäläinen
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Hailiang Huang
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jie Huang
- Boston VA Research Institute, Boston, MA, USA
- Brigham Women's Hospital Division of Aging, Harvard Medical School, Boston, MA, USA
| | - Cynthia Sandor
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Caleb Webber
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Bertram Muller-Myhsok
- Max Planck Institute of Psychiatry, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
- Clinic of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Elizabeth Loehrer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Alfons Macaya
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain
- Headache Research Group, VHIR, Autonomous University of Barcelona, Barcelona, Spain
| | - Thomas Hansen
- Danish Headache Center, Rigshospitalet Glostrup and University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Roskilde, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Roskilde, Denmark
- Department of Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Andres Metspalu
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Christian Kubisch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrea C Belin
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Arn M J M van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - John-Anker Zwart
- Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Dorret Boomsma
- Netherlands Twin Register, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Jes Olesen
- Danish Headache Center, Rigshospitalet Glostrup and University of Copenhagen, Copenhagen, Denmark
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dale R Nyholt
- Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andreja Avbersek
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - Larry Baum
- Centre for Genomic Sciences, University of Hong Kong, Hong Kong
| | - Samuel Berkovic
- Epilepsy Research Centre, University of Melbourne, Heidelberg, Australia
| | | | - Russell J Buono
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Claudia B Catarino
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Epilepsy Society, Chalfont-St-Peter, Bucks, UK
| | - Patrick Cossette
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal and Department of Neurosciences, Université de Montréal, Montréal, Canada
| | - Peter De Jonghe
- Neurogenetics Group, VIB-CMN, Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas N Ferraro
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
- Department of Psychiatry, Center for Neurobiology and Behavior, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jennifer Jamnadas-Khoda
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Reetta Kälviäinen
- Epilepsy Center/Neurocenter, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Wolfram S Kunz
- Department of Epileptology, University Bonn Medical Center, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, University Bonn Medical Center, Bonn, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Costin Leu
- Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London
| | - Dick Lindhout
- Department of Genetics, University Medical Center Utrecht, the Netherlands
- Epilepsy Foundation in the Netherlands (SEIN), Heemstede, the Netherlands
| | - Warren Lo
- Departments of Pediatrics and Neurology, Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Mark McCormack
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rikke S Møller
- Danish Epilepsy Centre, Filadelfia, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | | | - Ping-Wing Ng
- United Christian Hospital, Hong Kong
- Hong Kong Sanatorium and Hospital, Hong Kong
| | - Karen Oliver
- Epilepsy Research Centre, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Michael Privitera
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
- UC Gardner Neuroscience Institute, Cincinnati, OH, USA
| | - Rodney Radtke
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Thomas Sander
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Steven Schachter
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christoph Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Neurology, University of Munich Hospital, Grosshadern, University of Munich, Germany
| | - Ingrid Scheffer
- Department of Medicine, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Susanne Schoch
- Institute of Neuropathology, Bonn University Medical School, Bonn, Germany
| | - Sanjay M Sisodiya
- UCL Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Bucks, UK
| | | | - Michael Sperling
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genoa, "G. Gaslini" Institute, Genova, Italy
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, UK
| | - Frank Visscher
- Department of Neurology, Admiraal De Ruyter Hospital, Goes, The Netherlands
| | - Christopher D Whelan
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Federico Zara
- Laboratory of Neurogenetics, G. Gaslini Institute, Genova, Italy
| | - Erin L Heinzen
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | - Anthony Marson
- University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Felicitas Becker
- Department of Neurology and Epileptology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Austria
| | - Thomas Gasser
- Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Raphael Gibbs
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Peter Heutink
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Maria Martinez
- INSERM U1220, IRSD, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | | | - Manu Sharma
- Centre for Genetic Epidemiology, Institute for Clinical Epidemiology and Applied Biometery, University of Tubingen, Germany
| | | | - Kin Y Mok
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- Division of Life Science, Hong Kong University of Science and Technology, Hong Kong Special Administrative Region, China
| | - Sara Pulit
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Elizabeth Holliday
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - John Attia
- University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Thomas Battey
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Giorgio Boncoraglio
- Department of Cerebrovascular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- PhD Program in Neuroscience, University Milano-Bicocca, Monza, Italy
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Austin Health, Heidelberg, Australia
| | - Wei-Min Chen
- University of Virginia Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Braxton Mitchell
- Dept of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Peter Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, London, UK
- Ashford & St Peters NHS Foundation Trust, Surrey, UK
| | | | - Astrid Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Biosystems and Integrative Sciences Institute - BioISI, University of Lisboa, Lisboa, Portugal
| | - Hugh Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Christina Kourkoulis
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joana Pera
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - Miriam Raffeld
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Scott Silliman
- Department of Neurology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL, USA
| | | | - Laura M Thornton
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - N William Rayner
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, Cambridgeshire, UK
| | - Cathryn M Lewis
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Monica Gratacos
- Genes and Disease Programme, Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Filip Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poland
| | | | - Anu Raevuori
- Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Finland
| | - James I Hudson
- Harvard Medical School/McLean Hospital, Belmont, MA, USA
| | | | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno,Italy
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Katrin Mannik
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Jessica H Baker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Sara E Trace
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oliver S P Davis
- MRC Integrative Epidemiology Unit and Bristol Medical School, University of Bristol, Bristol, UK
| | - Sietske G Helder
- Zorg op Orde BV, Leidschendam, The Netherlands
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Stefan Ehrlich
- Division of Psychological & Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technischen Universität Dresden, Dresden, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child & Adolescent Psychiatry & Psychosomatic Medicine of University Clinics, RWTH Aachen, Aachen, Germany
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
- Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
- Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands
| | - Maurizio Clementi
- Medical Genetics Unit, Department SDB, University of Padova, Padova, Italy
| | - Monica Forzan
- UOC Genetica ed Epidemiologica Clinica Az. Ospedaliera, Padova, Italy
| | - Elisa Docampo
- Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liège, Belgium
- Department of Rheumatology, CHU Sart-Tilman, University of Liège, Liège, Belgium
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, Cancer Center and M. Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Joanna Hauser
- Department of Psychiatry, University of Medical Sciences, Poznan, Poland
| | | | - Mario Maj
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "luigi Vanvitelli", Naples, Italy
| | - Fragiskos Gonidakis
- Eating Disorders Unit, 1st Psychiatric Department, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Hana Papezova
- Eating Disorders Unit, Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic
- General University Hospital, Prague, Czech Republic
| | - Zeynep Yilmaz
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Stefan Herms
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Human Genetics, School of Medicine, University of Bonn & University Hospital Bonn, Bonn, Germany
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - Raquel Rabionet
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
- Department of Genetics, Microbiology & Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Centre for Genomic Regulation (CRG), Barcelona, Spain
| | - Danielle M Dick
- Departments of Psychology and Human & Molecular Genetics, College Behavioral and Emotional Health Institute, Virginia Commonwealth University, Richmond, Virginia
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Ole A Andreassen
- NORMENT, Div. of Mental Health and Addiction, University of Oslo, Oslo, Norway
- Oslo University Hospital, Oslo, Norway
| | - Thomas Espeseth
- NORMENT, Div. of Mental Health and Addiction, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Norway
- K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
| | - Vidar M Steen
- NORMENT, K.G. Jebsen Center for Psychosis Research, Department of Clinical Science, University of Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Dalila Pinto
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, and Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen W Scherer
- McLaughlin Centre and Department of Molecular Genetics, University of Toronto, Toronto, Canada
- The Centre for Applied Genomics, Hospital for Sick Children, Toronto, Canada
| | | | - Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Zentren für Seelische Gesundheit, BBRZ-Med, Vienna, Austria
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
| | | | - James Mitchell
- School of Medicine, University of North Dakota, Grand Forks, ND, USA
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Michael Strober
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Andrew W Bergen
- BioRealm, Walnut, California, USA
- Oregon Research Institute, Eugene, OR, USA
| | - Walter Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Bru Cormand
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
- Department of Genetics, Microbiology & Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Sánchez-Mora
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Ribasés
- Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Casas
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Programa Corporatiu "Neurodevelopment Disorders along Life Span", Institut Català de la Salut, Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Clinica Galatea y PAIMM, Mental Health Program for Impaired Physicians, Barcelona, Spain
| | - Amaia Hervas
- Child and Adolescent Mental Health Unit, Hospital Universitario Mútua de Terrassa, Barcelona, Spain
| | | | - Jan Haavik
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tetyana Zayats
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Biomedicine, University of Bergen, Norway
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
| | - Stefan Johansson
- K.G. Jebsen Centre for Neuropsychiatric Disorders, Department of Clinical Science, University of Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Nigel Williams
- Cardiff University, Medical Research Council Center for Neuropsychiatric Genetics & Genomics, Institute of Psychology, Medicine & Clinical Neuroscience, Cardiff, UK
