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Campos-Fernandez D, Rodrigo-Gisbert M, Abraira L, Quintana Luque M, Santafé M, Lallana S, Fonseca E, Toledo M, Gándara DF, Arikan F, Tomasello A, Sala Padró JX, Falip M, López-Ojeda P, Gabarrós A, Sánchez A, Santamarina E. Predictive Model for Estimating the Risk of Epilepsy After Aneurysmal Subarachnoid Hemorrhage: The RISE Score. Neurology 2024; 102:e209221. [PMID: 38527232 DOI: 10.1212/wnl.0000000000209221] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/02/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The occurrence of seizures after aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poorer functional and cognitive prognosis and less favorable quality of life. It would be of value to promptly identify patients at risk of epilepsy to optimize follow-up protocols and design preventive strategies. Our aim was to develop a predictive score to help stratify epilepsy risk in patients with aSAH. METHODS This is a retrospective, longitudinal study of all adults with aSAH admitted to our center (2012-2021). We collected demographic data, clinical and radiologic variables, data on early-onset seizures (EOSs), and data on development of epilepsy. Exclusion criteria were previous structural brain lesion, epilepsy, and ≤7 days' follow-up. Multiple Cox regression was used to evaluate factors independently associated with unprovoked remote seizures (i.e., epilepsy). The best fitting regression model was used to develop a predictive score. Performance was evaluated in an external validation cohort of 308 patients using receiver-operating characteristic curve analysis. RESULTS From an initial database of 743 patients, 419 met the inclusion criteria and were included in the analysis. The mean age was 60 ± 14 years, 269 patients (64%) were women, and 50 (11.9%) developed epilepsy within a median follow-up of 4.2 years. Premorbid modified Rankin Score (mRS) (hazard ratio [HR] 4.74 [1.8-12.4], p = 0.001), VASOGRADE score (HR 2.45 [1.4-4.2], p = 0.001), surgical treatment (HR 2.77 [1.6-4.9], p = 0.001), and presence of EOSs (HR 1.84 [1.0-3.4], p = 0.05) were independently associated with epilepsy. The proposed scale, designated RISE, scores 1 point for premorbid mRS ≥ 2 (R), VASOGRADE-Yellow (I, Ischemia), surgical intervention (S), and history of EOSs (E) and 2 points for VASOGRADE-Red. RISE stratifies patients into 3 groups: low (0-1), moderate (2-3), and high (4-5) risk (2.9%, 20.8%, and 75.7% developed epilepsy, respectively). On validation in a cohort from a different tertiary care center (N = 308), the new scale yielded a similar risk distribution and good predictive power for epilepsy within 5 years after aSAH (area under the curve [AUC] 0.82; 95% CI 0.74-0.90). DISCUSSION The RISE scale is a robust predictor of post-SAH epilepsy with immediate clinical applicability. In addition to facilitating personalized diagnosis and treatment, RISE may be of value for exploring future antiepileptogenesis strategies.
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Affiliation(s)
- Daniel Campos-Fernandez
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Laura Abraira
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Quintana Luque
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manel Santafé
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Sofia Lallana
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Elena Fonseca
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Manuel Toledo
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Darío F Gándara
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Fuat Arikan
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Jacint X Sala Padró
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Merce Falip
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Pablo López-Ojeda
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Andreu Gabarrós
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Anna Sánchez
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- From the Epilepsy Unit (D.C.-F., M.R.-G., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Neurology Department, Vall d'Hebron University Hospital; Epilepsy Research Group (D.C.-F., L.A., M.Q.L., S.L., E.F., M.T., E.S.), Vall d'Hebron Institut de Recerca (VHIR), Barcelona; Medicine Department (D.C.-F., S.L., M.T., E.S.), Universitat Autònoma de Barcelona, Bellaterra; Intensive Care Department (M.S., A.S.); Neurosurgery Department (D.F.G., F.A.); Neuroradiology Department (A.T.), Vall d'Hebron University Hospital; Epilepsy Unit (J.X.S.P., M.F.), Neurology Department; and Neurosurgery Department (P.L.-O., A.G.), Bellvitge University Hospital, Barcelona, Spain
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Lallana S, Fonseca E, Quintana M, Abraira L, Campos-Fernández D, López-Maza S, Santamarina E, Toledo M, Salas-Puig J. Antiseizure medication withdrawal in adult patients with idiopathic generalized epilepsy: Performance of two seizure recurrence prediction models. Epilepsy Behav 2024; 153:109718. [PMID: 38428177 DOI: 10.1016/j.yebeh.2024.109718] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Currently, there is a limited availability of tools to predict seizure recurrence after discontinuation of antiseizure medications (ASMs). This study aimed to establish the seizure recurrence rate following ASM cessation in adult patients with idiopathic generalized epilepsy (IGE) and to assess the predictive performance of the Lamberink and the Stevelink prediction models using real-world data. METHODS Retrospective longitudinal study in IGE patients who underwent ASM withdrawal in a tertiary epilepsy clinic since June 2011, with the latest follow up in January 2024. The minimum follow-up period was 12 months. Clinical and demographic variables were collected, and the seizure recurrence prediction models proposed by Lamberink and Stevelink were applied and evaluated. RESULTS Forty-seven patients (mean age 33.15 ± 8 [20-55] years; 72.35 % women) were included. During the follow-up period, seizures recurred in 25 patients (53.2 %). Median time to recurrence was 8 months [IQR 3-13.5 months], and 17 patients (68 %) relapsed within the first year. None of the relapsing patients developed drug-resistant epilepsy. The only significant risk factor associated with recurrence was a seizure-free period of less than 2 years before discontinuing medication (91.7 % vs 40 %, p =.005). The Stevelink prediction model at both 2 (p =.015) and 5 years (p =.020) achieved statistical significance, with an AUC of 0.72 (95 % CI 0.56-0.88), while the Lamberink model showed inadequate prognostic capability. CONCLUSION In our real-world cohort, a seizure-free period of at least 2 years was the only factor significantly associated with epilepsy remission after ASM withdrawal. Larger studies are needed to accurately predict seizure recurrence in IGE patients.
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Affiliation(s)
- Sofía Lallana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Abraira L, López-Maza S, Quintana M, Fonseca E, Toledo M, Campos-Fernández D, Lallana S, Grau-López L, Ciurans J, Jiménez M, Becerra JL, Bustamante A, Rubiera M, Penalba A, Montaner J, Álvarez Sabin J, Santamarina E. Exploratory study of blood biomarkers in patients with post-stroke epilepsy. Eur Stroke J 2024:23969873241244584. [PMID: 38557165 DOI: 10.1177/23969873241244584] [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] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION In addition to clinical factors, blood-based biomarkers can provide useful information on the risk of developing post-stroke epilepsy (PSE). Our aim was to identify serum biomarkers at stroke onset that could contribute to predicting patients at higher risk of PSE. PATIENTS AND METHODS From a previous study in which 895 acute stroke patients were followed-up, 51 patients developed PSE. We selected 15 patients with PSE and 15 controls without epilepsy. In a biomarker discovery setting, 5 Olink panels of 96 proteins each, were used to determine protein levels. Biomarkers that were down-regulated and overexpressed in PSE patients, and those that showed the strongest interactions with other proteins were validated using an enzyme-linked immunosorbent assay in samples from 50 PSE patients and 50 controls. A ROC curve analysis was used to evaluate the predictive ability of significant biomarkers to develop PSE. RESULTS Mean age of the PSE discovery cohort was 68.56 ± 15.1, 40% women and baseline NIHSS 12 [IQR 1-25]. Nine proteins were down-expressed: CASP-8, TNFSF-14, STAMBP, ENRAGE, EDA2R, SIRT2, TGF-alpha, OSM and CLEC1B. VEGFa, CD40 and CCL4 showed greatest interactions with the remaining proteins. In the validation analysis, TNFSF-14 was the single biomarker showing statistically significant downregulated levels in PSE patients (p = 0.006) and it showed a good predictive capability to develop PSE (AUC 0.733, 95% CI 0.601-0.865). DISCUSSION AND CONCLUSION Protein expression in PSE patients differs from that of non-epileptic stroke patients, suggesting the involvement of several different proteins in post-stroke epileptogenesis. TNFSF-14 emerges as a potential biomarker for predicting PSE.
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Affiliation(s)
- Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Sofía Lallana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Laia Grau-López
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jordi Ciurans
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Jiménez
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Alejandro Bustamante
- Stroke Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Álvarez Sabin
- Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus. Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
- Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
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Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Ortiz de Zarate Z, Fonseca E, Abraira L, Santamarina E, Campos-Fernández D, Quintana M, Sánchez J, Goméz-Andrés D, Sala J, Raspall M, Felipe-Rucián A, Del Toro M, Macaya A, Toledo M. EPITRANS. Quality assessment of the epilepsy transition process. Eur J Paediatr Neurol 2024; 48:121-128. [PMID: 38241904 DOI: 10.1016/j.ejpn.2024.01.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/14/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To analyze the differences in clinical management during the epilepsy transition process from pediatric to adult care and to determine the quality of life and degree of satisfaction of patients and caregivers during the transition. METHODS This is a longitudinal study including patients with epilepsy transferred from pediatric to adult epilepsy care between 2013 and 2017. Patients had a minimum follow-up of 3 years before the transition visit and at least 3 years consulting in the adults section. Clinical characteristics were retrieved from the medical chart. Quality of life and satisfaction questionnaires were administered by online access to patients and caregivers at the end of the adult follow-up period. RESULTS 99 patients (50.5 % women, mean transition age 16.5 ± 1 years old) were included. Before the transition visit, 90 % of patients received a transition discussion and 88 % had a formal clinical report. In the pediatric period, patients were visited more frequently, had more EEGs and genetic studies, and were seen by the same neuropediatrician (P<0.05). In the adult period, patients underwent a larger number of prolonged video EEGs and were prescribed polytherapy more often (P<0.05). Quality of life remained steady during the entire transition, but satisfaction with the care received was significantly higher during the pediatric period. CONCLUSIONS Significant differences were seen in epilepsy care during transition from pediatric to adult management, and this had an impact on the degree of satisfaction reported by patients and caregivers. Our results provide evidence of the potential value of development and early implementation of a protocolled transition program.
