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Filippi C, Damioli S, Accorsi P, Crotti E, Fazzi EM, Galli J, Martelli P, Morandi A, Muda A, Pinghini S, Saottini S, Sforza SE, Milito G, Giordano L. Early onset absence epilepsy of childhood: Epidemiologic data, treatment and outcome in a sample of 56 patients born between 2000 and 2018. Seizure 2024; 118:47-52. [PMID: 38636356 DOI: 10.1016/j.seizure.2024.03.014] [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: 02/13/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE The aim of our work is to describe the characteristics of Early Onset Absence Epilepsy (EOAE) and to observe whether specific anamnestic, clinical or electroencephalographic characteristics can influence the drug sensitivity of this pathology. METHODS We carried out a retrospective study of patients affected by absence epilepsy with onset under four years of age, born between January 1st 2000 and December 31st 2018, who were reffered to the Regional Epilepsy Center of Spedali Civili of Brescia. We then divided the sample into three groups based on the age of onset. RESULTS Our sample is composed of 56 patients. Among the children with epilepsy onset under two years of age (11), all were still on therapy after three and six years of follow-up, and 64 % of them required polytherapy. Among patients with epilepsy onset between two and three years of age (24), 87 % were still on therapy after three years of follow-up and 68 % after six years of follow-up; 46 % of these subjects required polytherapy. Among patients with epilepsy onset between three and four years of age (21), 89 % were still on therapy after three years of follow-up and 38 % after six years of follow-up; 38 % of them required polytherapy. CONCLUSIONS We observe that patients with an earlier epilepsy onset have a worse outcome and a lower drug sensitivity. This may allow to predict in which cases it would be appropriate to maintain antiseizure therapy for a prolonged period.
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Affiliation(s)
- C Filippi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy.
| | - S Damioli
- NeMO - Brescia Clinical Center for Neuromuscular Diseases, Brescia Italy
| | - P Accorsi
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - E Crotti
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - E M Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia Italy
| | - J Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - P Martelli
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - A Morandi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - A Muda
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S Pinghini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S Saottini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S E Sforza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - G Milito
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - L Giordano
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
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Takeuchi H, Higurashi N, Toga Y. Prophylactic antiseizure medications for recurrent status epilepticus in nonsyndromic childhood epilepsy. Brain Dev 2024:S0387-7604(24)00043-3. [PMID: 38519270 DOI: 10.1016/j.braindev.2024.03.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The management of status epilepticus (SE) has mainly focused on the termination of ongoing SE episodes. However, long-term therapeutic strategies for the prevention of SE are lacking. This study aimed to investigate the effectiveness of prophylactic antiseizure medications (ASMs) for SEs in nonsyndromic childhood epilepsy. METHODS This retrospective study was conducted at Jikei University Hospital. Patients <18 years of age, diagnosed with epilepsy, and experiencing three or more SE episodes within 1 year between April 1, 2017, and October 1, 2021, were included. ASMs introduced for seizure types that developed into SE were evaluated. The effectiveness of ASMs was determined by using the "Rule of Three": An ASM was determined effective if patients were free of SE for a duration at least three times that of their longest SE interval in 12 months prior to intervention. RESULTS The investigation included a total of 32 ASMs administered to 13 patients. The longest interval between SE episodes before ASM administration was 28-257 d. The first SE interval after ASM administration was 12-797 d. Levetiracetam (LEV) and clobazam (CLB) showed effectiveness in 2/10 and 5/6 patients, respectively. Other ASMs were ineffective. The leading etiology of epilepsy was perinatal brain injury, identified in four patients, and CLB was effective in all of them. CONCLUSIONS The present study suggests that CLB and LEV may prolong the SE interval in some cases of nonsyndromic childhood epilepsy. CLB may be beneficial, particularly in patients with perinatal brain injury.
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Affiliation(s)
- Hirokazu Takeuchi
- Department of Pediatrics, Jikei University School of Medicine Tokyo, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan; Division of Neurology, Saitama Children's Medical Center, Saitama, Saitama Children's Medical Center, 1-2 Chuo-ku Saitama-shi, Saitama 330-8777, Japan.
| | - Norimichi Higurashi
- Department of Pediatrics, Jikei University School of Medicine Tokyo, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yurika Toga
- Department of Pediatrics, Jikei University School of Medicine Tokyo, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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Fasaludeen A, McTague A, Jose M, Banerjee M, Sundaram S, Madhusoodanan UK, Radhakrishnan A, Menon RN. Genetic variant interpretation for the neurologist - A pragmatic approach in the next-generation sequencing era in childhood epilepsy. Epilepsy Res 2024; 201:107341. [PMID: 38447235 DOI: 10.1016/j.eplepsyres.2024.107341] [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: 11/27/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
Genetic advances over the past decade have enhanced our understanding of the genetic landscape of childhood epilepsy. However a major challenge for clinicians ha been understanding the rationale and systematic approach towards interpretation of the clinical significance of variant(s) detected in their patients. As the clinical paradigm evolves from gene panels to whole exome or whole genome testing including rapid genome sequencing, the number of patients tested and variants identified per patient will only increase. Each step in the process of variant interpretation has limitations and there is no single criterion which enables the clinician to draw reliable conclusions on a causal relationship between the variant and disease without robust clinical phenotyping. Although many automated online analysis software tools are available, these carry a risk of misinterpretation. This guideline provides a pragmatic, real-world approach to variant interpretation for the child neurologist. The focus will be on ascertaining aspects such as variant frequency, subtype, inheritance pattern, structural and functional consequence with regard to genotype-phenotype correlations, while refraining from mere interpretation of the classification provided in a genetic test report. It will not replace the expert advice of colleagues in clinical genetics, however as genomic investigations become a first-line test for epilepsy, it is vital that neurologists and epileptologists are equipped to navigate this landscape.
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Affiliation(s)
- Alfiya Fasaludeen
- Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Amy McTague
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Manna Jose
- Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Moinak Banerjee
- Human Molecular Genetics Laboratory, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Soumya Sundaram
- Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - U K Madhusoodanan
- Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Ashalatha Radhakrishnan
- Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India
| | - Ramshekhar N Menon
- Dept of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Thiruvananthapuram, Kerala, India.
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Hassan MH, Nassar AY, Meki ARMA, Nasser SA, Bakri AH, Radwan E. Pharmacogenetic study of phosphatase and tensin homolog polymorphism (rs701848) in childhood epilepsy: relation to circulating Wnt signaling. Neurol Res 2024; 46:99-110. [PMID: 37706249 DOI: 10.1080/01616412.2023.2257465] [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: 05/22/2023] [Accepted: 07/30/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The present study aimed at evaluating the potential contribution of Phosphatase and Tensin Homolog (PTEN) and its gene polymorphism (PTEN rs701848 T/C) in relation to Wingless/integrase-1 (Wnt) signaling in childhood epilepsy and the impact of antiepileptic medications on their serum levels. METHODS This study included 100 children with epilepsy (50 pharmacoresistant and 50 pharmacoresponsive) and 50 matched controls. All subjects had their genotypes for the PTEN rs701848T/C polymorphism assessed using TaqManTM assays and real-time PCR. By using the sandwich ELISA technique, the blood concentrations of PTEN and Wnt3a were measured. RESULTS Serum Wnt3a levels in epileptic patients were significantly higher than in the control group, p < 0.001. Children with epilepsy who received oxcarbazepine had considerably lower serum Wnt3a levels than those who didn't, p < 0.001.With an AUC of 0.71, the cutoff value for diagnosing epilepsy as serum Wnt3a > 6.2 ng/mL has a sensitivity of 55% and a specificity of 80%. When compared to controls, epileptic children had considerably more (TT) genotype and less (TC and CC) genotypes, p < 0.05 for all. Epileptic children had significantly higher (T) allele frequency than controls, p = 0.006 with OR (95%CI) = 1.962(1.206-3.192). Pharmacoresistant epileptic children had significantly higher (TT) genotype compared to pharmacoresponsive type (p = 0.020). CONCLUSION We originally found a strong association between PTEN rs701848 T/C and childhood epilepsy, in particular pharmacoresistant type. Serum Wnt3a levels increased in epilepsy, but were not significantly different between different alleles of PTEN. In pharmaco-responsive children Wnt3a levels differed significantly between the different PTEN genotypes. Antiepileptics may affect Wnt3a levels.