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry/Psychotherapy, University Medical Center, Goettingen, Germany
| | - Jonna Kuntsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert D Oades
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - Tobias Banaschewski
- Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands
| | - Alejandro Arias Vasquez
- Department of Psychiatry & Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alysa E Doyle
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Klaus-Peter Lesch
- Laboratory of Psychiatric Neurobiology, Institute of Molecular Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Translational Psychiatry, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Division of Molecular Psychiatry, Center of Mental Health, University of Wuerzburg, Wuerzburg, Germany
| | - Christine Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Olga Rivero
- Division of Molecular Psychiatry, Center of Mental Health, University of Wuerzburg, Wuerzburg, Germany
| | - Haukur Palmason
- Landspitali National University Hospital, Reykjavik, Iceland
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Kate Langley
- School of Psychology, Cardiff University, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Marcella Rietschel
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stephanie H Witt
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Soeren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Hospital of Telemark, Kragerø, Norway
| | - Anders D Børglum
- Department of Biomedicine and Human Genetics, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Integrative Sequencing (iSEQ), Aarhus University, Aarhus, Denmark
- Aarhus Genome Center, Aarhus, Denmark
| | - Irwin Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Beth Wilmot
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Nikolas Molly
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Claiton H D Bau
- Departamento de Genética, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jennifer Crosbie
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Russell Schachar
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Sandra K Loo
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - James J McGough
- Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Eugenio H Grevet
- ADHD Outpatient Clinic, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elise Robinson
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Weiss
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Elena Bacchelli
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Anthony Bailey
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Institute of Mental Health, University of British Columbia, Vancouver, Canada
| | - Vanessa Bal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Agatino Battaglia
- Stella Maris Clinical Research Institute for Child and Adolescent Neuropsychiatry, Pisa, Italy
| | - Catalina Betancur
- Sorbonne Université, INSERM, CNRS, Neuroscience Paris Seine, Institut de Biologie Paris Seine, Paris, France
| | - Patrick Bolton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre in Mental Health Maudsley Hospital, London, UK
| | - Rita Cantor
- Department of Human Genetics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Silvia De Rubeis
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frederico Duque
- Child Developmental Center, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Andrew Green
- Dept of Clinical Genetics, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sabine M Klauck
- Division of Molecular Genome Analysis and Division of Cancer Genome Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marion Leboyer
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
- Faculté de Médecine, Université Paris Est, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Pat Levitt
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elena Maestrini
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Shrikant Mane
- Yale Center for Genome Analysis, Yale University, New Haven, CT, USA
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel Moreno- De-Luca
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jeremy Parr
- Institute of Neuroscience, Newcastle University, Newcastle, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
- Northumberland, Tyne & Wear NHS Foundation Trust, Northumberland, UK
| | - Regina Regan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Genomics Medicine Ireland, Dublin, Ireland
| | | | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Vorstman
- Department of Psychiatry, Hospital for Sick Children and University of Toronto, Toronto, Canada
- Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada
| | - Thomas Wassink
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ellen Wijsman
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Edwin Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan Santangelo
- Center for Psychiatric Research, Maine Medical Center Research Institute, Portland, ME, USA
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debre Hospital, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Bernadette Rogé
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé (CERPPS), Université Toulouse Jean Jaurès, Toulouse, France
- CERESA, Toulouse, France
- Institut Universitaire de France, Paris, France
| | - Tiago Magalhaes
- Genomics Medicine Ireland, Dublin, Ireland
- Academic Centre on Rare Diseases University College Dublin (ACoRD/UCD), Dublin, Ireland
| | - Dan Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Human Genetics Branch, National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Robert C Thompson
- Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jana Strohmaier
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- SRH University Heidelberg, Academy for Psychotherapy, Heidelberg, Germany
| | - Keith Matthews
- Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
- Advanced Interventions Service, NHS Tayside, Dundee, UK
| | - Ingrid Melle
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Derek Morris
- Cognitive Genetics and Cognitive Therapy Group, Neuroimaging, Cognition and Genomics (NICOG) Centre, School of Psychology and Discipline of Biochemistry, National University of Ireland Galway, Galway, Ireland
| | | | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stéphane Jamain
- Inserm U955, Psychiatrie Translationnelle, Créteil, France
- Faculté de Médecine, Université Paris Est, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Anna Maaser
- Institute of Human Genetics, School of Medicine, University of Bonn & University Hospital Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Sascha B Fischer
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Céline S Reinbold
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - José Guzman-Parra
- Unidad de Salud Mental, Hospital Regional Universitario de Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Fermin Mayoral
- Unidad de Salud Mental, Hospital Regional Universitario de Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Sven Cichon
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | | | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Black Dog Institute, Sydney, Australia
| | | | - John Rice
- Washington University, St. Louis, MO, USA
| | - James B Potash
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nick Craddock
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Guy A Rouleau
- Montreal Neurological Institute, McGill University, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montréal, Canada
| | - Roel Ophoff
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience & Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
- UMC Utrecht, Utrecht, The Netherlands
| | - Carlos Pato
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Eli Stahl
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Markus Leber
- Hospital for Psychiatry and Psychotherapy, Cologne, Germany
| | - Piotr M Czerski
- Laboratory of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
- Department of Translational Research in Psychiatry, Max-Planck Institute of Psychiatry, Munich, Germany
| | - Ian R Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Danielle Posthuma
- Department Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands
- Department Clinical Genetics, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Till F M Andlauer
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, School of Medicine, University of Bonn & University Hospital Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Human Genomics Research Group, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Fabian Streit
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Tracy Air
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Grant Sinnamon
- Bela Menso Brain and Behaviour Centre, James Cook University, Varsity Lakes, Australia
- Bond University, Faculty of Society and Design, Robina, Australia
| | - Naomi R Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Donald J MacIntyre
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Porteous
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Margarita Rivera
- Department of Biochemistry and Molecular Biology II, Institute of Neurosciences, Center for Biomedical Research, University of Granada, Granada, Spain
- MRC Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Jakob Grove
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
- Center for Integrative Sequencing (iSEQ), Aarhus University, Aarhus, Denmark
- Department of Biomedicine and Human Genetics, Aarhus University, Aarhus, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Christel M Middeldorp
- Child Health Research Centre, University of Queensland, Brisbane, Australia
- Child and Youth Mental Health Service, Children's Health Queensland Health and Hospital Service, Brisbane, Australia
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Divya Mehta
- School of Psychology and Counselling, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Johannes H Smit
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
- Department of Research and Innovation, GGZ Ingeest, Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Rick Jansen
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Eco de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
| | - Erin Dunn
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Qingqin S Li
- Janssen Research & Development LLC, Titusville, NJ, USA
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Robert A Schoevers
- Research School of Behavioural and Cognitive Neurosciences, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aartjan Tf Beekman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry GGZ INGEEST, Amsterdam, the Netherlands
| | - James A Knowles
- Department of Cell Biology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Departments of Psychiatry and Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada
| | - Cathy L Barr
- Krembil Research Institute, University Health Network, Toronto, Canada
- Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Gabriel Bedoya-Berrio
- Grupo de Genética Molecular, Instituto de Biología, Facultad de Ciencias Exactas y Naturales, Universidad de Antioquia, Medellín, Colombia
| | | | - Helena Brentani
- Department of Psychiatry, Sao Paulo Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Beatriz Camarena
- Depto. Farmacogenética, Instituto Nacional de Psiquiatria Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Carolina Cappi
- Department of Psychiatry, Sao Paulo Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Danielle Cath
- Department of Psychiatry, University of Groningen and University Medical Center, Groningen, the Netherlands
- Department of Specialized Trainings, GGZ Drenthe Mental Health Care Services, Assen, the Netherlands
| | | | | | | | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Eske M Derks
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrea Dietrich
- University of Groningen, Groningen, the Netherlands
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nelson Freimer
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience & Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gloria Gerber
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Marco Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Gregory L Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Andreas Hartmann
- Centre National Maladie 'Syndrome Rare Gilles de la Tourette', Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Départment de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC Université Paris 06, UMR S 1127, CNRS UMR 7225, ICM, Paris, France
| | - Matthew E Hirschtritt
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alden Huang
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Chaim Huyser
- De Bascule, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Samuel Kuperman
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Christine Lochner
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Gholson J Lyon
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Fabio Macciardi