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Affiliation(s)
- Z Ortiz de Zarate
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain.
| | - L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - D Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - J Sánchez
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
| | - D Goméz-Andrés
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - J Sala
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Raspall
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - A Felipe-Rucián
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Del Toro
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - A Macaya
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain; Research Group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Spain
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6
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Rodrigo-Gisbert M, Abraira L, Quintana M, Gómez-Dabó L, López-Maza S, Sueiras M, Thonon V, Campos-Fernández D, Lallana S, Fonseca E, Toledo M, Santamarina E. Risk assessment of long-term epilepsy after de novo status epilepticus with clinical and electroencephalographic biomarkers: The AFTER score. Epilepsy Behav 2023; 149:109531. [PMID: 37995538 DOI: 10.1016/j.yebeh.2023.109531] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The risk of developing epilepsy after de novo status epilepticus (SE) is nonnegligible. The individualized management of patients with high risk of subsequent epilepsy could improve long-term quality of life and cognitive impairment. We aimed to ascertain potential biomarkers of subsequent epilepsy and to construct a scoring system possessing predictive value for the diagnosis of post-SE epilepsy during follow-up. METHODS The study data were obtained from a prospective registry of all SE episodes occurring in patients over 16 years attended in our tertiary center from February 2011 to April 2022. Clinical data, electroencephalography findings, treatment, and long-term clinical data were prospectively recorded. We selected SE patients at risk of developing epilepsy (acute symptomatic and cryptogenic etiologies with no previous history of epilepsy) and analyzed the risk of developing subsequent epilepsy. RESULTS We included 230 patients. Median age was 65 years ± 16.9 SD and 112/230 (48.7 %) were women. One-hundred ninety-eight patients (86.1 %) had an acute symptomatic SE, whereas 32 patients (13.9 %) presented with a cryptogenic SE. A total of 55 patients (23.9 %) developed an unprovoked remote seizure and were diagnosed with epilepsy. After adjusting for identifiable confounders in a multivariable Cox regression analysis cryptogenic etiology (HR 2.24 [1.13-4.46], p = 0.022), first-line treatment initiation ≥1 h (HR 2.12 [1.03-4.36], p = 0.041], RDA/LPD/GPD EEG patterns (HR 1.88 [1.07-3.32], p = 0.028), and super-refractoriness (HR 2.90 [1.40-5.99], p = 0.004) emerged as independent predictors of post-SE epilepsy. Based on these findings, we constructed the AFTER score (1 point for each item) with a robust capability to predict post-SE epilepsy at 5 years (AUC 74.3 %, 95 %CI 64.3-84.3 %, p < 0.001). CONCLUSIONS The AFTER score is a robust predictor of the development of epilepsy after new onset SE using clinical and electroencephalographic biomarkers (such as etiology, time to first-line treatment initiation, EEG pattern and super-refractoriness). Prospective studies are warranted to validate the score in other populations.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Laura Gómez-Dabó
- Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - María Sueiras
- Neurophysiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vanesa Thonon
- Neurophysiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Sofía Lallana
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Research group on Status Epilepticus and Acute Seizures, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
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7
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Santamarina E, Rodrigo-Gisbert M, Abraira L, Campos-Fernández D, Quintana M, Gómez-Dabó L, Fonseca E, Lallana S, Toledo M. Response: "What is the risk of unprovoked seizures after acute symptomatic status epilepticus?". Epilepsia 2023; 64:3410-3411. [PMID: 37804071 DOI: 10.1111/epi.17790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Gómez-Dabó
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sofía Lallana
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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8
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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9
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Rodrigo-Gisbert M, Gómez-Dabó L, Quintana M, Campos-Fernández D, Lallana S, Fonseca E, Abraira L, Toledo M, Santamarina E. Prediction of long-term unprovoked seizures after status epilepticus. Epilepsia 2023; 64:2399-2408. [PMID: 37347842 DOI: 10.1111/epi.17697] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Possible long-term consequences of status epilepticus (SE) include cognitive and behavioral impairment and the development of chronic epilepsy. However, these aspects have not been systematically studied in clinical practice. We aimed to evaluate long-term seizure recurrence after SE and the potential risk factors for their development. METHODS Data were obtained from a prospective registry of all SE episodes occurring in adult patients who attended our center from February 2011 to April 2022. Clinical data, electroencephalographic findings, treatment, and long-term data were prospectively recorded. We performed a cross-sectional study of consecutive SE patients without previous epilepsy diagnosis, and analyzed the development of unprovoked remote seizures. RESULTS A total of 849 patients were registered in the database. After excluding in-hospital mortality (198/849, 23.3%) and patients with prior epilepsy history (291/849, 44.7%), 360 patients (42.4%) with a first SE episode were included. The median age was 68 years (interquartile range [IQR] = 56-79), and 176 patients (48.9%) were women. The median time to first-line treatment initiation was 2 h (IQR = .7-7.4), and it was correlated with SE duration (R = .375, p < .001). One hundred nine patients (30.3%) presented unprovoked seizures during a median follow-up of 1.8 years (IQR = .5-4.3). After adjusting for identifiable confounders in a multivariable Cox regression analysis, progressive symptomatic etiology (hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.17-3.33, p = .011), time to first-line treatment initiation > 1.5 h (HR = 1.89, 95% CI = 1.25-2.87, p = .003), and superrefractory SE (HR = 2.34, 95% CI = 1.26-4.33, p = .007) were independently associated with a greater risk of unprovoked seizure recurrence. In contrast, older patients (HR = .99, 95% CI = .97-.99, p = .021) and an acute symptomatic etiology (HR = .44, 95% CI .28-.68, p < .001) were at lower risk of unprovoked seizure recurrence. SIGNIFICANCE The etiology of SE, the delay in initiating SE treatment, and the presence of superrefractoriness have been identified as potentials factors associated with unprovoked remote seizures following a new onset SE. Therefore, prompt and appropriate management should be applied to avoid seizure recurrence.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Gómez-Dabó
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sofía Lallana
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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10
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Sinka L, Abraira L, Imbach LL, Zieglgänsberger D, Santamarina E, Álvarez-Sabín J, Ferreira-Atuesta C, Katan M, Scherrer N, Bicciato G, Terziev R, Simmen C, Schubert KM, Elshahabi A, Baumann CR, Döhler N, Erdélyi-Canavese B, Felbecker A, Siebel P, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Nilo A, Janes F, Merlino G, Valente M, Zafra-Sierra MP, Bayona-Ortiz H, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Pinho e Melo T, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model. JAMA Neurol 2023; 80:605-613. [PMID: 37036702 PMCID: PMC10087089 DOI: 10.1001/jamaneurol.2023.0611] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 08/13/2022] [Accepted: 12/16/2022] [Indexed: 04/11/2023]
Abstract
Importance Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. Objective To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. Design, Setting, and Participants This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. Exposures Type of acute symptomatic seizure. Main Outcomes and Measures All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). Results A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. Conclusions and Relevance In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up.
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Affiliation(s)
- Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | | | | | - Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - José Álvarez-Sabín
- Epilepsy Unit, Department of Neurology, Vall d’Hebron Hospital Universitari, Barcelona, and Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Carolina Ferreira-Atuesta
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cyril Simmen
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kai Michael Schubert
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Adham Elshahabi
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian R. Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Nico Döhler
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | | | - Ansgar Felbecker
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Philip Siebel
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Michael Winklehner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Tim J. von Oertzen
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Judith N. Wagner
- Department of Neurology 1, Kepler Universitätsklinikum, Neuromed Campus, Linz, Austria
| | - Gian Luigi Gigli
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Anna Serafini
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Francesco Janes
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Giovanni Merlino
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Mariarosaria Valente
- Department of Medicine, University of Udine and Clinical Neurology, Udine University Hospital, Udine, Italy
| | - María Paula Zafra-Sierra
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Hernan Bayona-Ortiz
- Department of Neurology, Fundación Santa Fe de Bogotá, Universidad de Los Andes, Universidad del Bosque, Bogotá, Colombia
| | - Julian Conrad
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology and German Center for Vertigo and Balance Disorders-IFB-LMU, Ludwig Maximilians University of Munich, Munich, Germany
| | - Stefan Evers
- Department of Neurology, University of Muenster, Muenster, Germany
- Department of Neurology, Krankenhaus Lindenbrunn, Coppenbrügge, Germany
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Frauke Roell
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
- Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - John S. Duncan
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Barbara Tettenborn
- Department of Neurology, Kantonsspital St. Gallen, St Gallen, Switzerland
| | - Matthias J. Koepp
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
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11
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Llauradó A, Campos D, Quintana M, Ballvé A, Fonseca E, Abraira L, Giffreu A, Toledo M, Santamarina E. Reponse of second-line treatment in focal status epilepticus: A tertiary hospital experience. Epilepsy Res 2022; 185:106988. [PMID: 35907324 DOI: 10.1016/j.eplepsyres.2022.106988] [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: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the response to various antiseizure medications (ASMs) in the treatment of focal status epilepticus (SE) in the established phase, and the effect of administering several ASMs prior to sedation. METHODS All SE cases in patients aged > 16 years treated with non-BZDs ASMs were prospectively collected in our centre from February 2011 to April 2019. In total, 281 episodes were analysed. RESULTS Median age at SE onset was 65.1 years; 47 % were focal motor and 53 % focal non-motor episodes. SE cessation was achieved in 79 % episodes with second-line drugs, whereas a third line (anesthetics) was required in 47 episodes. SE cessation was achieved in only 27 % with the first ASM, 48 % with the second, and 51 % with the third. Prompt resolution of the SE episode with a first or second ASM was associated with a better outcome than episodes requiring a larger number of drugs (p = 0.024). The first option in our sample was levetiracetam in 70 % of cases. Among the total of non-responding SE cases treated with levetiracetam as the first ASM option, 107 were subsequently given lacosamide (seizure cessation in 53.3 %) and 34 valproic acid (seizure cessation in 29.4 %) (p = 0.015). CONCLUSION Our findings further support the notion that early termination of SE with a first or second ASM confers a better functional outcome. The large difference in response between the first ASM and consecutive ones suggests that the sum of different ASMs might be the key to resolving focal SE.