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Affiliation(s)
- Mohammed H Hassan
- Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Y Nassar
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdel-Raheim M A Meki
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Biochemistry, Sphinx University, New Assiut city, Assiut, Egypt
| | - Shimaa A Nasser
- Department of Biochemistry, Faculty of Pharmacy, South Valley University, Qena, Egypt
| | - Ali Helmi Bakri
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Eman Radwan
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Biochemistry, Sphinx University, New Assiut city, Assiut, Egypt
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Carson L, Parlatini V, Safa T, Baig B, Shetty H, Phillips-Owen J, Prasad V, Downs J. The association between early childhood onset epilepsy and attention-deficit hyperactivity disorder (ADHD) in 3237 children and adolescents with Autism Spectrum Disorder (ASD): a historical longitudinal cohort data linkage study. Eur Child Adolesc Psychiatry 2023; 32:2129-2138. [PMID: 35927526 PMCID: PMC10576710 DOI: 10.1007/s00787-022-02041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
Children and young people with Autism Spectrum Disorder (ASD) have an increased risk of comorbidities, such as epilepsy and Attention-Deficit/Hyperactivity Disorder (ADHD). However, little is known about the relationship between early childhood epilepsy (below age 7) and later ADHD diagnosis (at age 7 or above) in ASD. In this historical cohort study, we examined this relationship using an innovative data source, which included linked data from routinely collected acute hospital paediatric records and childhood community and inpatient psychiatric records. In a large sample of children and young people with ASD (N = 3237), we conducted a longitudinal analysis to examine early childhood epilepsy as a risk factor for ADHD diagnosis while adjusting for potential confounders, including socio-demographic characteristics, intellectual disability, family history of epilepsy and associated physical conditions. We found that ASD children and young people diagnosed with early childhood epilepsy had nearly a twofold increase in risk of developing ADHD later in life, an association which persisted after adjusting for potential confounders (adjusted OR = 1.72, CI95% = 1.13-2.62). This study suggests that sensitive monitoring of ADHD symptoms in children with ASD who have a history of childhood epilepsy may be important to promote early detection and treatment. It also highlights how linked electronic health records can be used to examine potential risk factors over time for multimorbidity in neurodevelopmental conditions.
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Affiliation(s)
- Lauren Carson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tara Safa
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Benjamin Baig
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hitesh Shetty
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jacqueline Phillips-Owen
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vibhore Prasad
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Håkansson S, Wickström R, Zelano J. Selection and Continuation of Antiseizure Medication in Children With Epilepsy in Sweden From 2007 to 2020. Pediatr Neurol 2023; 144:19-25. [PMID: 37116405 DOI: 10.1016/j.pediatrneurol.2023.03.016] [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: 08/31/2022] [Revised: 02/03/2023] [Accepted: 03/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Knowledge on antiseizure medication (ASM) use and retention for children with epilepsy is limited, partly because of extensive off-label use of newer drugs with limited registration. We used prescription data to study prescription patterns on a population-wide scale and compared the proportion of patients remaining on monotherapy of ASMs with and without formal indication for different age groups. METHODS A total of 14,681 individuals aged <18 years were included, using cross-referenced Swedish registers from 2007 to 2020. Kaplan-Meier retention rates were calculated for all ASMs. The most common pathways of the first three medications per patient were analyzed. RESULTS In children older than one month and up to age one year, monotherapy retention rates were the highest for oxcarbazepine, valproic acid, and carbamazepine. Among children aged one to five years, oxcarbazepine and levetiracetam were among ASMs that do not have a monotherapy indication in Sweden but still had high retention rates. In the age group five to 12 years, lamotrigine and oxcarbazepine had the highest retention rate. In males aged 12 to 18 years, valproic acid was the most common choice followed by lamotrigine, whereas lamotrigine was the first choice of ASM for females, exceeding the second and third most common options levetiracetam and oxcarbazepine by a factor of two and three, respectively. CONCLUSION Off-label medication is common in children with epilepsy but does not seem to be associated with lower retention. The restrictions regarding valproic acid for females of childbearing age seem to have been well implemented in Swedish neuropediatric care.
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Affiliation(s)
- Samuel Håkansson
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
| | - Ronny Wickström
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Wallenberg Center for Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden.
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Zhu J, Lu J, Shen X, He Y, Xia H, Li W, Guo H, Zhang J, Fan X. SCN1A Polymorphisms and Haplotypes Are Associated With Valproic Acid Treatment Outcomes in Chinese Children With Epilepsy. Pediatr Neurol 2023; 146:55-64. [PMID: 37451178 DOI: 10.1016/j.pediatrneurol.2023.06.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/20/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sodium channel genes, especially SCN1A, were reported to play an important role in the treatment outcomes of antiseizure medications. The aim of this study was to explore the association of SCN1A polymorphisms with efficacy and adverse drug reactions (ADRs) related to valproic acid (VPA) among Chinese children with epilepsy. METHODS A total of 126 children with epilepsy treated with VPA for at least 12 months were enrolled in this study. Three single nucleotide polymorphisms (SNPs) of SCN1A including rs2298771, rs10167228, and rs3812718 were genotyped using Sequenom MassArray system. Bioinformatics tools were used to explore the potential targets and pathways of SCN1A in VPA-related ADRs. RESULTS The three SNPs in this study were found to be closely associated with treatment outcomes for VPA. Carriers of SCN1A rs3812718 TT genotype tended to be seizure-free with VPA treatment (P = 0.007). AA genotype of rs10167228 and TT genotype of rs2298771 might be protective factors for weight gain induced by VPA, whereas TA genotype of rs10167228 and CT genotype of rs2298771 increased the risk. TAT haplotype carriers were found to respond better to VPA treatment (P = 0.017), whereas CTC haplotype might be a risk factor for VPA-induced weight gain (P = 0.035). Bioinformatics analysis suggested that SCN1A might play a role in VPA-induced weight gain by regulating gated channel activity and GABAergic synapse pathway. CONCLUSION This study revealed that SCN1A rs2298771, rs10167228, and rs3812718 polymorphisms and haplotypes might affect the treatment outcomes of VPA in Chinese children with epilepsy.
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Affiliation(s)
- Jiahao Zhu
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Jieluan Lu
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Xianhuan Shen
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Yaodong He
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Hanbing Xia
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Wenzhou Li
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Huijuan Guo
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Jianping Zhang
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China.
| | - Xiaomei Fan
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China.
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Brock DC, Abbott M, Reed L, Kammeyer R, Gibbons M, Angione K, Bernard TJ, Gaskell A, Demarest S. Epilepsy panels in clinical practice: Yield, variants of uncertain significance, and treatment implications. Epilepsy Res 2023; 193:107167. [PMID: 37230012 DOI: 10.1016/j.eplepsyres.2023.107167] [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: 03/18/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE There has been increasing utilization of genetic testing for pediatric epilepsy in recent years. Little systematic data is available examining how practice changes have impacted testing yields, diagnostic pace, incidence of variants of uncertain significance (VUSs), or therapeutic management. METHODS A retrospective chart review was performed at Children's Hospital Colorado from February 2016 through February 2020. All patients under 18 years for whom an epilepsy gene panel was sent were included. RESULTS A total of 761 epilepsy gene panels were sent over the study period. During the study period, there was a 292% increase in the average number of panels sent per month. The time from seizure onset to panel result decreased over the study period from a median of 2.9 years to 0.7 years. Despite the increase in testing, the percentage of panels yielding a disease-causing result remained stable at 11-13%. A total of 90 disease-causing results were identified, > 75% of which provided guidance in management. Children were more likely to have a disease-causing result if they were < 3 years old at seizure onset (OR 4.4, p < 0.001), had neurodevelopmental concerns (OR 2.2, p = 0.002), or had a developmentally abnormal MRI (OR 3.8, p < 0.001). A total of 1417 VUSs were identified, equating to 15.7 VUSs per disease-causing result. Non-Hispanic white patients had a lower average number of VUSs than patients of all other races/ethnicities (1.7 vs 2.1, p < 0.001). SIGNIFICANCE Expansion in the volume of genetic testing corresponded to a decrease in the time from seizure onset to testing result. Diagnostic yield remained stable, resulting in an increase in the absolute number of disease-causing results annually-most of which have implications for management. However, there has also been an increase in total VUSs, which likely resulted in additional clinical time spent on VUS resolution.
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Affiliation(s)
- Dylan C Brock
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Megan Abbott
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Laurel Reed
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Ryan Kammeyer
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Melissa Gibbons
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Katie Angione
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Timothy J Bernard
- Children's Hospital Colorado Anschutz Medical Campus, Aurora 13123 East 16th Avenue, Aurora, CO 80045; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Alisa Gaskell
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
| | - Scott Demarest
- Precision Medicine Institute, Children's Hospital Colorado Anschutz Medical Campus, Aurora 1312 East 16th Avenue, Aurora, CO 80045, USA; University of Colorado, Anschutz Medical Campus School of Medicine, Department of Pediatrics, Section of Neurology Anschutz Medical Campus, Aurora 13001 E 17th Pl, Aurora, CO 80045.