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Marcos Madruga-Garrido
- Sección de Neuropediatría, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Irene A Malaty
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Barendrecht, The Netherlands
| | - Lauren McGrath
- Department of Psychology, University of Denver, Denver, CO, USA
| | - Eurípedes C Miguel
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Humberto Nicolini
- National Institute of Genomic Medicine (INMEGEN), Ciudad de México, Mexico
- Clinical Research, Grupo Médico Carracci, Mexico City, Mexico
| | - Michael S Okun
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
- Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Andrew Pakstis
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Peristera Paschou
- Department of Biological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - John Piacentini
- Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Kerstin Plessen
- Division of Adolescent and Child Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Child and Adolescent Mental Health Centre, Mental Health Services Capital Region Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Vasily Ramensky
- Moscow Institute of Physics and Technology, Dolgoprudny, Institusky 9, Moscow, Russia
| | - Eliana M Ramos
- Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Victor Reus
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary M Robertson
- Division of Neuropsychiatry, University College London, London, UK
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technischen Universität Dresden, Dresden, Germany
| | - Maria Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, Brazil
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jack F Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Paul Sandor
- Department of Psychiatry, University of Toronto, Toronto, Canada
- University Health Network, University of Toronto, Toronto, Canada
- Youthdale Treatment Centers, Toronto, Canada
| | - Dan J Stein
- Groote Schuur Hospital, Cape Town, South Africa
- MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Fotis Tsetsos
- Department of Molecular Biology and Genetics, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Sarah Weatherall
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Yulia Worbe
- Sorbonne Université, Faculty of Médecine, Paris, France
- Reference center for Gilles de la Tourette syndrome, Pitie-Salpetriere Hospital, Paris, France
- Department of Physiology, Saint Antoine Hospital, Paris, France
| | - Gwyneth Zai
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole McLaughlin
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Hans-Jorgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- INSERM, U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Paris, France
- IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France
| | | | | | - Ana Valencia-Duarte
- Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
- Laboratorio de Genética Molecular, SIU, Universidad de Antioquia, Medellín, Colombia
| | - Elvira Bramon
- Division of Psychiatry, Molecular Psychiatry Laboratory,University College London, London, UK
| | - Nancy Buccola
- School of Nursing, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Wiepke Cahn
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Murray Cairns
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
- Priority Research Centre for Brain and Mental Health Research, Hunter Medical Research Institute, Newcastle, Australia
- Schizophrenia Research Institute, Sydney, Australia
| | - Siow A Chong
- Institute of Mental Health, Singapore, Singapore
| | - David Cohen
- Assistance Publique - Hopitaux de Paris, GH Pitié-Salpêtrière, Paris, France
- Sorbonne Université, CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, Paris, France
| | - Benedicto Crespo-Facorro
- Departments of Medicine and Psychiatry, School of Medicine University of Cantabria-IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - James Crowley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael Davidson
- Minerva Neurosciences Inc., Waltham, MA, USA
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lynn DeLisi
- VA Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Timothy Dinan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - Gary Donohoe
- Neuroimaging, Cognition and Genomics (NICOG) Centre, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Elodie Drapeau
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jubao Duan
- Center for Psychiatric Genetics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Lieuwe Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Arkin, Amsterdam, the Netherlands
| | - David Hougaard
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | | | - Andrey Khrunin
- Department of Molecular Bases of Human Genetics, Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
| | - Janis Klovins
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | | | - Jimmy Lee Chee Keong
- Institute of Mental Health, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Svetlana Limborska
- Department of Human Genetics, Institute of Molecular Genetics, Russian Academy of Sciences, Moscow, Russia
| | - Carmel Loughland
- Hunter New England Local Health District, Newcastle, Australia
- University of Newcastle, Callaghan, Australia
| | - Jouko Lönnqvist
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Mattheisen
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Colm McDonald
- Centre for Neuroimaging and Cognitive Genomics (NICOG), National University of Ireland, Galway, Galway, Ireland
- NCBES Galway Neuroscience Centre, National University of Ireland, Galway, Galway, Ireland
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Igor Nenadic
- Philipps-Universität Marburg and Marburg University Hospital UKGM, Marburg, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jim van Os
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Victoria, Australia
- Centre for Neural Engineering, Department of Electrical and Electronic Engineering, University of Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Michele Pato
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Tracey Petryshen
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Digby Quested
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Panos Roussos
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alan R Sanders
- Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | | | - Sibylle G Schwab
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Kang Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| | - Hon-Cheong So
- School of Biomedical Sciences, Chinese University of Hong Kong, Shatin, Hong Kong
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- Chinese University of Hong Kong, Hong Kong
| | | | - Mythily Subramaniam
- Institute of Mental Health, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Draga Toncheva
- Department of Medical Genetics, Medical University, Sofia, Bulgaria
| | - John Waddington
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Mark Weiser
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Wei Cheng
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert Cloninger
- Departments of Psychiatry and Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - David Curtis
- UCL Genetics Institute, University College London, London, UK
- Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, London, UK
| | - Pablo V Gejman
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, NorthShore University HealthSystem Research Institute, Evanston, IL, USA
| | - Frans Henskens
- School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Morten Mattingsdal
- NORMENT, K.G. Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Sang-Yun Oh
- Department of Statistics and Applied Probability, University of California, Santa Barbara, CA, USA
- Computational Research Division, Lawrence Berkeley National Laboratory, University of California at Berkeley, Berkeley, CA, USA
| | - Rodney Scott
- University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- NSW Health Pathology, Newcastle, Australia
| | - Bradley Webb
- Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Gerome Breen
- Institute of Psychiatry, Psychology & Neuroscience, Social Genetics & Developmental Psychiatry Center, MRC, Kings College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London & Maudsley NHS Trust & King's College London, London, UK
| | - Claire Churchhouse
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Cynthia M Bulik
- Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark Daly
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Rita Guerreiro
- UK Dementia Research Institute, University College London, London, UK
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - Peter Holmans
- Cardiff University, Medical Research Council Center for Neuropsychiatric Genetics & Genomics, Institute of Psychology, Medicine & Clinical Neuroscience, Cardiff, UK
| | - Kenneth S Kendler
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Bobby Koeleman
- Division Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carol A Mathews
- Department of Psychiatry and UF Genetics Institute, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Alkes Price
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeremiah Scharf
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Sklar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie Williams
- Cardiff University, Medical Research Council Center for Neuropsychiatric Genetics & Genomics, Institute of Psychology, Medicine & Clinical Neuroscience, Cardiff, UK
- Dementia Research Institute, Cardiff University, Cardiff, UK
| | - Nicholas W Wood
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
- UCL Genetics Institute, University College London, London, UK
| | - Chris Cotsapas
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Aarno Palotie
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jordan W Smoller
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Sullivan
- Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Genetics and Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jonathan Rosand
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aiden Corvin
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
- Neuropsychiatric Genetics Research Group, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Benjamin M Neale
- Analytic Translational Genetics Unit, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Richard Anney
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Josephine Elia
- Department of Pediatrics, Nemours A.I. duPont Hospital for Children, Wilmington, DE, USA
- Department of Psychiatry, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Grigoroiu-Serbanescu
- Alexandru Obregia Clinical Psychiatric Hospital, Biometric Psychiatric Genetics Research Unit, Bucharest, Romania
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Shinnar RC, Shinnar S, Cnaan A, Clark P, Dlugos D, Hirtz DG, Hu F, Liu C, Masur D, Weiss EF, Glauser TA. Pretreatment behavior and subsequent medication effects in childhood absence epilepsy. Neurology 2017; 89:1698-1706. [PMID: 28916534 DOI: 10.1212/wnl.0000000000004514] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/26/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To characterize pretreatment behavioral problems and differential effects of initial therapy in children with childhood absence epilepsy (CAE). METHODS The Child Behavior Checklist (CBCL) was administered at baseline, week 16-20, and month 12 visits of a randomized double-blind trial of ethosuximide, lamotrigine, and valproate. Total problems score was the primary outcome measure. RESULTS A total of 382 participants at baseline, 310 participants at the week 16-20 visit, and 168 participants at the month 12 visit had CBCL data. At baseline, 8% (95% confidence interval [CI] 6%-11%) of children with CAE had elevated total problems scores (mean 52.9 ± 10.91). At week 16-20, participants taking valproic acid had significantly higher total problems (51.7 [98.3% CI 48.6-54.7]), externalizing problems (51.4 [98.3% CI 48.5-54.3]), attention problems (57.8 [98.3% CI 55.6-60.0]), and attention-deficit/hyperactivity problems (55.8 [98.3% CI 54.1-57.6]) scores compared to participants taking ethosuximide (46.5 [98.3% CI 43.4-49.6]; 45.8 [98.3% CI 42.9-48.7]; 54.6 [98.3% CI 52.4-56.9]; 53.0 [98.3% CI 51.3-54.8]). Lack of seizure freedom and elevated week 16-20 Conner Continuous Performance Test confidence index were associated with worse total problems scores. At month 12, participants taking valproic acid had significantly higher attention problems scores (57.9 [98.3% CI 55.6-60.3]) compared to participants taking ethosuximide (54.5 [95% CI 52.1-56.9]). CONCLUSIONS Pretreatment and ongoing behavioral problems exist in CAE. Valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine, further reinforcing ethosuximide as the preferred initial therapy for CAE. CLINICALTRIALSGOV IDENTIFIER NCT00088452. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for children with CAE, valproic acid is associated with worse behavioral outcomes than ethosuximide or lamotrigine.