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Affiliation(s)
| | - Daniel Campos
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | | | - Elena Fonseca
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | - Manuel Toledo
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
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12
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Fonseca E, Quintana M, Seijo‐Raposo I, Ortiz de Zárate Z, Abraira L, Santamarina E, Álvarez‐Sabin J, Toledo M. Interictal brain activity changes in temporal lobe epilepsy: A quantitative electroencephalogram analysis. Acta Neurol Scand 2022; 145:239-248. [PMID: 34687043 DOI: 10.1111/ane.13543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/19/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the usefulness of quantitative electroencephalography (qEEG) in the analysis of baseline activity in patients with temporal lobe epilepsy (TLE) and identify measures potentially associated with disease duration and drug resistance. MATERIALS AND METHODS Cross-sectional study of adult patients with TLE and controls who underwent video-EEG monitoring. Representative artifact-free resting wakefulness baseline EEG segments were selected for quantitative analysis. The fast Fourier transform (FFT) approach was used for the power spectral analysis, with computation of FFT power ratios and alpha-delta and alpha-theta ratios for both hemispheres. The resulting measures were compared between TLE patients and controls and their values as predictors of epilepsy duration and drug resistance analyzed. RESULTS Thirty-nine TLE patients and 23 controls were included. The TLE patients had a lower alpha-delta ratio in the posterior quadrant ipsilateral to the epileptic focus and a lower alpha-theta ratio in the ipsilateral anterior/posterior quadrants and temporal region. A younger age at onset and longer epilepsy duration correlated with a higher theta power ratio in the contralateral anterior and posterior quadrants and temporal region. No qEEG measures predicted drug resistance. CONCLUSIONS Quantitative electroencephalography background activity may contribute to the diagnosis of TLE and provide useful information on disease duration. A lower alpha-delta and alpha-theta ratio may be reliable baseline qEEG measures for identifying patients with TLE. A higher contralateral theta power ratio may be indicative of longer epilepsy duration.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Iván Seijo‐Raposo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Zuriñe Ortiz de Zárate
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Department of Pediatric Neurology Vall d'Hebron University Hospital Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - José Álvarez‐Sabin
- Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
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13
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Abraira L, Salas-Puig J, Quintana M, Seijo-Raposo IM, Santamarina E, Fonseca E, Toledo M. Overnight switch from levetiracetam to brivaracetam. Safety and tolerability. Epilepsy Behav Rep 2021; 16:100504. [PMID: 34901817 PMCID: PMC8640256 DOI: 10.1016/j.ebr.2021.100504] [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: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Brivaracetam has a more selective action to SV2A binding site than levetiracetam. Neuropsychological adverse events improved in 76% of patients that switched. An overnight switch is well-tolerated in our relatively small Spanish sample.
Brivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam. This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9 ± 17.8 years, women 48.8%). Focal epilepsy represented 75.6% (n = 31) of patients (structural cause [n = 25], unknown cause [n = 6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n = 22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n = 8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients’ reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively. An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs.
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Affiliation(s)
- L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - J Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - I M Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
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14
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Turon M, Jiménez-Balado J, Abraira L, Fonseca E, Quintana M, Toledo M, Delgado P, Maisterra O, Salas-Puig X, Álvarez-Sabín J, Santamarina E. Effect of late-onset epilepsy on cognitive functioning in patients with small vessel disease. Epilepsy Behav 2021; 123:108238. [PMID: 34375799 DOI: 10.1016/j.yebeh.2021.108238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE Late-onset epilepsy (LOE) often has underlying cerebrovascular cause and has been associated with neurocognitive deficits and dementia. Nevertheless, the interplay between these factors has not been studied thus far. Hence, we conducted a retrospective cross-sectional study aimed to explore how unprovoked epileptic seizures along with vascular-related factors contribute to neurocognitive impairments in patients with cerebral small vessel disease. METHODS Twenty-seven patients with LOE aged > 60 years with concomitant cerebral small vessel disease (cSVD) and a matched group of cSVD without epilepsy were cognitively assessed. Demographic, clinical, and vascular information were obtained and vascular burden score was calculated for each patient. Multiple linear regression models were used to explore the relationship between epilepsy and cognitive measures adjusting for demographic and vascular risk factors. RESULTS Compared with cSVD, cSVD-LOE group showed a poorer performance on verbal memory measures, visuomotor tracking and speed processing and phonetic fluency. In the multiple regression analysis, the presence of epilepsy was found to be the major predictor for verbal memory dysfunction, specifically in verbal short recall (p = 0.008) and verbal learning (p < 0.001). No interactions between vascular burden and epilepsy were found. CONCLUSION Patients who had cSVD with concurrent LOE showed poorer performance on memory function compared with patients with cSVD without epilepsy, and they showed a different cognitive profile from that typically manifested by patients with cSVD. The presence of epilepsy, but not seizure localization nor vascular burden, was the major contributor to the decrease in verbal memory.
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Affiliation(s)
- Marc Turon
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Jiménez-Balado
- Neurovascular Research Lab, Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Research Lab, Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - José Álvarez-Sabín
- Neurovascular Research Lab, Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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15
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Ferreira‐Atuesta C, Döhler N, Erdélyi‐Canavese B, Felbecker A, Siebel P, Scherrer N, Bicciato G, Schweizer J, Sinka L, Imbach LL, Katan M, Abraira L, Santamarina E, Álvarez‐Sabín J, Winklehner M, von Oertzen TJ, Wagner JN, Gigli GL, Serafini A, Janes F, Merlino G, Valente M, Gregoraci G, Conrad J, Evers S, Lochner P, Roell F, Brigo F, Bentes C, Peralta AR, Melo TPE, Keezer MR, Duncan JS, Sander JW, Tettenborn B, Koepp MJ, Galovic M. Seizures after Ischemic Stroke: A Matched Multicenter Study. Ann Neurol 2021; 90:808-820. [PMID: 34505305 PMCID: PMC9292028 DOI: 10.1002/ana.26212] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 03/12/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/30/2023]
Abstract
Objective The purpose of this study was to identify risk factors for acute symptomatic seizures and post‐stroke epilepsy after acute ischemic stroke and evaluate the effects of reperfusion treatment. Methods We assessed the risk factors for post‐stroke seizures using logistic or Cox regression in a multicenter study, including adults from 8 European referral centers with neuroimaging‐confirmed ischemic stroke. We compared the risk of post‐stroke seizures between participants with or without reperfusion treatment following propensity score matching to reduce confounding due to treatment selection. Results In the overall cohort of 4,229 participants (mean age 71 years, 57% men), a higher risk of acute symptomatic seizures was observed in those with more severe strokes, infarcts located in the posterior cerebral artery territory, and strokes caused by large‐artery atherosclerosis. Strokes caused by small‐vessel occlusion carried a small risk of acute symptomatic seizures. 6% developed post‐stroke epilepsy. Risk factors for post‐stroke epilepsy were acute symptomatic seizures, more severe strokes, infarcts involving the cerebral cortex, and strokes caused by large‐artery atherosclerosis. Electroencephalography findings within 7 days of stroke onset were not independently associated with the risk of post‐stroke epilepsy. There was no association between reperfusion treatments in general or only intravenous thrombolysis or mechanical thrombectomy with the time to post‐stroke epilepsy or the risk of acute symptomatic seizures. Interpretation Post‐stroke seizures are related to stroke severity, etiology, and location, whereas an early electroencephalogram was not predictive of epilepsy. We did not find an association of reperfusion treatment with risks of acute symptomatic seizures or post‐stroke epilepsy. ANN NEUROL 2021;90:808–820
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Affiliation(s)
- Carolina Ferreira‐Atuesta
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Nico Döhler
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Specialist Clinic for Neurorehabilitation, Kliniken BeelitzBeelitz‐HeilstättenGermany
| | | | - Ansgar Felbecker
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Philip Siebel
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Natalie Scherrer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Giulio Bicciato
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Juliane Schweizer
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lucia Sinka
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Lukas L. Imbach
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
| | - Mira Katan
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of ZurichZurichSwitzerland
| | - Laura Abraira
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Estevo Santamarina
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - José Álvarez‐Sabín
- Epilepsy Unit, Department of NeurologyVall d'Hebron Hospital UniversitariBarcelonaSpain
- Universitat Autonoma de BarcelonaBellaterraSpain
| | - Michael Winklehner
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
- Division of Neuropathology and Neurochemistry, Department of NeurologyMedical University of ViennaViennaAustria
| | | | | | - Gian Luigi Gigli
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Anna Serafini
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Francesco Janes
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Giovanni Merlino
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | - Mariarosaria Valente
- Department of MedicineUniversity of Udine and Clinical Neurology, Udine University HospitalUdineItaly
| | | | - Julian Conrad
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of Neurology and German Center for Vertigo and Balance Disorders‐IFB‐LMULudwig Maximilians University of MunichMunichGermany
| | - Stefan Evers
- Department of NeurologyUniversity of MuensterMuensterGermany
- Department of NeurologyKrankenhaus LindenbrunnCoppenbrüggeGermany
| | | | - Frauke Roell
- Department of NeurologySaarland University Medical CenterHomburgGermany
| | - Francesco Brigo
- Division of NeurologyHospital of Merano‐Meran (SABES‐ASDAA)MeranoItaly
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Ana Rita Peralta
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Teresa Pinho e Melo
- Department of Neurosciences and Mental Health (Neurology)Hospital de Santa Maria‐CHLN, Faculdade de Medicina, Universidade de LisboaLisboaPortugal
| | - Mark R. Keezer
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Centre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - John S. Duncan
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Josemir W. Sander
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Stichting Epilepsie Instellingen Nederland – (SEIN)HeemstedeThe Netherlands
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
- Department of Neurology, West of China HospitalChengduChina
| | | | - Matthias J. Koepp
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
| | - Marian Galovic