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Tschamper MK, Larsen MH, Wahl AK, Jakobsen R. Developing and maintaining health literacy: A continuous emotional, cognitive, and social process for parents of children with epilepsy-A qualitative study. Epilepsy Behav 2023; 142:109222. [PMID: 37088063 DOI: 10.1016/j.yebeh.2023.109222] [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: 01/18/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
Childhood epilepsy is often complicated by neurobehavioral comorbidities, and parents are expected to actively engage in managing the condition. Insufficient parental health literacy (HL) has been associated with reduced health outcomes for children with epilepsy. Little is known about the parents' experiences of information seeking, social support, navigating the healthcare system, and interactions with healthcare professionals and how these skills may contribute to the development of sufficient HL. This study explored parents' experiences of their caregiver responsibility and the development of their HL in relation to caring for their child with epilepsy. Ten parents of children under 12 years of age with epilepsy were purposedly sampled and interviewed individually, using semi-structured interviews. The interviews were analyzed using qualitative content analysis, in line with Graneheim & Lundman. The analyses resulted in three themes, each comprising two sub-themes. The themes were: (1) Alone with the responsibility, (2) The combat for information and support, and (3) Developing vigilance and distrust in system competence. Lack of flexibility in healthcare services, insufficient multidisciplinary collaboration, and unclear treatment provider responsibility made the parents feel alone in the caregiver's responsibility. Poor local provider competence related to childhood epilepsy was a barrier to developing sufficient HL. A trusting relationship with professionals and timely access to competent health services were facilitators for developing HL. Higher HL made the parents more critical for the healthcare services, which triggered vigilance and reduced their trust in the professionals' information. For the parents, developing and maintaining HL was a continuous emotional, cognitive, and social process. Health information and care support need to be adjusted to the severity of the child's condition, the resources are available, and the parent's HL. The results of this study may contribute to the development of future interventions for strengthening parental HL in the childhood epilepsy context.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway; National Centre for Epilepsy, Department of Neurology, Oslo University Hospital, Norway.
| | | | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway.
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Türay S, Cangür Ş, Kahraman G, Kayabaşı E, Çetiner ÖF, Aydın B, Öztürk CE. Can the Gut Microbiota Serve as a Guide to the Diagnosis and Treatment of Childhood Epilepsy? Pediatr Neurol 2023; 145:11-21. [PMID: 37245274 DOI: 10.1016/j.pediatrneurol.2023.04.006] [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: 12/07/2022] [Revised: 03/12/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND To investigate the activity of the gut-brain axis in the pathogenesis of childhood epilepsy and to define biomarkers capable of assisting with determining new strategies in that context. METHODS Twenty children with epilepsy of "unknown etiology" and seven healthy controls in the same age group were included in the study. The groups were compared using a questionnaire. Stool samples were stored in tubes containing DNA/RNA Shield (Zymo Research) with a sterile swab. Sequencing was carried out using the MiSeq System (Illumina). The 16S rRNA sequencing of samples using next-generation sequencing involved V4 variable region polymerase chain reaction amplification concluded by 2 × 250-bp paired-end sequencing of amplicons and at least 50,000 reads (>Q30) per sample. DNA sequences were classified at the genus level using the Kraken program. Bioinformatics and statistical analysis were then performed. RESULTS Individuals' gut microbiota relative abundance values differed between the groups at the genus, order, class, family, and phylum levels. Flavihumibacter, Niabella, Anoxybacillus, Brevundimonas, Devosia, and Delftia were seen only in the control group, whereas Megamonas and Coriobacterium were observed only in the epilepsy group. The linear discriminant analysis effect size method identified 33 taxa as important in differentiating the groups. CONCLUSIONS We think that bacterial varieties (such as Megamonas and Coriobacterium) that differ between the two groups can be employed as useful biomarkers in the diagnosis and follow-up of epileptic patients. We also predict that, in addition to epilepsy treatment protocols, the restoration of eubiotic microbiota may increase the success of treatment.
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Affiliation(s)
- Sevim Türay
- Department of Pediatric Neurology, Duzce University Medical Faculty, Duzce, Turkey; Duzce University Faculty of Medicine, Duzce, Turkey.
| | - Şengül Cangür
- Duzce University Faculty of Medicine, Duzce, Turkey; Department of Biostatistics and Medical Informatics, Duzce University Medical Faculty, Duzce, Turkey
| | - Gözde Kahraman
- Duzce University Faculty of Medicine, Duzce, Turkey; Department of Medical Microbiology, Duzce University Medical Faculty, Duzce, Turkey
| | - Eda Kayabaşı
- Duzce University Faculty of Medicine, Duzce, Turkey; Department of Medical Microbiology, Duzce University Medical Faculty, Duzce, Turkey
| | - Ömer Faruk Çetiner
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Istanbul Tip Capa Campus, Istanbul, Turkey
| | - Burak Aydın
- Traditional and Complementary Medicine Research Department, Istanbul Health Sciences University, Istanbul, Turkey; Istanbul Health Sciences University Haydarpasa Campus, Istanbul, Turkey
| | - Cihadiye Elif Öztürk
- Faculty of Medicine, Department of Medical Microbiology, Istanbul Arel University, Istanbul, Turkey; Istanbul Arel University, Istanbul, Turkey
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Bakri AH, Hassan MH, Ahmed AEA, Alotaibi G, Halim PR, Abdallah AAM, Rashwan NI. Serum Levels of Growth-Associated Protein-43 and Neurotrophin-3 in Childhood Epilepsy and Their Relation to Zinc Levels. Biol Trace Elem Res 2023; 201:689-697. [PMID: 35349008 PMCID: PMC9849170 DOI: 10.1007/s12011-022-03213-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders, and it places a significant economic strain on the healthcare system around the world. Although the exact mechanism of epilepsy has yet to be illustrated, various pathogenic cascades involving neurotransmitters and trace elements have been reported. We aimed to investigate the serum levels of growth-associated protein-43 (GAP-43) and neurotrophin-3 (NT-3) among cohort of Egyptian children with epilepsy and correlate these biomarkers with their zinc levels. METHODS This case-control study included 50 pediatric patients with epilepsy who were comparable with 50 controls. Neurological assessment and electroencephalogram (EEG) were done to all included children. Biochemical measurements of serum GAP-43 and NT-3 using enzyme linked immunosorbent assays (ELISA), and total antioxidant capacity (TAC) and zinc using colorimetric assays, were performed to all participants. RESULTS There was significantly frequent positive parental consanguinity among cases with significantly frequent generalized onset seizures (94%) than simple partial seizure (6%). There were significantly lower serum GAP-43 and zinc levels with significantly higher TAC among cases vs. the controls, p˂0.05 for all. There was no significant difference in the serum levels of NT-3 among epileptic children vs. the controls, p = 0.269. Serum Zn was positively correlated with GAP-43 level among epileptic children (r = 0.381, p = 0.006). Serum GAP-43 in diagnosing childhood epilepsy at cut-off point ≤ 0.6 ng/mL showed 78% sensitivity, 62% specificity, positive predictive value (PPV) = 50.6%, negative predictive value (NPP) = 84.9% with AUC = 0.574. CONCLUSION GAP-43 can be considered a sensitive good negative biomarker in childhood epilepsy which correlated positively with the zinc status.
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Affiliation(s)
- Ali Helmi Bakri
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohammed H Hassan
- Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, 83523, Egypt.
| | - Ahmed El-Abd Ahmed
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ghallab Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Shaqra, Saudi Arabia
| | - Pola Rafat Halim
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
| | | | - Nagwan I Rashwan
- Department of Pediatrics, Faculty of Medicine, South Valley University, Qena, Egypt
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12
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Robles-Lopez K, Barar H, Clarke DF, Julich K. Impact of the 2021 north american winter storms on children with epilepsy. Epilepsy Behav Rep 2023; 21:100592. [PMID: 36875916 PMCID: PMC9978468 DOI: 10.1016/j.ebr.2023.100592] [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: 12/27/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Purpose In February 2021 a series of winter storms caused power outages for nearly 10 million people in the United States, Northern Mexico and Canada. In Texas, the storms caused the worst energy infrastructure failure in state history, leading to shortages of water, food and heat for nearly a week. Impacts on health and well-being from natural disasters are greater in vulnerable populations such as individuals with chronic illnesses, for example due to supply chain disruptions. We aimed to determine the impact of the winter storm on our patient population of children with epilepsy (CWE). Methods We conducted a survey of families with CWE that are being followed at Dell Children's Medical Center in Austin, Texas. Results Of the 101 families who completed the survey, 62% were negatively affected by the storm. Twenty-five percent had to refill antiseizure medications during the week of disruptions, and of those needing refills, 68% had difficulties obtaining the medications, leading to nine patients-or 36% of those needing a refill-running out of medications and two emergency room visits because of seizures and lack of medications. Conclusions Our results demonstrate that close to 10% of all patients included in the survey completely ran out of antiseizure medications, and many more were affected by lack of water, heat, power and food. This infrastructure failure emphasizes the need for adequate disaster preparation for vulnerable populations such as children with epilepsy for the future.