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Affiliation(s)
- Ruth C Shinnar
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD.
| | - Shlomo Shinnar
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Avital Cnaan
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Peggy Clark
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Dennis Dlugos
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Deborah G Hirtz
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Fengming Hu
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Chunyan Liu
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - David Masur
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Erica F Weiss
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
| | - Tracy A Glauser
- From Montefiore Medical Center (R.C.S., S.S., D.M., E.F.W.), Albert Einstein College of Medicine, Bronx, NY; George Washington University (A.C.), Washington, DC; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (P.C., C.L., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; National Institute of Neurological Disorders and Stroke (D.G.H.); and Henry M. Jackson Foundation for the Advancement of Military Medicine (F.H.), Bethesda, MD
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25
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Kessler SK, Shinnar S, Cnaan A, Dlugos D, Conry J, Hirtz DG, Hu F, Liu C, Mizrahi EM, Moshé SL, Clark P, Glauser TA. Pretreatment seizure semiology in childhood absence epilepsy. Neurology 2017; 89:673-679. [PMID: 28724582 DOI: 10.1212/wnl.0000000000004226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/23/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine seizure semiology in children with newly diagnosed childhood absence epilepsy and to evaluate associations with short-term treatment outcomes. METHODS For participants enrolled in a multicenter, randomized, double-blind, comparative-effectiveness trial, semiologic features of pretreatment seizures were analyzed as predictors of treatment outcome at the week 16 to 20 visit. RESULTS Video of 1,932 electrographic absence seizures from 416 participants was evaluated. Median seizure duration was 10.2 seconds; median time between electrographic seizure onset and clinical manifestation onset was 1.5 seconds. For individual seizures and by participant, the most common semiology features were pause/stare (seizure 95.5%, participant 99.3%), motor automatisms (60.6%, 86.1%), and eye involvement (54.9%, 76.5%). The interrater agreement for motor automatisms and eye involvement was good (72%-84%). Variability of semiology features between seizures even within participants was high. Clustering analyses revealed 4 patterns (involving the presence/absence of eye involvement and motor automatisms superimposed on the nearly ubiquitous pause/stare). Most participants experienced more than one seizure cluster pattern. No individual semiologic feature was individually predictive of short-term outcome. Seizure freedom was half as likely in participants with one or more seizure having the pattern of eye involvement without motor automatisms than in participants without this pattern. CONCLUSIONS Almost all absence seizures are characterized by a pause in activity or staring, but rarely is this the only feature. Semiologic features tend to cluster, resulting in identifiable absence seizure subtypes with significant intraparticipant seizure phenomenologic heterogeneity. One seizure subtype, pause/stare and eye involvement but no motor automatisms, is specifically associated with a worse treatment outcome.
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Affiliation(s)
- Sudha Kilaru Kessler
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX.
| | - Shlomo Shinnar
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Avital Cnaan
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Dennis Dlugos
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Joan Conry
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Deborah G Hirtz
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Fengming Hu
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Chunyan Liu
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Eli M Mizrahi
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Solomon L Moshé
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Peggy Clark
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Tracy A Glauser
- From the Children's Hospital of Philadelphia (S.K.K., D.D.), Perelman School of Medicine, University of Pennsylvania; Montefiore Medical Center (S.S., S.L.M.), Albert Einstein College of Medicine, Bronx, NY; Children's National Health System (A.C., J.C., F.H.), Washington, DC; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; Comprehensive Epilepsy Center (C.L., P.C., T.A.G.), Division of Neurology, Cincinnati Children's Hospital Medical Center, OH; and Baylor College of Medicine (E.M.M.), Houston, TX
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Glauser TA, Holland K, O'Brien VP, Keddache M, Martin LJ, Clark PO, Cnaan A, Dlugos D, Hirtz DG, Shinnar S, Grabowski G. Pharmacogenetics of antiepileptic drug efficacy in childhood absence epilepsy. Ann Neurol 2017; 81:444-453. [PMID: 28165634 DOI: 10.1002/ana.24886] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine whether common polymorphisms in CACNA1G, CACNA1H, CACNA1I, and ABCB1 are associated with differential short-term seizure outcome in childhood absence epilepsy (CAE). METHODS Four hundred forty-six CAE children in a randomized double-blind trial of ethosuximide, lamotrigine, and valproate had short-term seizure outcome determined. Associations between polymorphisms (minor allele frequency ≥ 15%) in 4 genes and seizure outcomes were assessed. In vitro electrophysiology on transfected CACNA1H channels determined impact of 1 variant on T-type calcium channel responsiveness to ethosuximide. RESULTS Eighty percent (357 of 446) of subjects had informative short-term seizure status (242 seizure free, 115 not seizure free). In ethosuximide subjects, 2 polymorphisms (CACNA1H rs61734410/P640L, CACNA1I rs3747178) appeared more commonly among not-seizure-free participants (p = 0.011, odds ratio [OR] = 2.63, 95% confidence limits [CL] = 1.25-5.56; p = 0.026, OR = 2.38, 95% CL = 1.11-5.00). In lamotrigine subjects, 1 ABCB1 missense polymorphism (rs2032582/S893A; p = 0.015, OR = 2.22, 95% CL = 1.16-4.17) was more common in not-seizure-free participants, and 2 CACNA1H polymorphisms (rs2753326, rs2753325) were more common in seizure-free participants (p = 0.038, OR = 0.52, 95% CL = 0.28-0.96). In valproate subjects, no common polymorphisms were associated with seizure status. In vitro electrophysiological studies showed no effect of the P640L polymorphism on channel physiology in the absence of ethosuximide. Ethosuximide's effect on rate of decay of CaV 3.2 was significantly less for P640L channel compared to wild-type channel. INTERPRETATION Four T-type calcium channel variants and 1 ABCB1 transporter variant were associated with differential drug response in CAE. The in vivo P640L variant's ethosuximide effect was confirmed by in vitro electrophysiological studies. This suggests that genetic variation plays a role in differential CAE drug response. Ann Neurol 2017;81:444-453.
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Affiliation(s)
- Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Katherine Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Valerie P O'Brien
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mehdi Keddache
- University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lisa J Martin
- University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Peggy O Clark
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Avital Cnaan
- Division of Biostatistics and Study Methodology, Children's National Health System, Washington, DC
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Deborah G Hirtz
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Shlomo Shinnar
- Division of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Gregory Grabowski
- University of Cincinnati College of Medicine, Cincinnati, OH.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Cnaan A, Shinnar S, Arya R, Adamson PC, Clark PO, Dlugos D, Hirtz DG, Masur D, Glauser TA. Second monotherapy in childhood absence epilepsy. Neurology 2016; 88:182-190. [PMID: 27986874 DOI: 10.1212/wnl.0000000000003480] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 10/04/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine optimal second monotherapy for children with childhood absence epilepsy (CAE) experiencing initial treatment failure. METHODS Children with CAE experiencing treatment failure during the double-blind phase of a randomized controlled trial comparing ethosuximide, valproic acid, and lamotrigine were randomized to open-label second monotherapy with one of the 2 other study therapies. Primary study outcome was freedom from failure proportion at week 16-20 and month 12 visits after randomization. Secondary study outcome was percentage of participants experiencing attentional dysfunction at these visits. RESULTS A total of 208 children were enrolled, randomized, and received second therapy. At both week 16-20 visit and month 12 visit, ethosuximide's (63%, 57%) and valproic acid's (65%, 49%) freedom from failure proportions were similar to each other and higher than lamotrigine's (45%, 36%, p = 0.051 and p = 0.062). At both time points, ethosuximide and valproic acid had superior seizure control compared to lamotrigine (p < 0.0001). At both the week 16-20 and month 12 visits, attentional dysfunction was numerically more common with valproic acid than with ethosuximide or lamotrigine. For each medication, second monotherapy freedom from failure proportions demonstrated noninferiority to initial monotherapy freedom from failure proportions. CONCLUSIONS As second monotherapy, ethosuximide and valproic acid, demonstrated higher freedom from failure proportions and greater efficacy than lamotrigine; valproic acid was associated with more attentional dysfunction. Ethosuximide is the optimal second monotherapy for children with CAE not responding to initial therapy with other medications. CLINICALTRIALSGOV IDENTIFIER NCT00088452. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for children with CAE experiencing initial treatment failure, second monotherapy with ethosuximide or valproic acid is superior to lamotrigine.