- Department of Clinical & Experimental EpilepsyUCL Queen Square Institute of NeurologyQueen SquareLondonUnited Kingdom
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
- Department of Neurology, Clinical Neuroscience CenterUniversity Hospital and University of ZurichZurichSwitzerland
- Chalfont Centre for EpilepsyChalfont St. PeterUnited Kingdom
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16
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Fonseca E, Campos Blanco DM, Castro Vilanova MD, Garamendi Í, Gómez-Eguilaz M, Pérez Díaz H, Poza JJ, Querol-Pascual MR, Quiroga-Subirana P, Rodríguez-Osorio X, Zurita Santamaría J, Centeno M, Díaz de Cerio Julián L, Estévez-María JC, Martínez Agredano P, Mauri Llerda JÁ, Sala-Padró J, Falip M, Abraira L, Santamarina E, Seijo-Raposo I, Quintana M, Toledo M. Relationship between sleep quality and cognitive performance in patients with epilepsy. Epilepsy Behav 2021; 122:108127. [PMID: 34147020 DOI: 10.1016/j.yebeh.2021.108127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the relationship between self-reported sleep quality and cognitive function in patients with epilepsy (PWE), as well as anxiety and depressive symptoms and patient quality of life (QoL). METHODS This multicenter cross-sectional study included PWE aged ≥12 years who were receiving ≥1 anti-seizure medication (ASM) and had not been diagnosed with a sleep disorder. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Montreal Cognitive Assessment test (MoCA), the Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). RESULTS The study enrolled 150 patients aged 16-83 years, mean age (standard deviation [SD]) 40.6 (15.2) years; 58.7% were female and 75.3% had focal epilepsy. Mean (SD) PSQI score was 4.71 (3.08), 44.4% of patients had impaired sleep quality (PSQI score ≥5), 19.9% had pathologic excessive daytime sleepiness (ESS score >12), and 32.7% had mild cognitive impairment (MoCA score <26). Within the PSQI, sleep disturbance (P = 0.036) and use of sleep medication (P = 0.006) scores were significantly higher in patients with mild cognitive impairment. Multiple regression analysis showed older age (regression coefficient [B], -0.086; 95% confidence interval [CI], -0.127, -0.045; P < 0.001) and the use of sleep medication component of the PSQI [B, -1.157; 95% CI, -2.064, -0.220; P = 0.013) were independently associated with lower MoCA score. Poor sleep quality was associated with probable anxiety and depression symptoms, and directly correlated with reduced QoL. CONCLUSIONS In PWE, sleep quality was not significantly independently associated with mild cognitive impairment, although poor sleep quality had a negative effect on mood and QoL.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Xiana Rodríguez-Osorio
- Epilepsy Unit, Neurology Service, Hospital Clínico Universitario of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María Centeno
- Clínica Universitaria de Navarra, Pamplona, Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - Leyre Díaz de Cerio Julián
- Neurology Department, Lozano Blesa University Hospital, Aragon Sanitary Research Institute, Zaragoza, Spain
| | | | | | - José Ángel Mauri Llerda
- Neurology Department, Lozano Blesa University Hospital, Aragon Sanitary Research Institute, Zaragoza, Spain
| | | | - Mercè Falip
- Epilepsy Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
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17
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Santamarina E, Parejo-Carbonell B, Abraira L, Gutiérrez-Viedma A, Fonseca E, Seijo I, Abarrategui B, Salas-Puig X, Quintana M, Toledo M, García-Morales I. Status epilepticus without impairment of consciousness: Long-term outcomes according to duration. Epilepsy Behav 2021; 120:108007. [PMID: 33992961 DOI: 10.1016/j.yebeh.2021.108007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The point after which non-convulsive status epilepticus (NCSE) can cause permanent damage remains to be elucidated. The aim of this study was to analyze the association between time to resolution and long-term outcomes in NCSE. METHODS We performed a retrospective study of all patients with focal NCSE without consciousness impairment at two tertiary care hospitals in Spain. All the data were registered prospectively and the study period was December 2014-May 2018. We collected information on demographics, SE etiology, time to administration of different lines of treatment, time to NCSE resolution, and outcomes at discharge, 1 year, and 4 years. Clinical outcome was prospectively categorized as good (return to baseline function) or poor (new disability and death). RESULTS Seventy-four patients with a mean (±SD) age of 63.4 ± 17.5 years and a mean follow-up time of 2.4 ± 2.2 years were studied. A poor outcome at discharge was associated with a potentially fatal etiology (p < 0.001), EMSE score (Epidemiology-based Mortality Score in Status Epilepticus) (p = 0.012), lateral periodic discharges on EEG (p = 0.034), and occurrence of major complications during hospitalization (p = 0.007). An SE duration of >100 h was clearly associated with a worse outcome (p < 0.001). In the multiple regression analysis, the only independent predictors of a poor outcome at discharge were an SE duration of >+100 hours (p = 0.001), a potentially fatal etiology (p = 0.001), and complications during hospitalization (p = 0.010). An SE duration of >100 hours retained its value as the optimal cutoff point for predicting poor outcomes at both 1 year (p = 0.037) and 4 years (p = 0.05). Other predictors of poor long-term outcomes were a potentially fatal etiology (p < 0.001) and EMSE score (p = 0.034) at 1 year, and progressive symptomatic etiology at 4 years (p = 0.025). SIGNIFICANCE In patients with focal NCSE without consciousness impairment, a potentially fatal etiology and an SE duration of >100 h were associated with poor short-term and long-term outcomes.
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Affiliation(s)
- E Santamarina
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - B Parejo-Carbonell
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - L Abraira
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - A Gutiérrez-Viedma
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - E Fonseca
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - I Seijo
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - B Abarrategui
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
| | - X Salas-Puig
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Department of Neurology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - I García-Morales
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
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Lallana S, Fonseca E, Restrepo JL, Quintana M, Seijo‐Raposo I, Abraira L, Santamarina E, Álvarez‐Sabín J, Toledo M. Medium-term effects of COVID-19 pandemic on epilepsy: A follow-up study. Acta Neurol Scand 2021; 144:99-108. [PMID: 33905117 PMCID: PMC8207097 DOI: 10.1111/ane.13439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/26/2021] [Accepted: 04/11/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyze the medium-term impact of the COVID-19 pandemic on epilepsy patients, focusing on psychological effects and seizure control. METHODS Prospective follow-up study to evaluate the medium-term effects of the COVID-19 pandemic on a cohort of epilepsy patients from a tertiary hospital previously surveyed during the first peak of the pandemic. Between July 1, 2020, and August 30, 2020, the patients answered an online 19-item questionnaire, HADS, and PSIQ scales. Short- and medium-term effects of the pandemic confinement and the perception of telemedicine were compared. RESULTS 153 patients completed the questionnaire, mean ± SD age, 47.6 ± 19.3 years; 49.7% women. Depression was reported by 43 patients, significantly more prevalent than in the short-term analysis (29.2% vs. 19.7%; p = .038). Anxiety (38.1% vs. 36.1%; p = 0.749) and insomnia (28.9% vs. 30.9%, p = .761) remained highly prevalent. Seventeen patients reported an increase in seizure frequency (11.1% vs. 9.1%, p = .515). The three factors independently associated with an increase in seizure frequency in the medium term were drug-resistant epilepsy (odds ratio [OR] = 8.2, 95% CI 2.06-32.52), depression (OR = 6.46, 95% CI 1.80-23.11), and a reduction in income (OR = 5.47, 95% CI 1.51-19.88). A higher proportion of patients found telemedicine unsatisfactory (11.2% vs. 2.4%), and a lower percentage (44.8% vs. 56.8%) found it very satisfactory (p = .005). CONCLUSIONS Depression rates increased significantly after the first wave. Depression, drug-resistant epilepsy, and a reduction in family income were independent risk factors for an increased seizure frequency. Perception of telemedicine worsened, indicating need for re-adaptation.
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Affiliation(s)
- Sofía Lallana
- Neurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
| | - Elena Fonseca
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Manuel Quintana
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Iván Seijo‐Raposo
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Laura Abraira
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Estevo Santamarina
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Manuel Toledo
- Epilepsy UnitNeurology DepartmentVall d’Hebron University HospitalBarcelonaSpain
- Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
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Vilaseca A, Fonseca E, Anciones Martín C, Seijo-Raposo I, Abraira L, Santamarina E, Quintana M, Álvarez-Sabin J, Gil-Nagel A, Toledo M. Thumb-up sign: Characterization of an undescribed seizure semiologic sign. Seizure 2021; 89:62-64. [PMID: 34015572 DOI: 10.1016/j.seizure.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Andreu Vilaseca
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Elena Fonseca
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain.
| | | | - Iván Seijo-Raposo
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Laura Abraira
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Estevo Santamarina
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Manuel Quintana
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - José Álvarez-Sabin
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | | | - Manuel Toledo
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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20
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. Neurologia 2021; 38:S0213-4853(21)00053-0. [PMID: 33875301 DOI: 10.1016/j.nrl.2021.02.014] [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: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Quintana
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - L Abraira
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Toledo
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Ballvé A, Salas‐Puig J, Quintana M, Campos D, Llauradó A, Raspall M, Fonseca E, Abraira L, Santamarina E, Toledo M. Levetiracetam as first-line monotherapy for Idiopathic Generalized Epilepsy in women. Acta Neurol Scand 2021; 143:407-412. [PMID: 33452703 DOI: 10.1111/ane.13389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/05/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Levetiracetam (LEV) is effective in Idiopathic Generalized Epilepsy (IGE) and seems to be a good alternative to valproic acid in women of childbearing age. However, there is lack of approval for this indication as monotherapy. The aim of this study is to assess the efficacy of LEV as a first-line therapy in this population. METHODS The study is a descriptive analysis of women aged between 16 and 45 years old diagnosed with IGE and treated with LEV as first-line monotherapy. Minimum follow-up was 24 months. RESULTS 26 women. Mean age: 25.4 years (17-43). 14 Juvenile Myoclonic Epilepsy; 8 Tonic-Clonic Seizures Alone; 4 Juvenile Absence. Mean follow-up: 68.3 months (24-120). 11 patients (40.7%) continued to take LEV as monotherapy, of which 10 were seizure-free, and three (11.5%) continue to be seizure-free after withdrawing LEV. 12 patients (46.2%) required a change of treatment: 25% (3/12) due to lack of efficacy, 42% (5/12) due to adverse effects and 33% (4/12) due to both. Irritability was the most frequent adverse effect. At the last assessment, three patients (11.5%) continued to have seizures despite polytherapy. Estimated retention rates were 78.1% at one year (SE 7.3%) and 51% at 5 years (SE 9.8%). Estimated median retention time is 72 months (CI 95%: 50.9-93.1). CONCLUSION LEV could be an effective drug as first-line treatment for IGE in women of childbearing potential. The adverse effects are its main limitation. Comparative studies are needed in order to establish it for this indication.