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Affiliation(s)
- Karla Robles-Lopez
- The University of Texas at Austin Dell Medical School, Department of Neurology, 1601 Trinity St, Bldg B, Austin, TX 78701, United States
| | - Hepsiba Barar
- The University of Texas at Austin Dell Medical School, Department of Neurology, 1601 Trinity St, Bldg B, Austin, TX 78701, United States.,Huston-Tillotson University, 900 Chicon St, Austin, TX 78702, United States
| | - Dave F Clarke
- The University of Texas at Austin Dell Medical School, Department of Neurology, 1601 Trinity St, Bldg B, Austin, TX 78701, United States
| | - Kristina Julich
- The University of Texas at Austin Dell Medical School, Department of Neurology, 1601 Trinity St, Bldg B, Austin, TX 78701, United States
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Kuchenbuch M, Chiron C, Milh M. Overview of therapeutic options for epilepsy. Arch Pediatr 2022; 29:5S14-5S19. [PMID: 36585066 DOI: 10.1016/s0929-693x(22)00285-8] [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: 12/29/2022]
Abstract
Tuberous sclerosis (TSC) epilepsy includes infantile spasms and focal seizures before the age of 2 years, whereas focal seizures are predominant over 2 years and generalized seizures may occasionally be part of Lennox-Gastaut syndrome. The better and earlier the seizure control, the better the child's subsequent cognitive and behavioral prognosis. As for epilepsy of other causes, therapeutic options depend on the type of seizure/epilepsy, age and drug resistance, but there are significant specificities for TSC. (1) As first-line treatment, vigabatrin is unanimously recommended for infantile spasms and focal seizures before 2 years and is also widely used for seizures over 2 years, as are levetiracetam and carbamazepine. (2) If seizures persist (about 40% of children and adolescents), cannabidiol and everolimus, an inhibitor of the mTOR pathway, have recently been approved as adjunctive therapy to the arsenal of antiseizure medications authorized for this age group and to the ketogenic diet. (3) Surgery is an essential treatment option in cases of drug resistance and should be discussed as soon as two treatments have failed. Presurgical investigations and operating techniques have recently progressed spectacularly, for example laser thermocoagulation with stereotactic location. A particularity of TSC is the possibility of sequential interventions on several epileptogenic tubers. (4) Finally, the innovative principle of initiating "pre-seizure" treatment with vigabatrin from the first months of life has just proven effective on the subsequent development of epilepsy in TSC. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- M Kuchenbuch
- Département de Pédiatrie et Génétique, CHU de Nancy, France.
| | - C Chiron
- Inserm U1141 et APHP, Service de Neurologie pédiatrique, Hôpital Necker-Enfants Malades, Paris, France; Service de Neurologie Pédiatrique, Necker Enfants Malades, APHP, centre de référence épilepsies rares, Paris, France
| | - M Milh
- Service de Neurologie pédiatrique, Hôpital de la Timone, CHU de Marseille, France
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Sharawat IK, Panda PK, Kumar V, Ramachandran A, Bhardwaj S, Murugan VK, Pradhan AK, Rajendiran R, Bhat NK. Effectiveness of prophylactic iron supplementation in the reduction of recurrence of febrile seizures in children: A prospective study with comparison with historical controls. J Neurosci Rural Pract 2022; 13:718-724. [PMID: 36743742 PMCID: PMC9893947 DOI: 10.25259/jnrp-2022-7-19] [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: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary objective of the study was to compare the number of patients with febrile seizure recurrence within 1 year of presenting to our institute, among patients who received and didn't receive oral iron supplementation. Materials and Methods This prospective intervention study with historical controls was conducted to compare the number of patients with febrile seizure recurrence within 1 year, among patients who received and did not receive oral iron supplementation. The intervention group additionally received prophylactic iron supplementation of 20 mg biweekly for 1 year. Results A total of 53 patients each were enrolled in both the groups, with comparable baseline characteristics. Although there was a trend toward a lower rate of recurrence of febrile seizures in the interventional group, as compared to the control group, it did not reach the point of statistical significance (P = 0.35). Both in the worst-case scenario and best-case scenario, there was a trend toward less risk of recurrence of febrile seizure in the intervention group, but it did not reach the point of statistical significance (P = 0.43 and 0.52). For the original scenario, worst-case scenario, and best-case scenario, the absolute risk reduction was 6.5%, 7%, and 6%, respectively, with corresponding number needed to treat (NNT) being 15, 14, and 16, respectively. The trend for absolute risk reduction was more pronounced in those with complex febrile seizures with an NNT of 6.5, but it still did not reach the point of statistical significance (P = 0.16). Moderate/severe IDA was also found to be an independent risk factor for recurrence of febrile seizure in the intervention group (P = 0.03). Conclusion Oral serum iron supplementation does not significantly reduce the recurrence rate of febrile seizures in children aged 6-60 months. However, there is a trend toward reduction in the frequency of recurrence of febrile seizures, which is more pronounced in the subset with complex febrile seizures.
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Affiliation(s)
- Indar Kumar Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prateek Kumar Panda
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vinod Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Aparna Ramachandran
- Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India
| | - Sanjot Bhardwaj
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Amit Kumar Pradhan
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajkali Rajendiran
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sherlock C, Madigan C, Linehan C, Keenan L, Downes M. Academic attainment following pediatric epilepsy surgery: A systematic review. Epilepsy Behav 2022; 134:108847. [PMID: 35914437 DOI: 10.1016/j.yebeh.2022.108847] [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: 03/09/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
Academic skills, such as reading, spelling and arithmetic, are central to meaningful engagement with society throughout adolescence and into adulthood. The disruption caused by on-going seizure activity places children with drug-resistant epilepsy at a particularly high risk of poor academic attainment. Though epilepsy surgery during childhood has long-been associated with various cognitive changes, less is known of the extent to which pediatric epilepsy surgery impacts academic attainment. The aim of the present systematic review was to identify the nature of the effect of pediatric epilepsy surgery on the core academic skills of reading, writing, and arithmetic. The electronic databases Embase, Medline, PubMed, PsychInfo, OpenAire, and the ISRCTN registry were searched for studies examining academic attainment following epilepsy surgery in childhood, over the last three decades. Two thousand three-hundred and sixty-eight articles were screened for relevance. Thirteen studies met the inclusion criteria. Study quality and reliability were independently assessed by two reviewers. Results indicate that academic attainment primarily stabilizes in the first year following epilepsy surgery. Though changes to learning ability would not be expected in this early recovery phase, this review indicates that children do not, at least, lose the academic skills they have acquired before surgery. Postoperative declines in performance were most notably recorded in assessments of arithmetic, suggesting an area of potential vulnerability in this cohort. These declines were noted in cohorts with the longest periods between seizure onset and surgery. While older age at onset and seizure freedom correlated with improved academic attainment, further research is necessary to fully understand the specific effect of epilepsy surgery on academic attainment. Still, the present review provides valuable information regarding the likely academic outcomes in the early years following surgical treatment for drug-resistant epilepsy.
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Affiliation(s)
- Clara Sherlock
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Cathy Madigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Lisa Keenan
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
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Tschamper MK, Wahl AK, Hermansen Å, Jakobsen R, Larsen MH. Parents of children with epilepsy: Characteristics associated with high and low levels of health literacy. Epilepsy Behav 2022; 130:108658. [PMID: 35358855 DOI: 10.1016/j.yebeh.2022.108658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Parents of children with epilepsy play a key role in the management of their child's condition. Their level of health literacy (HL), which refers to their ability to seek, understand, assess, remember, and utilize health information, is essential for handling the child optimally. The aim of this study was to investigate characteristics associated with high and low levels of different dimensions of HL in parents. HL was assessed with the multidimensional Health Literacy Questionnaire (parents' version) and the electronic Health Literacy Scale, using data from a cohort of 254 parents of children <12 years. Bivariate correlation and multiple hierarchal linear regression (STATA version 16 SE) were used to investigate variables associated with HL. Self-efficacy (St. β = 0.14-0.34) was the only variable that predicted higher scores on every HL scale. Being older than 35 years (St. β = 0.18-0.21), level of education (St. β = 0.16-0.27), and the child having a coordinator of services (St. β = 0.16-0.28) were associated with higher scores, while sick leave due to the child's epilepsy (St. β = -0.13 to -0.16), child comorbidities (St. β = -0.15 to -0.19), and higher levels of mental distress (St. β = -0.13 to -0.19) were associated with lower scores in several of the different HL dimensions. A total of 44.8% of the parents scored over the cutoff (≥1.85) predicting a mental disorder on the Hopkins symptom checklist. This is the first study to investigate multidimensional parental HL in a childhood epilepsy context. Our results highlight the need to investigate multiple variables, especially mental distress, to determine characteristics that may predict low parental HL. Further qualitative studies are needed to explore the underlying reasons for the parents' HL scores and to develop inventions tailored to meet different HL needs.