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Affiliation(s)
- Avital Cnaan
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD.
| | - Shlomo Shinnar
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Ravindra Arya
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Peter C Adamson
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Peggy O Clark
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Dennis Dlugos
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Deborah G Hirtz
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - David Masur
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
| | - Tracy A Glauser
- From Children's National Health System (A.C.), Washington, DC; Montefiore Medical Center (S.S., D.M.), Albert Einstein College of Medicine, New York, NY; Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine (R.A., P.O.C., T.A.G.), OH; The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania (P.C.A., D.D.); and National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD
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Knupp KG, Leister E, Coryell J, Nickels KC, Ryan N, Juarez-Colunga E, Gaillard WD, Mytinger JR, Berg AT, Millichap J, Nordli DR, Joshi S, Shellhaas RA, Loddenkemper T, Dlugos D, Wirrell E, Sullivan J, Hartman AL, Kossoff EH, Grinspan ZM, Hamikawa L. Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort. Epilepsia 2016; 57:1834-1842. [PMID: 27615012 DOI: 10.1111/epi.13557] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Infantile spasms (IS) represent a severe epileptic encephalopathy presenting in the first 2 years of life. Recommended first-line therapies (hormonal therapy or vigabatrin) often fail. We evaluated response to second treatment for IS in children in whom the initial therapy failed to produce both clinical remission and electrographic resolution of hypsarhythmia and whether time to treatment was related to outcome. METHODS The National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of IS. Children were considered nonresponders to first treatment if there was no clinical remission or persistence of hypsarhythmia. Treatment was evaluated as hormonal therapy (adrenocorticotropic hormone [ACTH] or oral corticosteroids), vigabatrin, or "other." Standard treatments (hormonal and vigabatrin) were compared to all other nonstandard treatments. We compared response rates using chi-square tests and multivariable logistic regression models. RESULTS One hundred eighteen infants were included from 19 centers. Overall response rate to a second treatment was 37% (n = 44). Children who received standard medications with differing mechanisms for first and second treatment had higher response rates than other sequences (27/49 [55%] vs. 17/69 [25%], p < 0.001). Children receiving first treatment within 4 weeks of IS onset had a higher response rate to second treatment than those initially treated later (36/82 [44%] vs. 8/34 [24%], p = 0.040). SIGNIFICANCE Greater than one third of children with IS will respond to a second medication. Choosing a standard medication (ACTH, oral corticosteroids, or vigabatrin) that has a different mechanism of action appears to be more effective. Rapid initial treatment increases the likelihood of response to the second treatment.
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Affiliation(s)
- Kelly G Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Erin Leister
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Jason Coryell
- Departments of Pediatrics and Neurology, School of Medicine, Oregon Health & Sciences University, Portland, Oregon, U.S.A
| | - Katherine C Nickels
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Nicole Ryan
- Division of Neurology, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - William D Gaillard
- Center For Neuroscience, Children's National Health System, Washington, District of Columbia, U.S.A
| | - John R Mytinger
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, U.S.A
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - John Millichap
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Douglas R Nordli
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A.,Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A
| | - Sucheta Joshi
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Renée A Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Dennis Dlugos
- Division of Neurology, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Elaine Wirrell
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph Sullivan
- Departments of Pediatrics and Neurology, University of California San Francisco, San Francisco, California, U.S.A
| | - Adam L Hartman
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Zachary M Grinspan
- Departments of Pediatrics and Healthcare Policy & Research, Weill Cornell Medical Center, New York, New York, U.S.A
| | - Lorie Hamikawa
- Department of Neurology, University of Washington, Seattle, Washington, U.S.A
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Dlugos D, Worrell G, Davis K, Stacey W, Szaflarski J, Kanner A, Sunderam S, Rogawski M, Jackson-Ayotunde P, Loddenkemper T, Diehl B, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area III: Improve Treatment Options for Controlling Seizures and Epilepsy-Related Conditions Without Side Effects. Epilepsy Curr 2016; 16:192-7. [PMID: 27330452 PMCID: PMC4913858 DOI: 10.5698/1535-7511-16.3.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dennis Dlugos
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Greg Worrell
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Kathryn Davis
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William Stacey
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
| | - Jerzy Szaflarski
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
| | - Andres Kanner
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
| | - Sridhar Sunderam
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
| | - Mike Rogawski
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
| | - Patrice Jackson-Ayotunde
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
| | - Tobias Loddenkemper
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Beate Diehl
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
| | - for the Epilepsy Benchmark Stewards
- Professor of Neurology and Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Associate Professor of Neurology, Mayo Systems Electrophysiology Laboratory, Departments of Neurology and Biomedical Engineering, Mayo Clinic, Rochester, MN
- Assistant Professor, Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Assistant Professor of Neurology, Department of Neurology, Department of Biomedical Engineering, University of Michigan
- Professor, Department of Neurology, University of Alabama at Birmingham Department of Neurology and UAB Epilepsy Center, Birmingham, AL
- Profressor of Clinical Neurology, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL
- Assistant Professor, Department of Biomedical Engineering, University of Kentucky, Lexington, KY
- Professor, Center for Neurotherapeutics Discovery and Development and Department of Neurology, UC Davis School of Medicine, Sacramento, CA
- Associate Professor, Department of Pharmaceutical Sciences, University of Maryland Eastern Shore, Princess Anne, MD
- Associate Professor, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA
- Clinical Neurophysiologist and Neurologist, Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta, GA
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Knupp KG, Coryell J, Nickels KC, Ryan N, Leister E, Loddenkemper T, Grinspan Z, Hartman AL, Kossoff EH, Gaillard WD, Mytinger JR, Joshi S, Shellhaas RA, Sullivan J, Dlugos D, Hamikawa L, Berg AT, Millichap J, Nordli DR, Wirrell E. Response to treatment in a prospective national infantile spasms cohort. Ann Neurol 2016; 79:475-84. [PMID: 26704170 DOI: 10.1002/ana.24594] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Infantile spasms are seizures associated with a severe epileptic encephalopathy presenting in the first 2 years of life, and optimal treatment continues to be debated. This study evaluates early and sustained response to initial treatments and addresses both clinical remission and electrographic resolution of hypsarrhythmia. Secondarily, it assesses whether response to treatment differs by etiology or developmental status. METHODS The National Infantile Spasms Consortium established a multicenter, prospective database enrolling infants with new diagnosis of infantile spasms. Children were considered responders if there was clinical remission and resolution of hypsarrhythmia that was sustained at 3 months after first treatment initiation. Standard treatments of adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin were considered individually, and all other nonstandard therapies were analyzed collectively. Developmental status and etiology were assessed. We compared response rates by treatment group using chi-square tests and multivariate logistic regression models. RESULTS Two hundred thirty infants were enrolled from 22 centers. Overall, 46% of children receiving standard therapy responded, compared to only 9% who responded to nonstandard therapy (p < 0.001). Fifty-five percent of infants receiving ACTH as initial treatment responded, compared to 39% for oral corticosteroids, 36% for vigabatrin, and 9% for other (p < 0.001). Neither etiology nor development significantly modified the response pattern by treatment group. INTERPRETATION Response rate varies by treatment choice. Standard therapies should be considered as initial treatment for infantile spasms, including those with impaired development or known structural or genetic/metabolic etiology. ACTH appeared to be more effective than other standard therapies.
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Affiliation(s)
- Kelly G Knupp
- Departments of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jason Coryell
- Departments of Pediatrics and Neurology, School of Medicine, Oregon Health & Sciences University, Portland, OR
| | | | - Nicole Ryan
- Division of Neurology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Erin Leister
- Colorado School of Public Health, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA
| | | | - Adam L Hartman
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, MD
| | | | - John R Mytinger
- Department of Pediatrics, Division of Pediatric Neurology, Ohio State University, Nationwide Children's Hospital, Columbus, OH
| | - Sucheta Joshi
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, MI
| | - Renée A Shellhaas
- Department of Pediatrics & Communicable Diseases (Division of Pediatric Neurology), University of Michigan, Ann Arbor, MI
| | - Joseph Sullivan
- Departments of Pediatrics and Neurology, University of San Francisco, San Francisco, CA
| | - Dennis Dlugos
- Division of Neurology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lorie Hamikawa
- Department of Neurology, University of Washington, Seattle, WA
| | - Anne T Berg
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John Millichap
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Douglas R Nordli
- Ann & Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elaine Wirrell
- Departments of Neurology and Pediatrics, Mayo Clinic, Rochester, MN
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Affiliation(s)
- David Bearden
- Department of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Marissa DiGiovine
- Department of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Dennis Dlugos
- Department of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Ethan Goldberg
- Department of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
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Shinnar S, Cnaan A, Hu F, Clark P, Dlugos D, Hirtz DG, Masur D, Mizrahi EM, Moshé SL, Glauser TA. Long-term outcomes of generalized tonic-clonic seizures in a childhood absence epilepsy trial. Neurology 2015; 85:1108-14. [PMID: 26311751 DOI: 10.1212/wnl.0000000000001971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 06/04/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine incidence and early predictors of generalized tonic-clonic seizures (GTCs) in children with childhood absence epilepsy (CAE). METHODS Occurrence of GTCs was determined in 446 children with CAE who participated in a randomized clinical trial comparing ethosuximide, lamotrigine, and valproate as initial therapy for CAE. RESULTS As of June 2014, the cohort had been followed for a median of 7.0 years since enrollment and 12% (53) have experienced at least one GTC. The median time to develop GTCs from initial therapy was 4.7 years. The median age at first GTC was 13.1 years. Fifteen (28%) were not on medications at the time of their first GTC. On univariate analysis, older age at enrollment was associated with a higher risk of GTCs (p=-0.0009), as was the duration of the shortest burst on the baseline EEG (p=0.037). Failure to respond to initial treatment (p<0.001) but not treatment assignment was associated with a higher rate of GTCs. Among patients initially assigned to ethosuximide, 94% (15/16) with GTCs experienced initial therapy failure (p<0.0001). A similar but more modest effect was noted in those initially treated with valproate (p=0.017) and not seen in those initially treated with lamotrigine. CONCLUSIONS The occurrence of GTCs in a well-characterized cohort of children with CAE appears lower than previously reported. GTCs tend to occur late in the course of the disorder. Children initially treated with ethosuximide who are responders have a particularly low risk of developing subsequent GTCs.