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Affiliation(s)
- Alejandro Ballvé
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Javier Salas‐Puig
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Daniel Campos
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Arnau Llauradó
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Miquel Raspall
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Department of Paediatric Neurology Vall d'Hebron University Hospital Barcelona Spain
| | - Elena Fonseca
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
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Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, Bentes C, Zelano J, Koepp MJ. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging 2021; 38:285-299. [PMID: 33619704 PMCID: PMC8007525 DOI: 10.1007/s40266-021-00837-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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] [Accepted: 01/23/2021] [Indexed: 12/14/2022]
Abstract
Stroke is the leading cause of seizures and epilepsy in older adults. Patients who have larger and more severe strokes involving the cortex, are younger, and have acute symptomatic seizures and intracerebral haemorrhage are at highest risk of developing post-stroke epilepsy. Prognostic models, including the SeLECT and CAVE scores, help gauge the risk of epileptogenesis. Early electroencephalogram and blood-based biomarkers can provide information additional to the clinical risk factors of post-stroke epilepsy. The management of acute versus remote symptomatic seizures after stroke is markedly different. The choice of an ideal antiseizure medication should not only rely on efficacy but also consider adverse effects, altered pharmacodynamics in older adults, and the influence on the underlying vascular co-morbidity. Drug-drug interactions, particularly those between antiseizure medications and anticoagulants or antiplatelets, also influence treatment decisions. In this review, we describe the epidemiology, risk factors, biomarkers, and management of seizures after an ischaemic or haemorrhagic stroke. We discuss the special considerations required for the treatment of post-stroke epilepsy due to the age, co-morbidities, co-medication, and vulnerability of stroke survivors.
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Affiliation(s)
- Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
| | - Carolina Ferreira-Atuesta
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Nico Döhler
- Specialist Clinic for Neurorehabilitation, Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Lucia Sinka
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Carla Bentes
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria-CHLN, Lisboa, Portugal
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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Llauradó A, Quintana M, Ballvé A, Campos D, Fonseca E, Abraira L, Toledo M, Santamarina E. Factors associated with resistance to benzodiazepines in status epilepticus. J Neurol Sci 2021; 423:117368. [PMID: 33652289 DOI: 10.1016/j.jns.2021.117368] [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: 11/05/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode. METHODS All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed. RESULTS Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001). SIGNIFICANCE The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
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Affiliation(s)
- Arnau Llauradó
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Alejandro Ballvé
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Daniel Campos
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain.
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Salas-Puig J, Sopelana D, Quintana M, Seijo-Raposo I, Abraira L, Fonseca E, Santamarina E, Toledo M. [Quality of life in adult patients with idiopathic generalised epilepsy. The EPILAK study]. Rev Neurol 2021; 72:195-202. [PMID: 33710609 DOI: 10.33588/rn.7206.2020518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Quality of life (QoL) is an important aspect in the treatment of patients with epilepsy. AIM To analyse the QoL using the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) in adults with idiopathic generalised epilepsy and to study factors associated with a worse QoL. PATIENTS AND METHODS A cross-sectional, multicentre, observational study conducted by 141 neurologists in all the autonomous communities of Spain. Each researcher analysed the QOLIE-10 of two males and two females over 18 years of age with idiopathic generalised epilepsy seen consecutively in public or private practice. The results were standardised: 0 was the worst QoL and 100 was the best. RESULTS A total of 546 patients were analysed. Women: 51.1% (n = 279). Mean age: 36 ± 15.3 years old (18-87). Childhood absence seizures: 7.5% (n = 41); juvenile absence seizures: 9.2% (n = 50); juvenile myoclonic seizures: 29.8% (n = 163); only tonic-clonic seizures: 53.5% (n = 292). Monotherapy: 63.2% (n = 345). Seizure-free in the last year: 53.1% (n = 290). Psychiatric comorbidity: anxiety: 28.4% (n = 155); depression: 14.1% (n = 77); attention deficit: 10.1% (n = 55). Employment status: in active employment: 47.2% (n = 258); student: 20% (n = 109); housewife/husband: 7.3% (n = 40); pensioner: 10.2% (n = 56); unemployed: 14.3% (n = 78). Marital status: married or in a relationship: 49.1% (n = 268); single: 43.7% (n = 239). Mean score on the QOLIE-10: 71.4 ± 19.1. Being female (p = 0.006), greater frequency of seizures (p < 0.001), polytherapy (p < 0.001), psychiatric comorbidity (p < 0.001) and unemployment (p < 0.001) were significantly associated with a worse QoL. CONCLUSIONS The QoL of patients with idiopathic/genetic generalised epilepsy is affected by poor seizure control, psychiatric comorbidity and unemployment, and women are more affected than men.
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Affiliation(s)
- J Salas-Puig
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - D Sopelana
- Hospital Universitario de Albacete, Albacete, España
| | - M Quintana
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - L Abraira
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Toledo
- Hospital Universitario Vall d'Hebron, Barcelona, España
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Fonseca E, Quintana M, Lallana S, Luis Restrepo J, Abraira L, Santamarina E, Seijo‐Raposo I, Toledo M. Epilepsy in time of COVID-19: A survey-based study. Acta Neurol Scand 2020; 142:545-554. [PMID: 32799337 PMCID: PMC7460986 DOI: 10.1111/ane.13335] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [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: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/21/2022]
Abstract
Objectives Collateral damage may occur in epilepsy management during the coronavirus (COVID‐19) pandemic. We aimed to establish the impact of this pandemic on epilepsy patients in terms of patient‐reported seizure control and emerging symptoms. Materials & Methods This is a cross‐sectional study including consecutive patients assessed by telephone contact in an epilepsy clinic during the first month of confinement. Demographic and clinical characteristics were recorded, and a 19‐item questionnaire was systematically completed. Data regarding the impact of confinement, economic effects of the pandemic, and subjective perception of telemedicine were recorded. Additional clinical data were obtained in patients with a COVID‐19 diagnosis. Results Two hundred and fifty‐five patients were recruited: mean age 48.2 ± 19.8 years, 121 (47.5%) women. An increase in seizure frequency was reported by 25 (9.8%) patients. Sixty‐eight (26.7%) patients reported confinement‐related anxiety, 22 (8.6%) depression, 31 (12.2%) both, and 72 (28.2%) insomnia. Seventy‐three (28.6%) patients reported a reduction in economic income. Logistic regression analysis showed that tumor‐related epilepsy etiology [OR = 7.36 (95% CI 2.17‐24.96)], drug‐resistant epilepsy [OR = 3.44 (95% CI 1.19‐9.95)], insomnia [OR = 3.25 (95% CI 1.18‐8.96)], fear of epilepsy [OR = 3.26 (95% CI 1.09‐9.74)], and income reduction [OR = 3.65 (95% CI 1.21‐10.95)] were associated with a higher risk of increased seizure frequency. Telemedicine was considered satisfactory by 214 (83.9%) patients. Five patients were diagnosed with COVID‐19, with no changes in seizure frequency. Conclusions The COVID‐19 pandemic has effects in epilepsy patients. Patients with tumor‐related, drug‐resistant epilepsy, insomnia, and economic difficulties are at a higher risk of increased seizure frequency. Telemedicine represents a suitable tool in this setting.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
| | - Sofía Lallana
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Juan Luis Restrepo
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
| | - Iván Seijo‐Raposo
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d’Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
- Epilepsy Research Group Vall d’Hebron Research Institute (VHIR) Barcelona Spain
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Campos-Fernández D, Fonseca E, Olivé-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, Santamarina E, Toledo M. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113:107511. [PMID: 33129044 DOI: 10.1016/j.yebeh.2020.107511] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Psychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. METHODS This is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State-Trait Anger Expression Inventory-2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. RESULTS We studied 157 patients. Seizure frequency (R = -0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = -0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = -2.453 [95% confidence interval (CI): -3.161, -1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = -1.984; P = .047) and irritability (Z = -3.669; P < .001) in their influence on QoL. CONCLUSION Depression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.
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Affiliation(s)
- Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Quintana M, Sánchez‐López J, Mazuela G, Santamarina E, Abraira L, Fonseca E, Seijo I, Álvarez‐Sabin J, Toledo M. Incidence and mortality in adults with epilepsy in northern Spain. Acta Neurol Scand 2020; 143:27-33. [PMID: 32969054 DOI: 10.1111/ane.13349] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to determine the regional incidence and mortality of adult epilepsy, compare mortality rates with the expected in the general population, and identify predictors of shorter survival. MATERIALS AND METHODS We included all consecutive newly diagnosed epilepsy visited at a university hospital in Spain throughout 2012. We collected all relevant clinical data up to December 2018. We analyzed the incidence of epilepsy in our catchment area, studied mortality rates, and explored factors predictive of shorter survival. RESULTS The annual incidence of epilepsy among adults was 37.7 cases/100,000 inhabitants. We studied 110 patients with newly diagnosed epilepsy. Mean age was 52.6 years, and 53.6% were men. Eighty-nine patients (80.9%) had focal epilepsy, 50 (45.5%) had a structural etiology, and 45 (40.9%) had an unknown cause. Nineteen patients died over a median follow-up of 5.3 years. Mortality was almost four times higher than expected in general population and was increased in patients aged 40-59 years. Mortality rates were 5.5%, 12%, and 16.8% in the first, second, and third year, after which they remained stable to the end of follow-up. Independent predictors of mortality were age (p = 0.001), tumor-related epilepsy (p = 0.003), and generalized seizures (p = 0.020). CONCLUSIONS There is a high incidence of epilepsy among adults in our geographic area, with a mortality rate quadrupling that expected for the general population. Age, generalized seizures, and tumor-related epilepsy are independently associated with a higher risk of death.