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Affiliation(s)
- Merete K Tschamper
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway.
| | - Astrid K Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Norway
| | - Åsmund Hermansen
- Faculty of Social Sciences, Oslo Metropolitan University, Norway
| | - Rita Jakobsen
- Lovisenberg Diaconal University College, Oslo, Norway
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Desli E, Spilioti M, Evangeliou A, Styllas F, Magkos F, Dalamaga M. The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials. Curr Nutr Rep 2022; 11:102-116. [PMID: 35303283 DOI: 10.1007/s13668-022-00405-4] [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] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Drug-resistant epilepsy represents around one-quarter of epilepsies worldwide. Although ketogenic diets (KD) have been used for refractory epilepsy since 1921, the past 15 years have witnessed an explosion of KD use in the management of epilepsy. We aimed to review evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of KD in drug-resistant epilepsy in children and adolescents. RECENT FINDINGS A literature search was performed in the Pubmed, Cohrane, Scopus, ClinicalTrials.gov, and Google Scholar databases. Predefined criteria were implemented regarding data extraction and study quality. Data were extracted from 14 RCTs in 1114 children and adolescents aged from 6 months to 18 years. Primary outcome was seizure reduction after the intervention. In 6 out of the 14 studies, there was a statistical significant seizure reduction by > 50% in the KD-treated group compared with the control group over a follow-up of 3-4 months. Secondary outcomes were adverse events, seizure severity, quality of life, and behavior. Gastrointestinal symptoms were the most frequent adverse events. Serious adverse events were rare. We conclude that the KD is an effective treatment for drug-resistant epilepsy in children and adolescents. Accordingly, RCTs investigating long-term impact, cognitive and behavioral effects, and cost-effectiveness are much anticipated.
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Affiliation(s)
- Evangelia Desli
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
| | - Martha Spilioti
- 1st Department of Neurology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Athanasios Evangeliou
- 4th Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Foteinos Styllas
- 1st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Faidon Magkos
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian, University of Athens, Athens, Greece
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Karabulut N, Abi Ö. Primary school teachers' health literacy levels, knowledge, and attitudes toward childhood epilepsy. Epilepsy Behav 2022; 127:108511. [PMID: 34991057 DOI: 10.1016/j.yebeh.2021.108511] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/11/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine primary school teachers' health literacy levels, knowledge and attitudes towards childhood epilepsy in the province of Iğdır in the east of Turkey. METHOD This descriptive and cross-sectional study involved 247 primary school teachers in the province of Iğdır in the east of Turkey between March and April 2021. The questionnaire form, the social attitude towards childhood epilepsies scale (SATCES), and the European health literacy scale (EHLS) were used in data collection. Normal distribution of data was evaluated by analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk tests). An independent sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data. RESULTS During an epileptic seizure, 63.1% of the teachers stated that they would try to open locked jaw by putting something between teeth. A statistically significant difference was found between the age of the teachers and the total mean score of SATCES (p < 0.05). A statistically significant difference was found between the gender of the teachers and the mean score of the affective and behavioral attitudes sub-dimension of the SATCES (p < 0.05). A statistically significant difference was found between the age of the teachers and the total mean score of the EHLS (p < 0.05). The health literacy scores of the teachers between the ages of 31 and 38 were significantly higher than the teachers over the age of 46. CONCLUSION The main findings of this study indicated the inadequate and wrong information of the teachers, and a positive attitude about epilepsy among primary school teachers. IMPLICATIONS It is recommended that health professionals organize training programs to In order to correct the inadequate and erroneous knowledge of teachers about epilepsy.
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Affiliation(s)
| | - Özlem Abi
- The Health Sciences Faculty, Igdır University, Iğdır, Turkey
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Pellino G, Faggioli R, Madrassi L, Falsaperla R, Suppiej A. Operational diagnosis of epilepsy in children at undetermined risk: A meta-analysis of prognostic factors for seizure recurrence. Epilepsy Behav 2022; 127:108498. [PMID: 34954509 DOI: 10.1016/j.yebeh.2021.108498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE According to the operational epilepsy definition adopted by the International League Against Epilepsy (ILAE) in 2014, in patients with one unprovoked seizure, clinicians must stratify the recurrence risk to determine if the criteria for diagnosis of epilepsy have been met and if antiseizure medications (ASM) are required. A remote symptomatic etiology was considered to be one of the best predictors for seizure recurrence, also according to the available prediction tools, but in children with a previously negative history and a normal neurological examination, estimating the probability of seizure relapse remains less obvious. This meta-analysis aimed to fill this gap of knowledge. METHODS The PubMed, Embase, and Scopus databases were searched from January 2000 to December 2020. We selected studies reporting children (1 month-18 years old) presenting a first unprovoked seizure. The absence of a known remote neurological pathology had to be clearly stated in the paper or the idiopathic/cryptogenic group data were used; the finding of epileptogenic structural brain MRI abnormalities during the diagnostic workup at the moment of the first unprovoked seizure was not an exclusion criterion. Factors analyzed, as possible predictors of recurrence, included: age at onset, sex, family history of epilepsy, type of seizure (focal or generalized), epileptiform abnormalities on EEG, and epileptogenic structural brain MRI abnormalities. RESULTS Four studies met the inclusion criteria and the sample size consisted of 741 children. The estimated recurrence rate within 3 years was 50% (95%CI:33.9%-66.0%). Among the predictors of recurrence, focal seizure (OR = 1.52; 95%CI = 1.05-2.19), epileptiform abnormalities on EEG (OR = 1.97; 95%CI = 1.31-2.96), and positive family history for epilepsy (OR = 2.37; 95%CI = 1.56-3.59) were associated with a statistically significant increased risk. CONCLUSION The analysis of data available until now cannot adequately assess the risk of recurrence after a first unprovoked seizure in neurotypical children. Prospective and multicenter cohort studies are expected.
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Affiliation(s)
- Giuditta Pellino
- Pediatric Unit, Azienda USL Ferrara - University Hospital of Ferrara, Ferrara, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Raffaella Faggioli
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Laura Madrassi
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU San Marco-Policlinico, University of Catania, Via Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Section of Pediatrics, University of Ferrara, Ferrara, Italy
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Gül Ü, Yolcu C, Ayça S, Elevli M. Effect of levetiracetam on cardiac repolarization in children with epilepsy. Epilepsy Res 2022; 179:106841. [PMID: 34894618 DOI: 10.1016/j.eplepsyres.2021.106841] [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: 09/19/2021] [Revised: 11/05/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Epileptic discharges occurring during seizure may affect many systems in the ictal, postictal, and interictal periods. Autonomic dysfunction and its negative impacts on the heart may cause life-threatening clinical manifestations, cardiac arrhythmias, and sudden cardiac death in epileptic patients. This study investigated the impact of levetiracetam (LEV) therapy on cardiac electrical activity in children with epilepsy. MATERIAL AND METHODS Our study included a total of 120 cases, comprising 40 newly diagnosed epilepsy patients, 40 epilepsy patients who had been receiving LEV therapy for at least 6 months, and 40 healthy individuals. Age at diagnosis, duration of LEV treatment, and familial history of cardiac disease were recorded in a standardized form. Electrocardiogram (ECG) parameters were calculated for all cases, echocardiography (ECHO) findings were noted, and the obtained data were compared using statistical methods. RESULTS A comparison of the ECG parameters showed that the Tpeak-Tend (Tp-e) interval, and the Tp-e/QT dispersion (QTd) and Tp-e/QTc dispersion (QTcd) ratios, of the newly diagnosed epilepsy patients were statistically significantly increased compared with the other two groups (p = <0.001, p = 0.001, and p = 0.007, respectively). There were no statistically significant differences between the three groups in terms of QTd and QTcd. DISCUSSION The repolarization differences in children with newly diagnosed epilepsy may have reflected early subclinical findings associated with the disease. We concluded that LEV monotherapy may make a positive contribution to early repolarization differences.
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Affiliation(s)
- Ümit Gül
- Haseki Education and Training Hospital, Department of Pediatrics, Istanbul, Turkey
| | - Canan Yolcu
- Haseki Education and Training Hospital, Department of Pediatric Cardiology, Istanbul, Turkey
| | - Senem Ayça
- Haseki Education and Training Hospital, Department of Pediatric Neurology, Istanbul, Turkey.
| | - Murat Elevli
- Haseki Education and Training Hospital, Department of Pediatrics, Istanbul, Turkey
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21
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Russo A, Cuteri V, Bansal L, Bonanni P, Danieli A, Pini A, Gobbi G. Brivaracetam in treating epileptic encephalopathy and refractory focal epilepsies in patients under 14 years of age. Iran J Child Neurol 2021; 15:95-104. [PMID: 34782846 PMCID: PMC8570622 DOI: 10.22037/ijcn.v15i4.29819] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022]
Abstract
Objectives To analyze the efficacy and safety of Brivaracetam in pediatric patients with epileptic encephalopathy or unresponsive focal epilepsy. Materials & Methods This retrospective study included eight pediatric patients with EE or unresponsive focal epilepsy. Inclusion criteria: (1) ≤14 years, (2) history of refractory epilepsy, (3) at least one month of continuous therapy with BRV, and (4) at least six months of follow-up. Exclusion criteria: (1) variation of concomitant antiepileptic drugs during the previous and/or subsequent four weeks of the BRV introduction, (2) levetiracetam in therapy, (3) epilepsy secondary to the progressive cerebral disease, tumor, or any other progressive neurodegenerative diseases, and (4) a status epilepticus a month before screening or during the baseline period. The efficacy of BRV was defined as ≥50% of seizure frequency reduction at the end of the follow-up, compared to baseline. Results: All patients showed ≥50% seizure frequency reduction, of whom 37.5% were seizure-free, 25% had a frequency reduction of ≥75%, and 37.5% had frequency reduction of ≥ 50%. All patients with an epilepsy onset >12 months and epilepsy duration of ≤6 years were seizure-free. The maximum effect was achieved at 2 mg/kg/day, and focal seizures revealed a better response than epileptic encephalopathy. A remarkably positive effect of the Brivaracetam was noticed in patients with encephalopathy regarding the status epilepticus during sleep; however, no relevant side-effects were noted. Conclusion: Brivaracetam was an effective and well-tolerated treatment in pediatric patients with epileptic encephalopathy or unresponsive focal epilepsy, especially for the epilepsy onset >12 months and the epilepsy duration ≤6 years. The total effect was not dose-dependent. Brivaracetam could represent an indication of encephalopathy regarding the status epilepticus during sleep.