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Affiliation(s)
- Shlomo Shinnar
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX.
| | - Avital Cnaan
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Fengming Hu
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Peggy Clark
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Dennis Dlugos
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Deborah G Hirtz
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - David Masur
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Eli M Mizrahi
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Solomon L Moshé
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
| | - Tracy A Glauser
- From Montefiore Medical Center (S.S., D.M., S.L.M.), Albert Einstein College of Medicine, New York, NY; Children's National Health System (A.C., F.H.), Washington, DC; Cincinnati Children's Hospital Medical Center (P.C., T.A.G.); the University of Cincinnati College of Medicine (P.C., T.A.G.), OH; The Children's Hospital of Philadelphia (D.D.), Perelman School of Medicine at the University of Pennsylvania; National Institute of Neurological Disorders and Stroke (D.G.H.), Bethesda, MD; and Baylor College of Medicine (E.M.M.), Houston, TX
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Bearden D, Strong A, Ehnot J, DiGiovine M, Dlugos D, Goldberg EM. Targeted treatment of migrating partial seizures of infancy with quinidine. Ann Neurol 2014; 76:457-61. [DOI: 10.1002/ana.24229] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 12/17/2022]
Affiliation(s)
- David Bearden
- Division of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Alanna Strong
- Perelman School of Medicine, University of Pennsylvania; Philadelphia PA
| | - Jessica Ehnot
- Department of Pharmacy; Upstate Golisano Children's Hospital; New York NY
| | - Marissa DiGiovine
- Division of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Dennis Dlugos
- Division of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
| | - Ethan M. Goldberg
- Division of Neurology; Children's Hospital of Philadelphia; Philadelphia PA
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Widdess-Walsh P, Dlugos D, Fahlstrom R, Joshi S, Shellhaas R, Boro A, Sullivan J, Geller E. Lennox-Gastaut syndrome of unknown cause: Phenotypic characteristics of patients in the Epilepsy Phenome/Genome Project. Epilepsia 2013; 54:1898-904. [DOI: 10.1111/epi.12395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Widdess-Walsh
- Institute of Neurology and Neurosurgery at St. Barnabas; Livingston New Jersey U.S.A
| | - Dennis Dlugos
- Departments of Neurology and Pediatrics; The Children's Hospital of Philadelphia; Philadelphia Pennsylvania U.S.A
| | - Robyn Fahlstrom
- Department of Neurology; University of California; San Francisco California U.S.A
| | - Sucheta Joshi
- Department of Pediatrics & Communicable Diseases; University of Michigan; Ann Arbor Michigan U.S.A
| | - Renée Shellhaas
- Department of Pediatrics & Communicable Diseases; University of Michigan; Ann Arbor Michigan U.S.A
| | - Alex Boro
- Department of Neurology; Montefiore Medical Center; New York New York U.S.A
| | - Joseph Sullivan
- Department of Neurology; University of California; San Francisco California U.S.A
| | - Eric Geller
- Institute of Neurology and Neurosurgery at St. Barnabas; Livingston New Jersey U.S.A
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Bearden D, Dlugos D, Brizzi K, Lowenthal E, Tracey E, Kessler S. Epilepsy in children with HIV/AIDS in Botswana: Prevalence, risk factors, and outcomes. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Berg AT, Baca CB, Loddenkemper T, Vickrey BG, Dlugos D. Priorities in pediatric epilepsy research: improving children's futures today. Neurology 2013; 81:1166-75. [PMID: 23966254 PMCID: PMC3795602 DOI: 10.1212/wnl.0b013e3182a55fb9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 06/26/2013] [Indexed: 11/15/2022] Open
Abstract
The Priorities in Pediatric Epilepsy Research workshop was held in the spirit of patient-centered and patient-driven mandates for developing best practices in care, particularly for epilepsy beginning under age 3 years. The workshop brought together parents, representatives of voluntary advocacy organizations, physicians, allied health professionals, researchers, and administrators to identify priority areas for pediatric epilepsy care and research including implementation and testing of interventions designed to improve care processes and outcomes. Priorities highlighted were 1) patient outcomes, especially seizure control but also behavioral, academic, and social functioning; 2) early and accurate diagnosis and optimal treatment; 3) role and involvement of parents (communication and shared decision-making); and 4) integration of school and community organizations with epilepsy care delivery. Key factors influencing pediatric epilepsy care included the child's impairments and seizure presentation, parents, providers, the health care system, and community systems. Care was represented as a sequential process from initial onset of seizures to referral for comprehensive evaluation when needed. We considered an alternative model in which comprehensive care would be utilized from onset, proactively, rather than reactively after pharmacoresistance became obvious. Barriers, including limited levels of evidence about many aspects of diagnosis and management, access to care--particularly epilepsy specialty and behavioral health care--and implementation, were identified. Progress hinges on coordinated research efforts that systematically address gaps in knowledge and overcoming barriers to access and implementation. The stakes are considerable, and the potential benefits for reduced burden of refractory epilepsy and lifelong disabilities may be enormous.
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Affiliation(s)
- Anne T Berg
- From the Ann & Robert H. Lurie Children's Hospital of Chicago (A.T.B.), Epilepsy Center, and Northwestern Memorial Feinberg School of Medicine, Department of Pediatrics, Chicago, IL; Department of Neurology (C.B.B., B.G.V.), University of California Los Angeles; Department of Neurology (C.B.B., B.G.V.), VA Greater Los Angeles Health Care System, Los Angeles, CA; Division of Epilepsy and Clinical Neurophysiology (T.L.), Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Pediatric Regional Epilepsy Program (D.D.), The Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Allen AS, Berkovic SF, Cossette P, Delanty N, Dlugos D, Eichler EE, Epstein MP, Glauser T, Goldstein DB, Han Y, Heinzen EL, Hitomi Y, Howell KB, Johnson MR, Kuzniecky R, Lowenstein DH, Lu YF, Madou MRZ, Marson AG, Mefford HC, Esmaeeli Nieh S, O'Brien TJ, Ottman R, Petrovski S, Poduri A, Ruzzo EK, Scheffer IE, Sherr EH, Yuskaitis CJ, Abou-Khalil B, Alldredge BK, Bautista JF, Berkovic SF, Boro A, Cascino GD, Consalvo D, Crumrine P, Devinsky O, Dlugos D, Epstein MP, Fiol M, Fountain NB, French J, Friedman D, Geller EB, Glauser T, Glynn S, Haut SR, Hayward J, Helmers SL, Joshi S, Kanner A, Kirsch HE, Knowlton RC, Kossoff EH, Kuperman R, Kuzniecky R, Lowenstein DH, McGuire SM, Motika PV, Novotny EJ, Ottman R, Paolicchi JM, Parent JM, Park K, Poduri A, Scheffer IE, Shellhaas RA, Sherr EH, Shih JJ, Singh R, Sirven J, Smith MC, Sullivan J, Lin Thio L, Venkat A, Vining EPG, Von Allmen GK, Weisenberg JL, Widdess-Walsh P, Winawer MR. De novo mutations in epileptic encephalopathies. Nature 2013; 501:217-21. [PMID: 23934111 PMCID: PMC3773011 DOI: 10.1038/nature12439] [Citation(s) in RCA: 1093] [Impact Index Per Article: 99.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 07/09/2013] [Indexed: 12/21/2022]
Abstract
Epileptic encephalopathies are a devastating group of severe childhood epilepsy disorders for which the cause is often unknown. Here we report a screen for de novo mutations in patients with two classical epileptic encephalopathies: infantile spasms (n = 149) and Lennox-Gastaut syndrome (n = 115). We sequenced the exomes of 264 probands, and their parents, and confirmed 329 de novo mutations. A likelihood analysis showed a significant excess of de novo mutations in the ∼4,000 genes that are the most intolerant to functional genetic variation in the human population (P = 2.9 × 10(-3)). Among these are GABRB3, with de novo mutations in four patients, and ALG13, with the same de novo mutation in two patients; both genes show clear statistical evidence of association with epileptic encephalopathy. Given the relevant site-specific mutation rates, the probabilities of these outcomes occurring by chance are P = 4.1 × 10(-10) and P = 7.8 × 10(-12), respectively. Other genes with de novo mutations in this cohort include CACNA1A, CHD2, FLNA, GABRA1, GRIN1, GRIN2B, HNRNPU, IQSEC2, MTOR and NEDD4L. Finally, we show that the de novo mutations observed are enriched in specific gene sets including genes regulated by the fragile X protein (P < 10(-8)), as has been reported previously for autism spectrum disorders.