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Affiliation(s)
- Manuel Quintana
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Javier Sánchez‐López
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Gonzalo Mazuela
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Elena Fonseca
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Iván Seijo
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Jose Álvarez‐Sabin
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department, Medicine Department Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona Spain
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Llauradó A, Santamarina E, Fonseca E, Olivé M, Requena M, Sueiras M, Guzmán L, Ballvé A, Campos D, Seijó I, Abraira L, Quintana M, Toledo M. How soon should urgent EEG be performed following a first epileptic seizure? Epilepsy Behav 2020; 111:107315. [PMID: 32694039 DOI: 10.1016/j.yebeh.2020.107315] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Patients with a first unprovoked epileptic seizure are often seen in emergency services. Electroencephalography (EEG) is indicated for diagnosing epilepsy, but the optimal time to perform this test has not been defined. This study aimed to determine the time interval following a seizure within which EEG has the greatest diagnostic yield. METHODS We conducted a retrospective study of all adult patients with a first unprovoked seizure who had undergone emergency EEG (July 2014-December 2019). Data collection included demographics, seizure type, time interval to EEG study, EEG pattern identified, and the prescription after emergency assessment. An optimal cut-off point for time to EEG was obtained, and an adjusted regression model was performed to establish associations with the presence of epileptiform abnormalities. RESULTS A total of 170 patients were included (mean age: 50.7 years, 40.6% women). Epileptiform discharges were identified in 34.1% of recordings, nonepileptiform abnormalities in 46.5%, and normal findings in 19.4%. A lower latency from seizure to EEG was associated with a higher probability of finding epileptiform discharges (median: 12.7 in the epileptiform EEGs vs. 20 h in the nonepileptiform EEGs, p < 0.001). The time interval associated with the highest probability of detecting an epileptiform EEG pattern was within the first 16 h after seizure onset: 52.1% of recordings performed before the 16-h cut-off showed these abnormal patterns compared with 20.2% performed after (p < 0.001). These findings were not related to the presence of an epileptogenic lesion in neuroimaging or to other clinical variables. The finding of epileptiform abnormalities was followed by a greater prescription of antiseizure drugs (96.4% vs. 66% in nonepileptiform patterns, p < 0.001). CONCLUSION The diagnostic yield of EEG following a first unprovoked epileptic seizure is highest when this test is performed within the first 16 h after onset of the event.
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Affiliation(s)
- A Llauradó
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain.
| | - E Fonseca
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Olivé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Requena
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Sueiras
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Guzmán
- EEG Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - A Ballvé
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - D Campos
- Neurology Department, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - I Seijó
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - L Abraira
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Hospital Vall Hebron, Passeig Vall d'Hebron 119-121, 08035 Barcelona, Spain
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Vilaseca-Jolonch A, Abraira L, Quintana M, Sueiras M, Thonon V, Toledo M, Salas-Puig J, Fonseca E, Cordero E, Martínez-Ricarte F, Santamarina E. Tumor-associated status epilepticus: A prospective cohort in a tertiary hospital. Epilepsy Behav 2020; 111:107291. [PMID: 32702656 DOI: 10.1016/j.yebeh.2020.107291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 04/19/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Tumor-associated status epilepticus (TASE) follows a relatively benign course compared with SE in the general population. Little, however, is known about associated prognostic factors. METHODS We conducted a prospective, observational study of all cases of TASE treated at a tertiary hospital in Barcelona, Spain between May 2011 and May 2019. We collected data on tumor and SE characteristics and baseline functional status and analyzed associations with outcomes at discharge and 1-year follow-up. RESULTS Eighty-two patients were studied; 58.5% (n = 48) had an aggressive tumor (glioblastoma or brain metastasis). Fifty-one patients (62.2%) had a favorable outcome at discharge compared with just 30 patients (25.8%) at 1-year follow-up. Fourteen patients (17.1%) died during hospitalization. Lateralized period discharges (LPDs) on the baseline electroencephalography (EEG), presence of metastasis, and SE severity were significantly associated with a worse outcome at discharge. The independent predictors of poor prognosis at 1-year follow-up were SE duration of at least 21 h, an aggressive brain tumor, and a nonsurgical treatment before SE onset. Lateralized period discharges, super-refractory SE, and an aggressive tumor type were independently associated with increased mortality. CONCLUSIONS Status epilepticus duration is the main modifiable factor associated with poor prognosis at 1-year follow-up. Accordingly, patients with TASE, like those with SE of any etiology, should receive early, aggressive treatment.
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Affiliation(s)
- Andreu Vilaseca-Jolonch
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - María Sueiras
- Neurophysiology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Vanessa Thonon
- Neurophysiology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Esteban Cordero
- Neurosurgery Department, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Francisco Martínez-Ricarte
- Neurosurgery Department, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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30
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Abraira L, Santamarina E, Cazorla S, Bustamante A, Quintana M, Toledo M, Fonseca E, Grau-López L, Jiménez M, Ciurans J, Luis Becerra J, Millán M, Hernández-Pérez M, Cardona P, Terceño M, Zaragoza J, Cánovas D, Gasull T, Ustrell X, Rubiera M, Castellanos M, Montaner J, Álvarez-Sabín J. Blood biomarkers predictive of epilepsy after an acute stroke event. Epilepsia 2020; 61:2244-2253. [PMID: 32857458 DOI: 10.1111/epi.16648] [Citation(s) in RCA: 24] [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] [Received: 03/16/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Blood biomarkers have not been widely investigated in poststroke epilepsy. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and analyze their association with the development of epilepsy at long term. METHODS A panel of 14 blood biomarkers was evaluated in patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z-scores. Stroke and epilepsy-related variables were also assessed: stroke severity, determined by National Institutes of Health Stroke Scale (NIHSS) score, stroke type and cause, time from stroke to onset of late seizures, and type of seizure. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with epilepsy. RESULTS From a cohort of 1115 patients, 895 patients were included. Mean ± standard deviation (SD) age was 72.0 ± 13.1 years, and 57.8% of patients were men. Fifty-one patients (5.7%) developed late seizures, with a median time to onset of 232 days (interquartile range [IQR] 86-491). NIHSS score ≥8 (P < .001, hazard ratio [HR] 4.013, 95% confidence interval [CI] 2.123-7.586) and a history of early onset seizures (P < .001, HR 4.038, 95% CI 1.802-9.045) were factors independently associated with a risk of developing epilepsy. Independent blood biomarkers predictive of epilepsy were high endostatin levels >1.203 (P = .046, HR 4.300, 95% CI 1.028-17.996) and low levels of heat shock 70 kDa protein-8 (Hsc70) <2.496 (P = .006, HR 3.795, 95% CI 1.476-9.760) and S100B <1.364 (P = .001, HR 2.955, 95% CI 1.534-5.491). The risk of epilepsy when these biomarkers were combined increased to 17%. The area under the receiver-operating characteristic (ROC) curve of the predictive model was stronger when clinical variables were combined with blood biomarkers (74.3%, 95% CI 65.2%-83.3%) than when they were used alone (68.9%, 95% CI 60.3%-77.6%). SIGNIFICANCE Downregulated S100B and Hsc70 and upregulated endostatin may assist in prediction of poststroke epilepsy and may provide additional information to clinical risk factors. In addition, these data are hypothesis-generating for the epileptogenic process.
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Affiliation(s)
- Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Cazorla
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Grau-López
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Jiménez
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jordi Ciurans
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | | | - Pere Cardona
- Stroke Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Josep Trueta University Hospital, Girona, Spain
| | - Josep Zaragoza
- Stroke Unit, Verge de la Cinta University Hospital, Tortosa, Spain
| | - David Cánovas
- Neurology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Xavier Ustrell
- Stroke Unit, Joan XXIII University Hospital, Tarragona, Spain
| | - Marta Rubiera
- Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Álvarez-Sabín
- Stroke Unit - Neurology department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abraira L, Giannini N, Santamarina E, Cazorla S, Bustamante A, Quintana M, Toledo M, Grau-López L, Jiménez M, Ciurans J, Becerra JL, Millán M, Cardona P, Terceño M, Zaragoza J, Cánovas D, Gasull T, Ustrell X, Rubiera M, Castellanos M, Dávalos A, Montaner J, Álvarez-Sabin J. Corrigendum to "Correlation of blood biomarkers with early-onset seizures after an acute stroke event" [Epilepsy Behav 104(Pt B) (2020 Mar)]. Epilepsy Behav 2020; 106:107045. [PMID: 32248061 DOI: 10.1016/j.yebeh.2020.107045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Nicola Giannini
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | - Sonia Cazorla
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Spain; Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Laia Grau-López
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Marta Jiménez
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Jordi Ciurans
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Juan Luis Becerra
- Epilepsy Unit, Neurology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Mikel Terceño
- Stroke Unit, Verge de la Cinta University Hospital, Tortosa, Spain
| | - Josep Zaragoza
- Stroke Unit, Joan XXIII University Hospital, Tarragona, Spain; Neurology Department, Parc Taulí University Hospital, Sabadell, Spain
| | - David Cánovas
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Teresa Gasull
- Cellular and Molecular Neurobiology Research Group, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Xavier Ustrell
- Stroke Unit, Josep Trueta University Hospital, Girona, Spain
| | - Marta Rubiera
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, Spain
| | - Antoni Dávalos
- Stroke Unit, Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Spain
| | - Jose Álvarez-Sabin
- Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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Turon M, Abraira L, Cazorla S, Fonseca E, Quintana M, Toledo M, Salas-Puig X, Santamarina E. Vascular risk factors as independent predictors of neurocognitive impairments in patients with late-onset epilepsy who have small-vessel disease. Epilepsy Behav 2020; 104:106443. [PMID: 31399342 DOI: 10.1016/j.yebeh.2019.106443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Received: 05/30/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE Late-onset epilepsy is often accompanied by underlying cerebrovascular disease and has been associated with neurocognitive deficits even dementia, but the interrelation between them remains unknown. In this study, we aimed to explore the contribution of vascular-related and epilepsy-related factors on neurocognitive outcomes in a sample of late-onset epilepsy with history of cerebral small vessel disease. METHODS In this retrospective cross-sectional study, a comprehensive neurocognitive assessment was performed in 25 patients aged >60 years with one or more unprovoked seizures and history of small-vessel disease. Raw scores of cognitive tests were transformed in T-scores and were grouped in 6 cognitive domains. Regression models were performed to explore the contribution of vascular risk factors (diabetes mellitus, arterial hypertension, dyslipidemia, and smoking habit) and epilepsy-related factors (drug-resistance, number of antiepileptic drugs, age at epilepsy onset, and epileptic focus localization). RESULTS Diabetes (p = 0.03) and smoking habit (p = 0.05) were the best independent factors to predict attention performance; diabetes also predicted visual memory function (p = 0.02); gender was related to verbal memory performance (p = 0.04) and speed processing (p = 0.02). Age at onset predicted that executive function (p = 0.05); age (p = 0.01) and gender (p = 0.03) were the major contributors to language performance. Epilepsy-related variables did not predict any cognitive outcomes. CONCLUSIONS Vascular risk factors and sociodemographic characteristics were the best predictors of cognitive outcomes in a sample of late-onset epilepsy with cerebral small-vessel disease. Epilepsy did not show influence on cognitive function. Longitudinal studies are necessary to clarify the relationship between vascular risk factors and epilepsy on progression of cognitive deterioration in patients with late-onset epilepsy. This article is part of the Special Issue "Seizures & Stroke".