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Affiliation(s)
- Angelo Russo
- Pediatric Neurologist and Psychiatrist - Epileptologist IRCCS, Institute of Neurological Sciences of Bologna Bellaria-Maggiore Hospital and Sant'Orsola University Hospital, Bologna Child Neurology Unit - Seizure Unit Bologna, Bologna, Italy
| | - Vittoria Cuteri
- Child Neurology and Psichiatric Unit, Departement of Medical and Surgical Science (DIMEC), S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Lalit Bansal
- Division of Neurology, Children's Mercy Hospital, University of Missouri Kansas City, Missouri, United States
| | - Paolo Bonanni
- l'IRCCS "Medea" - La Nostra Famiglia di Conegliano, U.O.C Epilessia e Psicopatologia, Italy
| | - Alberto Danieli
- l'IRCCS "Medea" - La Nostra Famiglia di Conegliano, U.O.C Epilessia e Psicopatologia, Italy
| | - Antonella Pini
- Pediatric Neurologist and Psychiatrist - Epileptologist IRCCS, Institute of Neurological Sciences of Bologna Bellaria-Maggiore Hospital and Sant'Orsola University Hospital, Bologna Child Neurology Unit - Seizure Unit Bologna, Bologna, Italy
| | - Giuseppe Gobbi
- IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy
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22
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Abstract
Routine electroencephalogram (EEG) has many limitations, especially the inability to capture reported habitual events in question. A prolonged EEG with synchronized video (video-EEG) overcomes some of these limitations by improving the sensitivity, specificity and the diagnostic yield by attempting to record the habitual events when they are frequent and when indicated. Video-EEG is employed commonly for the diagnosis and classification of epilepsy/epilepsy syndromes, to distinguish between seizures and seizures mimickers, for pre-surgical evaluation and in the management of critically ill children. The duration of recording would vary depending on the indication and frequency of events. Ambulatory EEG is another cost effective and convenient alternative in certain circumstances. However, availability of the machines and expertise, accessibility, affordability and labor intensive nature of the procedure limit widespread use in India. This review explores the role of video-EEG in the management of children with epileptic and non-epileptic paroxysmal events with respect to routine clinical practice in India.
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Affiliation(s)
- Lakshminarayanan Kannan
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India.
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Dinesh Nayak
- Department of Neurology and Epileptology, Advanced Center for Epilepsy, Gleneagles Global Health City, Perumbakkam, Chennai, 600100, India
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Abstract
There have been additions of newer antiseizure medications in the armamentarium of clinicians for the management of epilepsy. The newer antiseizure medications have advantages of better tolerability, lesser adverse effects, and minimal drug interactions in comparison with conventional antiseizure medications. However, high cost and availability are concerns. There are also peculiar pharmacokinetic and pharmacodynamic considerations for the pediatric age, particularly in the context of age-dependent electroclinical syndromes and precision-based medicine. This review attempts to provide a comprehensive and pragmatic update on newer antiseizure medications.
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Affiliation(s)
- Samata Singhi
- Department of Neurology, Kennedy Krieger Institute and Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA.
| | - Ajay Gupta
- Pediatric Epilepsy, Epilepsy Center, Department of Neurology/Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Malhi P, Annam A, Singhi P. Psychopathology and Quality of Life in Children with Epilepsy: A Cross-Sectional Study. Indian J Pediatr 2021; 88:712-4. [PMID: 33576951 DOI: 10.1007/s12098-021-03685-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
The study examined the relationship between psychopathology, seizure-related variables, and quality of life in children with epilepsy. Seventy-nine children with active epilepsy (Mean = 10.1 y, SD = 2.68) were consecutively recruited from the outpatient services of an advanced pediatric hospital. The Quality-of-Life in Childhood Epilepsy questionnaire and the Childhood Psychopathology Measurement Schedule (CPMS) were administered to the parents. The most compromised health-related quality of life (HRQOL) domain was the general health domain (Mean = 61.70, SD = 26.81). The mean intelligence quotient (IQ) score was 81.59 (SD = 12.34) and only 20% had IQs in the normal average range. The mean CPMS score was 7.41 (SD = 5.41). The psychopathology score and the IQ explained 43% of the variance in the total HRQOL score (F = 28.67, P = 0.0001) in the regression analysis. Childhood epilepsy is a significant public health concern and a multidisciplinary approach to management would help in addressing the multiple needs of the children with epilepsy and their families.
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25
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Loring KE, Mattiske T, Lee K, Zysk A, Jackson MR, Noebels JL, Shoubridge C. Early 17β-estradiol treatment reduces seizures but not abnormal behaviour in mice with expanded polyalanine tracts in the Aristaless related homeobox gene (ARX). Neurobiol Dis 2021; 153:105329. [PMID: 33711494 DOI: 10.1016/j.nbd.2021.105329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/18/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022] Open
Abstract
Children with severe intellectual disability have an increased prevalence of refractory seizures. Steroid treatment may improve seizure outcomes, but the mechanism remains unknown. Here we demonstrate that short term, daily delivery of an exogenous steroid 17β-estradiol (40 ng/g) in early postnatal life significantly reduced the number and severity of seizures, but did not improve behavioural deficits, in mice modelling mutations in the Aristaless-related homeobox gene (ARX), expanding the first (PA1) or second (PA2) polyalanine tract. Frequency of observed seizures on handling (n = 14/treatment/genotype) were significantly reduced in PA1 (32% reduction) and more modestly reduced in PA2 mice (14% reduction) with steroid treatment compared to vehicle. Spontaneous seizures were assessed (n = 7/treatment/genotype) at 7 weeks of age coinciding with a peak of seizure activity in untreated mice. PA1 mice treated with steroids no longer present with the most severe category of prolonged myoclonic seizures. Treated PA2 mice had an earlier onset of seizures coupled with a subsequent reduction in seizures later in postnatal life, with a complete absence of any seizures during the analysis at 7 weeks of age. Despite the reduction in seizures, 17β-estradiol treated mice showed no improvement in behavioural or cognitive outcomes in adulthood. For the first time we show that these deficits due to mutations in Arx are already present before seizure onset and do not worsen with seizures. ARX is a transcription factor and Arx PA mutant mice have deregulated transcriptome profiles in the developing embryonic brain. At postnatal day 10, treatment completion, RNAseq identified 129 genes significantly deregulated (Log2FC > ± 0.5, P-value<0.05) in the frontal cortex of mutant compared to wild-type mice. This list reflects genes deregulated in disease and was particularly enriched for known genes in neurodevelopmental disorders and those involved in signalling and developmental pathways. 17β-estradiol treatment of mutant mice significantly deregulated 295 genes, with only 23 deregulated genes overlapping between vehicle and steroid treated mutant mice. We conclude that 17β-estradiol treatment recruits processes and pathways to reduce the frequency and severity of seizures in the Arx PA mutant mice but does not precisely correct the deregulated transcriptome nor improve mortality or behavioural and cognitive deficits.
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Affiliation(s)
- Karagh E Loring
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Tessa Mattiske
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Kristie Lee
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Aneta Zysk
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Matilda R Jackson
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | - Cheryl Shoubridge
- Intellectual Disability Research, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia; Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
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26
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Celik H, Acikel SB, Ozdemir FMA, Aksoy E, Oztoprak U, Cucu E, Kucur O, Ceylan N, Yuksel D. Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period. Eur Neurol 2021; 84:192-199. [PMID: 33853068 PMCID: PMC8089456 DOI: 10.1159/000514826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
Background and Aim Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. Methods The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers' anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. Results There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. Conclusion Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.