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Abou-Khalil B, Alldredge B, Bautista J, Berkovic S, Bluvstein J, Boro A, Cascino G, Consalvo D, Cristofaro S, Crumrine P, Devinsky O, Dlugos D, Epstein M, Fahlstrom R, Fiol M, Fountain N, Fox K, French J, Freyer Karn C, Friedman D, Geller E, Glauser T, Glynn S, Haas K, Haut S, Hayward J, Helmers S, Joshi S, Kanner A, Kirsch H, Knowlton R, Kossoff E, Kuperman R, Kuzniecky R, Lowenstein D, McGuire S, Motika P, Nesbitt G, Novotny E, Ottman R, Paolicchi J, Parent J, Park K, Poduri A, Risch N, Sadleir L, Scheffer I, Shellhaas R, Sherr E, Shih JJ, Shinnar S, Singh R, Sirven J, Smith M, Sullivan J, Thio LL, Venkat A, Vining E, von Allmen G, Weisenberg J, Widdess-Walsh P, Winawer M. The epilepsy phenome/genome project. Clin Trials 2013; 10:568-86. [PMID: 23818435 DOI: 10.1177/1740774513484392] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Epilepsy is a common neurological disorder that affects approximately 50 million people worldwide. Both risk of epilepsy and response to treatment partly depend on genetic factors, and gene identification is a promising approach to target new prediction, treatment, and prevention strategies. However, despite significant progress in the identification of genes causing epilepsy in families with a Mendelian inheritance pattern, there is relatively little known about the genetic factors responsible for common forms of epilepsy and so-called epileptic encephalopathies. Study design The Epilepsy Phenome/Genome Project (EPGP) is a multi-institutional, retrospective phenotype-genotype study designed to gather and analyze detailed phenotypic information and DNA samples on 5250 participants, including probands with specific forms of epilepsy and, in a subset, parents of probands who do not have epilepsy. RESULTS EPGP is being executed in four phases: study initiation, pilot, study expansion/establishment, and close-out. This article discusses a number of key challenges and solutions encountered during the first three phases of the project, including those related to (1) study initiation and management, (2) recruitment and phenotyping, and (3) data validation. The study has now enrolled 4223 participants. CONCLUSIONS EPGP has demonstrated the value of organizing a large network into cores with specific roles, managed by a strong Administrative Core that utilizes frequent communication and a collaborative model with tools such as study timelines and performance-payment models. The study also highlights the critical importance of an effective informatics system, highly structured recruitment methods, and expert data review.
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Dlugos D, Shinnar S, Cnaan A, Hu F, Moshé S, Mizrahi E, Masur D, Sogawa Y, Le Pichon JB, Levine C, Hirtz D, Clark P, Adamson PC, Glauser T. Pretreatment EEG in childhood absence epilepsy: associations with attention and treatment outcome. Neurology 2013; 81:150-6. [PMID: 23719147 DOI: 10.1212/wnl.0b013e31829a3373] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In children with newly diagnosed childhood absence epilepsy (CAE), determine pretreatment EEG features and their associations with baseline neuropsychological function and short-term treatment outcome. METHODS In a multicenter, randomized clinical trial, patients with CAE underwent a pretreatment, 1-hour video-EEG and neuropsychological testing with freedom-from-failure and seizure-freedom (SF) outcome assessed at the 16- to 20-week visit. RESULTS Detailed evaluation of the pretreatment EEG was possible for 99.8% of participants (445/446). Median time to first seizure was 6.0 minutes (range 0-59 minutes), median number of seizures was 5 (range 1-60), and median seizure duration was 10.8 seconds (range 3.3-77.6 seconds). Median duration of shortest seizure per EEG was 7.5 seconds (range 3.0-77.6 seconds). Seizure frequency was not associated with baseline measures of attention, executive function, or treatment outcome. Presence of a seizure lasting ≥20 seconds was noted in 29% of subjects (129/440); these children had higher median omissions T score on the Conners Continuous Performance Test (56.3 vs 51.6, p = 0.01). Patients with a shortest seizure of longer duration were more likely to demonstrate treatment success by both freedom-from-failure (p = 0.02) and SF (p = 0.005) criteria, even after controlling for age, treatment group, and number of seizures, with good predictive value (area under the curve 78% for SF). CONCLUSIONS CAE is reliably and quickly confirmed by EEG. Occurrence of a seizure ≥20 seconds, but not overall seizure frequency, was associated with differential baseline measures of attention. Patients whose shortest pretreatment EEG seizure was longer in duration were more likely to achieve SF, regardless of treatment.
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Affiliation(s)
- Dennis Dlugos
- Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
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Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Adamson PC. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy: initial monotherapy outcomes at 12 months. Epilepsia 2012; 54:141-55. [PMID: 23167925 DOI: 10.1111/epi.12028] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Determine the optimal initial monotherapy for children with newly diagnosed childhood absence epilepsy (CAE) based on 12 months of double-blind therapy. METHODS A double-blind, randomized controlled clinical trial compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed CAE. Study medications were titrated to clinical response, and subjects remained in the trial unless they reached a treatment failure criterion. Maximal target doses were ethosuximide 60 mg/kg/day or 2,000 mg/day, valproic acid 60 mg/kg/day or 3,000 mg/day, and lamotrigine 12 mg/kg/day or 600 mg/day. Original primary outcome was at 16-20 weeks and included a video-electroencephalography (EEG) assessment. For this report, the main effectiveness outcome was the freedom from failure rate 12 months after randomization and included a video-EEG assessment; differential drug effects were determined by pairwise comparisons. The main cognitive outcome was the percentage of subjects experiencing attentional dysfunction at the month 12 visit. KEY FINDINGS A total of 453 children were enrolled and randomized; 7 were deemed ineligible and 446 subjects comprised the overall efficacy cohort. There were no demographic differences between the three cohorts. By 12 months after starting therapy, only 37% of all enrolled subjects were free from treatment failure on their first medication. At the month 12 visit, the freedom-from-failure rates for ethosuximide and valproic acid were similar (45% and 44%, respectively; odds ratio [OR]with valproic acid vs. ethosuximide 0.94; 95% confidence interval [CI] 0.58-1.52; p = 0.82) and were higher than the rate for lamotrigine (21%; OR with ethosuximide vs. lamotrigine 3.08; 95% CI 1.81-5.33; OR with valproic acid vs. lamotrigine 2.88; 95% CI 1.68-5.02; p < 0.001 for both comparisons). The frequency of treatment failures due to lack of seizure control (p < 0.001) and intolerable adverse events (p < 0.037) was significantly different among the treatment groups. Almost two thirds of the 125 subjects with treatment failure due to lack of seizure control were in the lamotrigine cohort. The largest subgroup (42%) of the 115 subjects discontinuing due to adverse events was in the valproic acid group. The previously reported higher rate of attentional dysfunction seen at 16-20 weeks in the valproic acid group compared with the ethosuximide or lamotrigine groups persisted at 12 months (p < 0.01). SIGNIFICANCE As initial monotherapy, the superior effectiveness of ethosuximide and valproic acid compared to lamotrigine in controlling seizures without intolerable adverse events noted at 16-20 weeks persisted at 12 months. The valproic acid cohort experienced a higher rate of adverse events leading to drug discontinuation as well as significant negative effects on attentional measures that were not seen in the ethosuximide cohort. These 12-month outcome data coupled with the study's prespecified decision-making algorithm indicate that ethosuximide is the optimal initial empirical monotherapy for CAE. This is the first randomized controlled trial meeting International League Against Epilepsy (ILAE) criteria for class I evidence for CAE (or for any type of generalized seizure in adults or children). (NCT00088452.).
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Affiliation(s)
- Tracy A Glauser
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
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Smart O, Maus D, Marsh E, Dlugos D, Litt B, Meador K. Mapping and mining interictal pathological gamma (30-100 Hz) oscillations with clinical intracranial EEG in patients with epilepsy. Expert Syst Appl 2012; 39:7355-7370. [PMID: 23105174 PMCID: PMC3480232 DOI: 10.1016/j.eswa.2012.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Localizing an epileptic network is essential for guiding neurosurgery and antiepileptic medical devices as well as elucidating mechanisms that may explain seizure-generation and epilepsy. There is increasing evidence that pathological oscillations may be specific to diseased networks in patients with epilepsy and that these oscillations may be a key biomarker for generating and indentifying epileptic networks. We present a semi-automated method that detects, maps, and mines pathological gamma (30-100 Hz) oscillations (PGOs) in human epileptic brain to possibly localize epileptic networks. We apply the method to standard clinical iEEG (<100 Hz) with interictal PGOs and seizures from six patients with medically refractory epilepsy. We demonstrate that electrodes with consistent PGO discharges do not always coincide with clinically determined seizure onset zone (SOZ) electrodes but at times PGO-dense electrodes include secondary seizure-areas (SS) or even areas without seizures (NS). In 4/5 patients with epilepsy surgery, we observe poor (Engel Class 4) post-surgical outcomes and identify more PGO-activity in SS or NS than in SOZ. Additional studies are needed to further clarify the role of PGOs in epileptic brain.