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Affiliation(s)
- Marc Turon
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Sonia Cazorla
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Fonseca E, Guzmán L, Quintana M, Abraira L, Santamarina E, Salas-Puig X, Toledo M. Efficacy, retention, and safety of brivaracetam in adult patients with genetic generalized epilepsy. Epilepsy Behav 2020; 102:106657. [PMID: 31731108 DOI: 10.1016/j.yebeh.2019.106657] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy, tolerability, and retention of brivaracetam (BRV) in genetic generalized epilepsy (GGE) in real-life practice. METHODS This is a retrospective cohort study of adult patients with GGE in whom BRV was started between 2016 and 2018, completing a follow-up period of ≥6 months. Clinical and electroencephalogram (EEG) characteristics were analyzed at baseline and at follow-up as outcome measures. RESULTS Brivaracetam was started in 37 patients (mean age: 29.9 ± 12.3 years; 73% women). Juvenile myoclonic epilepsy was the most common syndrome (43.2%). The primary indications for starting BRV were lack of efficacy (51.4%) and adverse events (AEs) (27%) of other antiepileptic drugs (AEDs). In total, 32.4% of patients received BRV monotherapy. Retention rate at 6 months was 81.1%; 83.8% of patients were considered responders, and 62.2% achieved seizure freedom. The primary reasons for withdrawal were treatment-emergent adverse events (TEAEs, 57.1%) and lack of efficacy (42.9%). The higher number of prior AED use was a risk factor for a lack of response [median = 4 (interquartile range (IQR): 3-4) vs 2 (IQR: 1-3); p < 0.05]. Patients with a previous response to valproic acid tended to have a higher response rate to BRV (86.7% vs 50%, p = 0.169). Eighty-three point eight percent (83.8%) of previous levetiracetam (LEV) responders also showed a good response to BRV. In terms of patients who presented LEV-related AEs, AE resolution was observed in 79.8%, particularly with regard to psychiatric AEs. Follow-up EEGs were compared with baseline EEGs in 25 patients (67.6%) during follow-up. Most patients showed a reduction (52%) or no change (36%) in interictal epileptiform discharge (IED) frequency. SIGNIFICANCE Brivaracetam shows good responder and retention rates in GGE and is generally well tolerated. It is an appropriate alternative treatment for GGE, especially in refractory epilepsy and when other AEDs are not tolerated.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Lorena Guzmán
- Neurophysiology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
| | - Xavier Salas-Puig
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron, 119-129, 08035 Barcelona, Spain.
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Santamarina E, Parejo Carbonell B, Sala J, Gutiérrez-Viedma Á, Miró J, Asensio M, Abraira L, Falip M, Ojeda J, López-González FJ, Rodríguez-Osorio X, Mauri JÁ, Aiguabella M, García Morales I, Toledo M. Use of intravenous brivaracetam in status epilepticus: A multicenter registry. Epilepsia 2019; 60:1593-1601. [PMID: 31260101 DOI: 10.1111/epi.16094] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 03/06/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The pharmacokinetics of brivaracetam (BRV), added to its effectiveness observed in animal models of status epilepticus (SE), makes this drug attractive for use in emergency situations. Our objective was to evaluate the use of intravenous BRV in a multicenter study. METHODS A retrospective multicenter registry of SE cases treated with BRV was created. These patients were evaluated between January and December 2018 at seven hospitals in Spain. Demographic variables, SE characteristics, concomitant drugs, loading doses, and response to treatment were collected. RESULTS Forty-three patients were registered. The mean age was 56 ± 23.1 years, 51.2% were male, 29 had previous epilepsy, 24 (55.8%) had prominent motor symptoms, and 19 had nonconvulsive symptoms. Regarding the etiology, 19 (44.2%) were considered acute symptomatic, 16 (17.2%) remote symptomatic, four (9.3%) progressive symptomatic, and four (9.3%) cryptogenic. Regarding concomitant antiepileptic drugs (AEDs), 17 had previously received levetiracetam (LEV). In 14 patients, BRV was used early (first or second AED). The median loading dose was 100 mg (range = 50-400), and the weight-adjusted dose was 1.8 mg/kg (range = 0.4-7.3). BRV was effective in 54% (n = 23), and a response was observed in <6 hours in 13 patients. We observed a tendency for it to be more effective when administered earlier (P = 0.09), but there were no differences regarding SE type and the concomitant use of LEV. In those with the fastest responses, we observed that both the total administered dose (300 mg vs 100 mg, P = 0.008) and the weight-adjusted dose (3.85 mg vs 1.43 mg, P = 0.006) were significantly higher. The receiver operating characteristic curve showed that the best cutoff point for a faster response was 1.82 mg/kg. SIGNIFICANCE BRV is useful for the treatment of SE, even when patients are already being treated with LEV. The response rate seems higher when it is administered earlier and at higher doses (>1.82 mg/kg).
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Affiliation(s)
| | | | - Jacint Sala
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Álvaro Gutiérrez-Viedma
- Epilepsy Unit, San Carlos Clinical Hospital, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Júlia Miró
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Montserrat Asensio
- Neurology Department, Alicante University General Hospital, Alicante, Spain
| | - Laura Abraira
- Epilepsy Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercé Falip
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Joaquín Ojeda
- Neurology Department, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | | | - Xiana Rodríguez-Osorio
- Epilepsy Unit, Santiago de Compostela University Clinical Hospital, Santiago de Compostela, Spain
| | - José Ángel Mauri
- Epilepsy Unit, Lozano-Blesa University Hospital, Zaragoza, Spain
| | - Maria Aiguabella
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | | | - Manuel Toledo
- Epilepsy Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Abraira L, Gramegna LL, Quintana M, Santamarina E, Salas-Puig J, Sarria S, Rovira A, Toledo M. Cerebrovascular disease burden in late-onset non-lesional focal epilepsy. Seizure 2019; 66:31-35. [DOI: 10.1016/j.seizure.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
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Abstract
Status epilepticus (SE) is a neurological emergency that requires urgent antiepileptic therapies, and a rapid treatment of its cause. In recent years, its definition has been updated to adapt it to all types of SE; this update helps to standardise the treatment. The new definition is based on two times: point t1, after which the event will not spontaneously cease, and period t2, after which neuronal damage may appear. There are three lines of treatment: first, benzodiazepines; second, antiepileptic drugs; and third, intravenous anaesthetics. The application of the different lines of treatment raises still unanswered questions, since the prognosis also depends on the aetiology, age and duration. For this reason, different prognostic scales are being developed to help us to assess its evolution and in turn, adapt the aggressiveness of the treatment to each patient.
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Affiliation(s)
- Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - Laura Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Manuel Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, España
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Santamarina E, Alpuente A, Maisterra O, Sueiras M, Sarria S, Guzman L, Abraira L, Salas-Puig J, Toledo M. Perampanel: A therapeutic alternative in refractory status epilepticus associated with MELAS syndrome. Epilepsy Behav Case Rep 2019; 11:92-95. [PMID: 30834194 PMCID: PMC6384302 DOI: 10.1016/j.ebcr.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/10/2022]
Abstract
To our knowledge, there are no reports of status epilepticus (SE) associated with mitochondrial diseases and treated with perampanel (PER). We present three cases of patients with refractory SE associated with MELAS syndrome who responded favorably to PER. All cases were diagnosed as non-convulsive SE (focal without impairment of level of consciousness). After an initial treatment with other anti-seizure drugs, PER was added in all cases (8, 16 and 12 mg) and cessation of SE was observed within the next 4-8 hours. All the cases involved a stroke-like lesion present on brain MRI. In our patients, PER was an effective option in SE associated with MELAS syndrome. Status epilepticus (SE) in MELAS is associated with a stroke-lesion and it is usually refractory. We present three cases of refractory SE and MELAS who responded favorably to Perampanel. Perampanel (PER) may be an effective option in SE associated with MELAS syndrome.
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Affiliation(s)
- Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Sueiras
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Lorena Guzman
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Requena M, Fonseca E, Olivé M, Abraira L, Quintana M, Mazuela G, Toledo M, Salas‐Puig X, Santamarina E. The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus. Eur J Neurol 2019; 26:760-e55. [DOI: 10.1111/ene.13885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/06/2018] [Indexed: 12/20/2022]
Affiliation(s)
- M. Requena
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - E. Fonseca
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Olivé
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - L. Abraira
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Quintana
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - G. Mazuela
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - M. Toledo
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - X. Salas‐Puig
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
| | - E. Santamarina
- Epilepsy Unit Hospital Universitario Vall d'Hebron Barcelona Spain
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Santamarina E, Parejo B, Abraira L, Gutiérrez-Viedma Á, Alpuente A, Abarrategui B, Toledo M, Mazuela G, Salas-Puig X, Quintana M, García-Morales I. Cost of status epilepticus (SE): Effects of delayed treatment and SE duration. Epilepsy Behav 2018; 89:8-14. [PMID: 30384104 DOI: 10.1016/j.yebeh.2018.09.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 07/28/2018] [Revised: 09/29/2018] [Accepted: 09/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The health expenditure related to status epilepticus (SE) is high because of lengthy hospitalization requirements and possible sequelae. We aimed to study the factors associated with this cost including the different timings of the treatment and SE duration. METHODS We evaluated retrospectively all SE recorded in 2 hospitals. The factors studied included the mean cost of hospitalization, demographics, clinical data, duration of hospitalization, in-hospital/out-of-hospital debut, time from onset to treatment, duration of SE, and destination at discharge. RESULTS Three hundred five patients were evaluated (December/2012-July/2017), 195 with out-of hospital and 110 with in-hospital debut. The cost of SE with out-of-hospital onset was significantly lower (6559€ vs 15,174€; p = 0.0001). In out-of-hospital cases, the factors independently related to expenditure were the level of consciousness (p < 0.001), presence of complications (p = 0.005), a potentially fatal etiology (p = 0.008), and duration of the episode (p = 0.003). Duration was significantly higher in patients discharged to a convalescence center (p = 0.006); this variable was significantly related to the time SE onset-arrival to hospital, and SE onset-administration of the treatment. In the in-hospital cases, cost was related to male sex (p = 0.002), the development of complications (p = 0.003), and the etiology (p = 0.016) but was not directly related to the SE duration or to the time onset-treatment. CONCLUSIONS The duration of SE and the speed with which proper management is applied have a direct impact on the healthcare expenditure resulting from out-of-hospital SE. In contrast, the etiology and development of complications are the main factors responsible for expenditure related to in-hospital SE.