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Affiliation(s)
- Halil Celik
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sadettin Burak Acikel
- Child and Adolescent Psychiatry Department, University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatih Mehmet Akif Ozdemir
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Erhan Aksoy
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ulkuhan Oztoprak
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ergin Cucu
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ozge Kucur
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Deniz Yuksel
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus, Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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27
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Panda PK, Sharawat IK. Early risk factors for encephalopathic transformation in children with benign childhood epilepsy with centrotemporal spikes. Brain Dev 2021; 43:601-602. [PMID: 33213973 DOI: 10.1016/j.braindev.2020.10.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
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Porat Rein A, Kramer U, Hausman Kedem M, Fattal-Valevski A, Mitelpunkt A. Early risk factors for encephalopathic transformation in children with benign childhood epilepsy with centrotemporal spikes. Brain Dev 2021; 43:603-604. [PMID: 33597109 DOI: 10.1016/j.braindev.2021.01.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Uri Kramer
- Faculty of Medicine, Tel-Aviv University, Israel; Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Sourasky Medical Center, Israel
| | - Moran Hausman Kedem
- Faculty of Medicine, Tel-Aviv University, Israel; Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Sourasky Medical Center, Israel
| | - Aviva Fattal-Valevski
- Faculty of Medicine, Tel-Aviv University, Israel; Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Sourasky Medical Center, Israel
| | - Alexis Mitelpunkt
- Faculty of Medicine, Tel-Aviv University, Israel; Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Sourasky Medical Center, Israel
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Celik H, Acikel SB, Ozdemir MAF, Aksoy E, Oztoprak U, Ceylan N, Yuksel D. Evaluation of the clinical characteristics of children with autism spectrum disorder and epilepsy and the perception of their parents on quality of life. Epilepsy Res 2021; 172:106599. [PMID: 33725663 DOI: 10.1016/j.eplepsyres.2021.106599] [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: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Autism spectrum disorder (ASD) is among the serious clinical pictures of early childhood, and its main symptoms are qualitative dysfunction in social interactions with impairment of verbal and nonverbal communication and limitations in interests and activities. METHODS This study aimed to examine the clinical conditions that mediate this comorbidity, compare parental quality of life in isolated ASD and ASD with epilepsy, demonstrate the relationships between clinical and EEG findings obtained in diagnostic evaluation, and examine the results in light of the literature. RESULTS The study sample consisted of 154 ASD patients; 26 were girls (16.9 %) and 128 (83.1 %) were boys. Of the patients with epilepsy, seizures were focal in 14 patients (9.1 %), generalized in 9 patients (5.8 %), and unspecified in 1 patient (0.6 %). Intellectual ability was found to be a significant predictor of epilepsy diagnosis. Mean (SD) total scores in the Quality of Life in Autism Questionnaire were 131.84 (10.68) among mothers of children with ASD-epilepsy and 148.33 (14.03) among mothers of children with ASD alone (P < .001). CONCLUSION Many psychiatric and medical conditions can co-occur with ASD. Determining the prognostic criteria for ASD is of great importance in coordinating lifelong autism rehabilitation. Improving autism-specific symptoms will benefit children with ASD as well as help mitigate parental anxiety.
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Affiliation(s)
- Halil Celik
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - S Burak Acikel
- Child and Adolescent Psychiatry Department University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - M Akif Fatih Ozdemir
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Erhan Aksoy
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Ulku Oztoprak
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Nesrin Ceylan
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
| | - Deniz Yuksel
- Department of Pediatric Neurology (DY) University of Health Sciences, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.
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Benjamin RN, Thomas M, Muthusamy K, Yoganathan S, Mathew V, Chacko AG, Prabhu K, Chacko G. Age-Dependent Reduction in Severity and Discrete Topographical Patterns in Rasmussen Encephalitis: A Link to Cortical Maturation? Pediatr Neurol 2020; 112:25-33. [PMID: 32911260 DOI: 10.1016/j.pediatrneurol.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/18/2020] [Revised: 06/30/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Autopsy studies in Rasmussen encephalitis reveal areas of sparing within the affected hemisphere. Clinical progression and inflammation are milder with an older onset. We sought to demonstrate radiological corroboration for these patterns. METHODS In our retrospective study, 38 cases were dichotomized into severe pan-hemispheric (all lobes involved) and sub-hemispheric groups (others) to identify age demographics and other severity predictors. The extent and patterns of radiological pathology in the cortex and subcortical structures were assessed by structured visual grading. Relevant clinical data were also reported. RESULTS Children with pan-hemispheric involvement were younger at onset (P < 0.001) and were more likely to present with status epilepticus (odds ratio 8.5, 95% confidence interval 1.5 to 50.0, P = 0.022). A history of perinatal asphyxia/hospitalization (P < 0.001) and delayed milestones (P = 0.013) were encountered exclusively in this group, and progression to a low-amplitude record background on electroencephalography, suggesting that cortical damage was identified frequently (P = 0.038, odds ratio = 5.7, 95% confidence interval 1.3 to 25.0). Visual grading revealed significant differences among both cortical (P < 0.001) and subcortical (P < 0.001) regions. On multivariate analysis, the odds for pan-hemispheric disease decreased per year of age at onset (P = 0.022, odds ratio 0.51, 95% confidence interval 0.085 to 0.725). Epilepsy surgery (n = 14) was associated with Engel Class 1 seizure control (P < 0.001). Immunosuppressive therapy (n = 20) did not demonstrate a significant seizure remission (P = 0.157, odds ratio 0.39, 95% confidence interval 0.10 to 1.55). CONCLUSIONS Our case series confirms the presence of specific topographical patterns of macroscopic radiological pathology over the affected hemisphere with a marked age-associated reduction in the odds for severe pan-hemispheric disease.
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Affiliation(s)
- Rohit Ninan Benjamin
- Associate Professor, Neurology, Department of Neurosciences, Christian Medical College, Vellore, India.
| | - Maya Thomas
- Professor and Head, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Karthik Muthusamy
- Professor, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Sangeetha Yoganathan
- Professor, Paediatric Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Vivek Mathew
- Professor and Head, Neurology, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Ari George Chacko
- Professor, Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Krishna Prabhu
- Professor, Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Professor of Neuropathology and Head, General Pathology, Department of General Pathology, Christian Medical College, Vellore, India
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Hassen O, Beyene A. The effect of seizure on school attendance among children with epilepsy: a follow-up study at the pediatrics neurology clinic, Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC Pediatr 2020; 20:270. [PMID: 32493250 PMCID: PMC7268295 DOI: 10.1186/s12887-020-02149-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background Epilepsy is the most common chronic neurological disease seen in Pediatrics Neurology Units in many developing countries. It affects negatively on school attendance and academic performance. This study tries to assess the extent and factors contributing school absenteeism among school-aged children and adolescents among epilepsy cases attending at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. Methods A hospital based follow-up study was conducted among school-aged children and adolescents with epilepsy between the ages of 7–18 years attending an outpatient Pediatric Neurology Clinic. A sample of consecutive 183 children and adolescents were included in the study full filling criteria of “attended school for at least 6 months in an academic year and walk by themselves with no disability.” The participants (children and their parents/caregivers) gave information concerning the socio-demographic characteristics of the child and the primary caregiver, and review of the child’s presentation and school absenteeism was defined as the average missed days per month over 6 months period and was asked in the questionnaire. Medical charts were thoroughly reviewed on the diagnosis and treatment they received. Study participants characteristics were described using frequency tables and factors associated with school absenteeism were analyzed using logistic regression. Results School absenteeism (≥1 days/month) over 6 month period among children aged 7-18 years with epilepsy was 69.4%. Factors which correlated with school absenteeism included female sex (AOR 2.19, 95% CI 1.03–4.84), children with known causes for seizures (AOR 2.51, 95% CI 1.09–5.86), not experiencing seizure at school (AOR 0.39(0.17–0.89) and longer epilepsy duration (AOR 2.36: 1.09, 5.15). The mean age at onset Epilepsy was 4.6 years (±SD = 3.6). One hundred and thirty two (72.1%) had generalized epilepsy, 49(26.8%) had focal epilepsy and the remaining 2(1.1%) had unclassified epilepsy. One hundred and thirty (71.4%) received mono-therapy. Conclusion Experience of school absenteeism reported by over two thirds of children aged 7–18 years with epilepsy attending an outpatient epilepsy clinic in Ethiopia. Children with known seizure should be followed regularly, and compensation for missed school has to be organized.