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Affiliation(s)
- Otis Smart
- Intelligent Control Systems Laboratory, Georgia Institute of Technology, Atlanta, GA 30332, USA
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA
| | - Douglas Maus
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Eric Marsh
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Dennis Dlugos
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Brian Litt
- Departments of Neurology and Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kimford Meador
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Bearden D, Brizzi K, Dlugos D, Goldfarb D, Kolson D, Lowenthal E, Steenhoff A, Kessler S. Epilepsy in Children with HIV/AIDS in Botswana: Prevalence, Risk Factors, and Outcomes (P01.260). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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You X, Adjouadi M, Guillen MR, Ayala M, Barreto A, Rishe N, Sullivan J, Dlugos D, Vanmeter J, Morris D, Donner E, Bjornson B, Smith ML, Bernal B, Berl M, Gaillard WD. Sub-patterns of language network reorganization in pediatric localization related epilepsy: a multisite study. Hum Brain Mapp 2011; 32:784-99. [PMID: 21484949 DOI: 10.1002/hbm.21066] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
To study the neural networks reorganization in pediatric epilepsy, a consortium of imaging centers was established to collect functional imaging data. Common paradigms and similar acquisition parameters were used. We studied 122 children (64 control and 58 LRE patients) across five sites using EPI BOLD fMRI and an auditory description decision task. After normalization to the MNI atlas, activation maps generated by FSL were separated into three sub-groups using a distance method in the principal component analysis (PCA)-based decisional space. Three activation patterns were identified: (1) the typical distributed network expected for task in left inferior frontal gyrus (Broca's) and along left superior temporal gyrus (Wernicke's) (60 controls, 35 patients); (2) a variant left dominant pattern with greater activation in IFG, mesial left frontal lobe, and right cerebellum (three controls, 15 patients); and (3) activation in the right counterparts of the first pattern in Broca's area (one control, eight patients). Patients were over represented in Groups 2 and 3 (P < 0.0004). There were no scanner (P = 0.4) or site effects (P = 0.6). Our data-driven method for fMRI activation pattern separation is independent of a priori notions and bias inherent in region of interest and visual analyses. In addition to the anticipated atypical right dominant activation pattern, a sub-pattern was identified that involved intensity and extent differences of activation within the distributed left hemisphere language processing network. These findings suggest a different, perhaps less efficient, cognitive strategy for LRE group to perform the task.
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Affiliation(s)
- Xiaozhen You
- College of Engineering and Computing, Florida International University, 10555 W. Flagler Street, Miami, FL 33174, USA
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Cramer J, Dlugos D, Wiegand‡ F, Novak G, Olson W, Grinspan A. Abstract #8: Trial Methodology of a Randomized, Double-blind, Parallel-Group Study Evaluating the Clinical Effectiveness of Carisbamate, Topiramate, and Levetiracetam As Adjunctive Treatment of Partial Onset Seizures in Adults. Neurotherapeutics 2010. [DOI: 10.1016/j.nurt.2010.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med 2010; 362:790-9. [PMID: 20200383 PMCID: PMC2924476 DOI: 10.1056/nejmoa0902014] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine. The most efficacious and tolerable initial empirical treatment has not been defined. METHODS In a double-blind, randomized, controlled clinical trial, we compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed childhood absence epilepsy. Drug doses were incrementally increased until the child was free of seizures, the maximal allowable or highest tolerable dose was reached, or a criterion indicating treatment failure was met. The primary outcome was freedom from treatment failure after 16 weeks of therapy; the secondary outcome was attentional dysfunction. Differential drug effects were determined by means of pairwise comparisons. RESULTS The 453 children who were randomly assigned to treatment with ethosuximide (156), lamotrigine (149), or valproic acid (148) were similar with respect to their demographic characteristics. After 16 weeks of therapy, the freedom-from-failure rates for ethosuximide and valproic acid were similar (53% and 58%, respectively; odds ratio with valproic acid vs. ethosuximide, 1.26; 95% confidence interval [CI], 0.80 to 1.98; P=0.35) and were higher than the rate for lamotrigine (29%; odds ratio with ethosuximide vs. lamotrigine, 2.66; 95% CI, 1.65 to 4.28; odds ratio with valproic acid vs. lamotrigine, 3.34; 95% CI, 2.06 to 5.42; P<0.001 for both comparisons). There were no significant differences among the three drugs with regard to discontinuation because of adverse events. Attentional dysfunction was more common with valproic acid than with ethosuximide (in 49% of the children vs. 33%; odds ratio, 1.95; 95% CI, 1.12 to 3.41; P=0.03). CONCLUSIONS Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects. (ClinicalTrials.gov number, NCT00088452.)
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Affiliation(s)
- Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA.
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Abstract
We aimed to determine whether analysis of EEG envelope trend aids bedside detection of neonatal seizures. Five neonatal EEGs with multiple seizures were used to determine optimal trend parameters for seizure detection. Using these parameters, envelope trends were generated on eight additional EEGs, evaluated by experienced and inexperienced users, and compared to traditional EEG interpretation. Seizures were best detected using envelope trend of 2-6 Hz activity over 20-s epochs. Experienced and inexperienced users identified 88% and 55% of prolonged seizures, respectively, 40% and 6% of brief seizures, and 20% and 0% of slowly evolving seizures. All users identified less than two false positives per hour. Thus, an experienced envelope trend user accurately identified longer seizures but did not identify brief or slowly evolving seizures. Less experienced users were less accurate. Trending may be a useful tool for seizure detection in some neonates.
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Affiliation(s)
- Nicholas S Abend
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Firpi H, Smart O, Worrell G, Marsh E, Dlugos D, Litt B. High-frequency oscillations detected in epileptic networks using swarmed neural-network features. Ann Biomed Eng 2007; 35:1573-84. [PMID: 17541826 DOI: 10.1007/s10439-007-9333-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
Localizing epileptic networks is a central challenge in guiding epilepsy surgery, deploying antiepileptic devices, and elucidating mechanisms underlying seizure generation. Recent work from our group and others suggests that high-frequency epileptic oscillations (HFEOs) arise from brain regions constituting epileptic networks, and may be important to seizure generation. HFEOs are brief 50-500 Hz pathologic events measured in intracranial field and unit recordings in patients with refractory epilepsy. They are challenging to detect due to low signal to noise ratio, and because they occur in multiple channels with great frequency. Their morphology is also variable and changes with distance from intracranial electrode contacts, which are sparsely placed for patient safety. Thus reliable, automated methods to detect HFEOs are required to localize and track seizure generation in epileptic networks. We present a novel method for mapping the temporal evolution of these oscillations in human epileptic networks. The technique combines a particle swarm optimization algorithm with a neural network to create features that robustly detect and track HFEOs in human intracranial EEG (IEEG) recordings. We demonstrate the algorithm's performance on IEEG data from six patients, one pediatric and five adult, and compare it to an existing method for detecting high-frequency oscillations.
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Affiliation(s)
- Hiram Firpi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, 777 Atlantic Dr., Atlanta, GA 30332-0250, USA.
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Gardner AB, Worrell GA, Marsh E, Dlugos D, Litt B. Human and automated detection of high-frequency oscillations in clinical intracranial EEG recordings. Clin Neurophysiol 2007; 118:1134-43. [PMID: 17382583 PMCID: PMC2020804 DOI: 10.1016/j.clinph.2006.12.019] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 12/15/2006] [Accepted: 12/26/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies indicate that pathologic high-frequency oscillations (HFOs) are signatures of epileptogenic brain. Automated tools are required to characterize these events. We present a new algorithm tuned to detect HFOs from 30 to 85 Hz, and validate it against human expert electroencephalographers. METHODS We randomly selected 28 3-min single-channel epochs of intracranial EEG (IEEG) from two patients. Three human reviewers and three automated detectors marked all records to identify candidate HFOs. Subsequently, human reviewers verified all markings. RESULTS A total of 1330 events were collectively identified. The new method presented here achieved 89.7% accuracy against a consensus set of human expert markings. A one-way ANOVA determined no difference between the mean F-measures of the human reviewers and automated algorithm. Human kappa statistics (mean kappa=0.38) demonstrated marginal identification consistency, primarily due to false negative errors. CONCLUSIONS We present an HFO detector that improves upon existing algorithms, and performs as well as human experts on our test data set. Validation of detector performance must be compared to more than one expert because of interrater variability. SIGNIFICANCE This algorithm will be useful for analyzing large EEG databases to determine the pathophysiological significance of HFO events in human epileptic networks.
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Affiliation(s)
- Andrew B Gardner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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