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Affiliation(s)
- Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Beatriz Parejo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Laura Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alicia Alpuente
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Belén Abarrategui
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gonzalo Mazuela
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Salas-Puig
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
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Santamarina E, Abraira L, Toledo M, González-Cuevas M, Quintana M, Maisterra O, Sueiras M, Guzman L, Salas-Puig J, Sabín JÁ. Prognosis of post-stroke status epilepticus: Effects of time difference between the two events. Seizure 2018; 60:172-177. [DOI: 10.1016/j.seizure.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/07/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022] Open
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Armangue T, Spatola M, Vlagea A, Mattozzi S, Cárceles-Cordon M, Martinez-Heras E, Llufriu S, Muchart J, Erro ME, Abraira L, Moris G, Monros-Giménez L, Corral-Corral Í, Montejo C, Toledo M, Bataller L, Secondi G, Ariño H, Martínez-Hernández E, Juan M, Marcos MA, Alsina L, Saiz A, Rosenfeld MR, Graus F, Dalmau J. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018; 17:760-772. [PMID: 30049614 DOI: 10.1016/s1474-4422(18)30244-8] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Herpes simplex encephalitis can trigger autoimmune encephalitis that leads to neurological worsening. We aimed to assess the frequency, symptoms, risk factors, and outcomes of this complication. METHODS We did a prospective observational study and retrospective analysis. In the prospective observational part of this study, we included patients with herpes simplex encephalitis diagnosed by neurologists, paediatricians, or infectious disease specialists in 19 secondary and tertiary Spanish centres (Cohort A). Outpatient follow-up was at 2, 6, and 12 months from onset of herpes simplex encephalitis. We studied another group of patients retrospectively, when they developed autoimmune encephalitis after herpes simplex encephalitis (Cohort B). We compared demographics and clinical features of patients who developed autoimmune encephalitis with those who did not, and in patients who developed autoimmune encephalitis we compared these features by age group (patients ≤4 years compared with patients >4 years). We also used multivariable binary logistic regression models to assess risk factors for autoimmune encephalitis after herpes simplex encephalitis. FINDINGS Between Jan 1, 2014, and Oct 31, 2017, 54 patients with herpes simplex encephalitis were recruited to Cohort A, and 51 were included in the analysis (median age 50 years [IQR 5-68]). At onset of herpes simplex encephalitis, none of the 51 patients had antibodies to neuronal antigens; during follow-up, 14 (27%) patients developed autoimmune encephalitis and all 14 (100%) had neuronal antibodies (nine [64%] had NMDA receptor [NMDAR] antibodies and five [36%] had other antibodies) at or before onset of symptoms. The other 37 patients did not develop autoimmune encephalitis, although 11 (30%) developed antibodies (n=3 to NMDAR, n=8 to unknown antigens; p<0·001). Antibody detection within 3 weeks of herpes simplex encephalitis was a risk factor for autoimmune encephalitis (odds ratio [OR] 11·5, 95% CI 2·7-48·8; p<0·001). Between Oct 7, 2011, and Oct 31, 2017, there were 48 patients in Cohort B with new-onset or worsening neurological symptoms not caused by herpes simplex virus reactivation (median age 8·8 years [IQR 1·1-44·2]; n=27 male); 44 (92%) patients had antibody-confirmed autoimmune encephalitis (34 had NMDAR antibodies and ten had other antibodies). In both cohorts (n=58 patients with antibody-confirmed autoimmune encephalitis), patients older than 4 years frequently presented with psychosis (18 [58%] of 31; younger children not assessable). Compared with patients older than 4 years, patients aged 4 years or younger (n=27) were more likely to have shorter intervals between onset of herpes simplex encephalitis and onset of autoimmune encephalitis (median 26 days [IQR 24-32] vs 43 days [25-54]; p=0·0073), choreoathetosis (27 [100%] of 27 vs 0 of 31; p<0·001), decreased level of consciousness (26 [96%] of 27 vs seven [23%] of 31; p<0·001), NMDAR antibodies (24 [89%] of 27 vs 19 [61%] of 31; p=0·033), and worse outcome at 1 year (median modified Rankin Scale 4 [IQR 4-4] vs 2 [2-3]; p<0·0010; seizures 12 [63%] of 19 vs three [13%] of 23; p=0·001). INTERPRETATION The results of our prospective study show that autoimmune encephalitis occurred in 27% of patients with herpes simplex encephalitis. It was associated with development of neuronal antibodies and usually presented within 2 months after treatment of herpes simplex encephalitis; the symptoms were age-dependent, and the neurological outcome was worse in young children. Prompt diagnosis is important because patients, primarily those older than 4 years, can respond to immunotherapy. FUNDING Mutua Madrileña Foundation, Fondation de l'Université de Lausanne et Centre Hospitalier Universitaire Vaudois, Instituto Carlos III, CIBERER, National Institutes of Health, Generalitat de Catalunya, Fundació CELLEX.
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Affiliation(s)
- Thaís Armangue
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Pediatric Neuroimmunology Unit, Neurology Department, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Marianna Spatola
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; University of Lausanne, Lausanne, Switzerland
| | - Alexandru Vlagea
- Immunology Department, Centre of Biomedical Diagnosis, Hospital Clínic, University of Barcelona, Barcelona, Spain; Functional Unit of Clinical Immunology, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Simone Mattozzi
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Section of Child Neuropsychiatry, Department of Medical Surgical and Experimental Medicine, University of Sassari (Sassari), Italy
| | - Marc Cárceles-Cordon
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eloy Martinez-Heras
- Laboratory of Advanced Imaging in Neuroimmunological Diseases (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Laboratory of Advanced Imaging in Neuroimmunological Diseases (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Muchart
- Department of Radiology, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - María Elena Erro
- Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Laura Abraira
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - German Moris
- Department of Neurology, Hospital Central de Asturias, Oviedo, Spain
| | - Luis Monros-Giménez
- Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Carmen Montejo
- Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Luis Bataller
- Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Gabriela Secondi
- Pediatric Neuroimmunology Unit, Neurology Department, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Helena Ariño
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Eugenia Martínez-Hernández
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Manel Juan
- Immunology Department, Centre of Biomedical Diagnosis, Hospital Clínic, University of Barcelona, Barcelona, Spain; Functional Unit of Clinical Immunology, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Maria Angeles Marcos
- Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Laia Alsina
- Functional Unit of Clinical Immunology, Research Institute of Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Albert Saiz
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Myrna R Rosenfeld
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Department of Neurology, University of Pennsylvania, PA, USA
| | - Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain; Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain; Department of Neurology, University of Pennsylvania, PA, USA; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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Abraira L, Grau-López L, Jiménez M, Becerra J. Psychiatric manifestations and dysautonomia at the onset of focal epilepsy in adults: Clinical signs indicating autoimmune origin. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abraira L, Sanabria A, Ortega G, Quintana M, Santamarina E, Salas-Puig J, Toledo M. [Social cognition and cognitive functions in patients with epilepsy treated with eslicarbazepine acetate]. Rev Neurol 2018; 66:361-367. [PMID: 29790568] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Epilepsy is accompanied by cognitive disorders, frequently aggravated by the use of antiepileptic drugs, which can affect social empathy. AIM To analyse the impact of treatment with eslicarbazepine acetate (ESL) on social cognition and prefrontal cognitive functions in adults with focal epilepsy. PATIENTS AND METHODS We conducted a prospective single-centre study with patients aged between 18 and 65 years with focal seizures treated with ESL. The patients were evaluated in their baseline visit and at six months after starting ESL treatment by means of tasks designed for theory of mind, executive and attentional functions, auditory-verbal memory, quality of life, and anxiety and depression. RESULTS Forty-one patients were treated with ESL, and 30 completed the follow-up. A significant improvement was observed in the theory of mind tasks. In the analysis stratified by sex, the men showed greater improvement. A cognitive improvement was observed in the Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span and Stroop tests. No differences were found in the Quality of Life in Epilepsy-31 Inventory or in the Hospital Anxiety and Depression Scale. These results were independent of the reduction in the number of seizures and the ESL dosage. CONCLUSION Treatment with ESL could improve some aspects of theory of mind in patients with epilepsy, especially in men and independently of the control of seizures, with no changes in quality of life, anxiety or depression.
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Affiliation(s)
- L Abraira
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - A Sanabria
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
- Fundacio ACE, Institut Catala de Neurociencies Aplicades, Barcelona, Espana
| | - G Ortega
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
- Fundacio ACE, Institut Catala de Neurociencies Aplicades, Barcelona, Espana
| | - M Quintana
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | | | - J Salas-Puig
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - M Toledo
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
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Abraira L, Grau-López L, Jiménez M, Becerra JL. Psychiatric manifestations and dysautonomia at the onset of focal epilepsy in adults: Clinical signs indicating autoimmune origin. Neurologia 2016; 33:S0213-4853(16)30048-2. [PMID: 27311973 DOI: 10.1016/j.nrl.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- L Abraira
- Departamento de Neurología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - L Grau-López
- Departamento de Neurología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - M Jiménez
- Departamento de Neurología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - J L Becerra
- Departamento de Neurología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Crespo AM, Abraira L, Guanyabens N, Millán M, Munuera J, Dávalos A, López-Cancio E. Recurrent Stroke with Rapid Development of Intracranial Stenoses in Polycythemia Vera. J Stroke Cerebrovasc Dis 2016; 25:e41-3. [PMID: 26825349 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/27/2015] [Revised: 11/27/2015] [Accepted: 12/22/2015] [Indexed: 12/13/2022] Open
Abstract
Polycythemia vera (PV) is a blood disorder in which the first expression may be an ischemic stroke. Stroke mechanism in PV is usually attributed to a hypercoagulability state and blood stasis. We report a case of a patient with PV presenting with recurrent ischemic stroke associated with the development of large intracranial stenosis in a period of 1 month. Stenosis was associated with microembolic signals detected by transcranial Doppler. One year later and after hematocrit control, stenosis persisted but microembolic signals disappeared. We discuss similar reports in the literature and the possible pathophysiological mechanism of large-vessel damage in these patients.
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Affiliation(s)
- Ane M Crespo
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Laura Abraira
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Nicolau Guanyabens
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mónica Millán
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Munuera
- MRI Unit Badalona, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Antoni Dávalos
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elena López-Cancio
- Department of Neuroscience, Stroke Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
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