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Affiliation(s)
- Oumer Hassen
- Pediatrics and Child Health, Hiwot Fana Specialized University Hospital, Haramaya University, Harar, Ethiopia.
| | - Ayalew Beyene
- Pediatrics and Child Health, Hiwot Fana Specialized University Hospital, Haramaya University, Harar, Ethiopia
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Conde-Guzón PA, Soria-Martín C, Cancho-Candela R, Quirós-Expósito P, Conde-Bartolomé P, Bulteau C. Parental report of quality of life in children with epilepsy: A Spanish/French comparison. Epilepsy Behav 2020; 105:106968. [PMID: 32092458 DOI: 10.1016/j.yebeh.2020.106968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epilepsy is a chronic neurological condition that affects the quality of life (QoL) of patients and their families. In this study, we compare two sets of reports on QoL that were completed by two samples of parents whose children have epilepsy. METHOD Parents of children with various types of epilepsy from Spain (N = 196) and France (N = 219) completed the same QoL questionnaire. Medical variables were recorded from the referred specialist doctor for each patient. RESULTS The factors associated with parental reports on QoL were similar in both countries. Parents of children with nonidiopathic generalized or unclassified epilepsy reported poorer QoL and the highest proportion of learning and behavioral problems. However, the intensity of difficulties varied between the two samples. CONCLUSIONS This questionnaire made it possible to detect comorbidities and daily life difficulties in children with epilepsy and their families. The type of epilepsy had the same influence on Spanish and French families' ratings of QoL. Families shared the same comorbidities in terms of hyperactivity/attention/sociability problems. Nevertheless, the intensity of reported difficulties varied in both countries, possibly because of differences in cultural and educational environments. This aspect should be further explored in future research.
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Affiliation(s)
- Pablo-A Conde-Guzón
- Department of Psychology, University of León, Spain, Campus de Vegazana, 24071 León, Spain.
| | - Carmen Soria-Martín
- Clinica PCH: Neurological and Neuropsychological Rehabilitation, Madrid, Spain; University Cardenal Cisneros, Faculty of Psychology, Avda. Jesuitas, 34, 28806 Alcalá de Henares, Spain
| | - Ramón Cancho-Candela
- Pediatric Neurology Unit, Pediatrics Department, Hospital Universitario Rio Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
| | - Pilar Quirós-Expósito
- Faculty of Psychology, Department of Basic Psychology, UNED, C/ Juan del Rosal, 10, 24040 Madrid, Spain.
| | - Pablo Conde-Bartolomé
- Faculty of Medicine, University of Salamanca, CM. San Bartolomé, C/Henry Collet, 37, 37007 Salamanca, Spain
| | - Christine Bulteau
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, 27, Rue Manin, 75019 Paris, France; Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France.
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Hussain SR, Orwa J, Sokhi DS, Kathomi CM, Dossajee H, Miyanji O, Ngugi A, Samia P. Determining the quality of life of children living with epilepsy in Kenya-A cross-sectional study using the CHEQOL-25 tool. Seizure 2020; 76:100-104. [PMID: 32059170 DOI: 10.1016/j.seizure.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/29/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Epilepsy is a chronic neurological disorder that is often diagnosed in childhood and may negatively impact physical, social and psychological abilities. Most tools measuring quality of life (QoL) rely on parent/caregiver feedback rather than the child's perspective. CHEQOL-25 is a QoL tool that documents both child and caregiver perspectives across five domains. The primary objective was to determine the QoL of children living with epilepsy (CWE) using the CHEQOL-25 tool in a Kenyan paediatric population. Other objectives were to describe the correlation between the caregivers' and children's' perspectives and describe factors affecting QoL. METHOD We conducted a cross-sectional study across four sites in Nairobi. Quantitative data was collected using a self-administered CHEQOL-25 questionnaire. Caregivers and their children aged 7-15 years attending neurology clinics participated in the study. We used Kappa statistics to compare child and caregiver responses. RESULTS A total of 354 participants were interviewed (177 children and 177 caregivers). A good QoL was reported by 60.5 % of children with a similar caregiver perception of 56.5 %. Caregivers with little education and male caregivers were associated with a poor QoL (p = 0.01); other socio-demographic factors had little impact on the measured QoL of CWE. Parent and child questionnaires correlated well in terms of response in terms of interpersonal (p = 0.001) and intrapersonal (p = 0.004) domains. CONCLUSION This study demonstrated that a good quality of life was reported by the majority of CWE and their caregivers, although some factors such as a male caregiver gender and lower level of education were associated with poor QoL.
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Affiliation(s)
- Syeda Ra'ana Hussain
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - James Orwa
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - Dilraj Singh Sokhi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | - Caroline Mbuba Kathomi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
| | | | - Osman Miyanji
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya; Kenya Association for the Welfare of People Living with Epilepsy (KAWE), P. O. Box 60790-00200, Nairobi, Kenya.
| | - Anthony Ngugi
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya
| | - Pauline Samia
- Aga Khan University Medical College of East Africa, The Aga Khan University Hospital, Nairobi, P. O. Box 30270-00100, Nairobi, Kenya.
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Giordano L, Tambucci R, Cocco IE, Angriman M, Coppola G, Operto FF, Farello G, Savasta S, Belcastro V, Verrotti A. Infantile spasms followed by childhood absence epilepsy: A case series. Seizure 2019; 74:77-80. [PMID: 31841970 DOI: 10.1016/j.seizure.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/20/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Infantile spasms (IS) represent a severe seizure disorder of infancy and early childhood characterized by epileptic spasms along with hypsarrhythmia often accompanied by intellectual disability. According to the current classification and terminology (3) IS can be categorized as known etiology, formerly known as "symptomatic", when an underlying cause has been observed prior to the onset of spasms, or of "unknown cause" with "unfavorable" and "favorable" outcome (previously referred as "cryptogenic" or "idiopathic", respectively). Single reports described children with "unknown cause and favorable outcome" (UC/FO) IS who later developed childhood absence epilepsy (CAE). This study aims to determine the prevalence of CAE following IS. METHODS a multicenter retrospective chart review was performed; children with UC/FO IS who subsequently developed CAE during follow-up were identified. Eight Italian pediatric epilepsy centers participated in this study. RESULTS seven out of 24 (29 %) children (3 males) showing a favorable outcome (UC/FO) IS received a second diagnosis of CAE during follow-up. Mean age at IS presentation was 5.8 months (SD ± 0.9). All achieved seizure control of IS at a mean age of 8.5 months (SD ± 1.3) (3 monotherapy, 4 polytherapy). CAE was diagnosed at a mean age of 8.0 years (SD ± 3.0). Six children achieved sustained remission of CAE with valproic acid, whereas 1 child required dual therapy by adding ethosuximide. CONCLUSION although it is not possible to determine whether the association between UC/FO IS and CAE implies a causality relationship, the later occurrence of CAE in patients with UC/FO IS might support a possible role of thalamo-cortical dysfunction.
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Affiliation(s)
- Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Renato Tambucci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | | | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Hospital of Bolzano, Bolzano, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Fisciano, Italy
| | - Francesca Felicia Operto
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni Farello
- Pediatric Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore Savasta
- Department of Pediatrics, Pavia University Foundation, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
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Abstract
There is a substantial body of research on social cognition in adults with epilepsy, and in broad categories such as focal and generalized epilepsies, but much less has been written about social cognition in children with epilepsy (CWE), and in childhood-onset epilepsy syndromes specifically. In several of these syndromes, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), two disorders with social cognitive impairments, are reported. There is strong evidence for social cognitive deficits in juvenile myoclonic epilepsy (JME). There is also a considerable amount of evidence for such deficits in a number of syndromes that may be associated with ASD or ADHD, including West syndrome (WS), Dravet syndrome (DS), and the Landau-Kleffner syndrome (LKS). However, the evidence is of variable quality and incomplete across the range of childhood epilepsy syndromes. In some syndromes, childhood epilepsy substantially increases the risk of severe social cognitive impairment, which may persist after the seizures remit. This paper presents an overview of current research on social cognition in childhood epilepsy, with a particular focus on syndromes with a high prevalence of autistic and behavioral comorbidities. Social cognitive impairments represent a considerable additional challenge for patients and caregivers. Early diagnosis and intervention might significantly improve long-term social cognitive outcomes, highlighting the need for greater awareness among clinicians of this important topic. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan".
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 5-7 Rush Court, Bedford MK40 3JT, UK; University College, London, UK; King's College, London, UK.
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Stewart E, Catroppa C, Gonzalez L, Gill D, Webster R, Lawson J, Sabaz M, Mandalis A, Barton B, McLean S, Lah S. Facial emotion perception and social competence in children (8 to 16 years old) with genetic generalized epilepsy and temporal lobe epilepsy. Epilepsy Behav 2019; 100:106301. [PMID: 31133510 DOI: 10.1016/j.yebeh.2019.04.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/28/2019] [Revised: 04/01/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
Abstract
Facial emotion perception (FEP) impairments are common in adults with epilepsy and associated with impaired psychosocial functioning. Research into the presence of FEP deficits in children with epilepsy and the functional implications of these deficits is limited. The primary aims of this study were to assess FEP abilities in children (8 to 16 years old) with genetic generalized epilepsy (GGE) and temporal lobe epilepsy (TLE) and examine whether FEP is related to everyday social functioning. Forty-four children (8 to 16 years) with epilepsy (22 GGE, 22 TLE) and 22 typically developing controls completed the Pictures of Facial Affect (POFA) battery to assess FEP and a brief test of intellectual functioning (intelligence quotient [IQ]). Parents completed questionnaires assessing social competence of their child. Neurologists completed the Global Assessment of Severity of Epilepsy (GASE) scale as a measure of overall epilepsy severity. Demographic and clinical information was obtained from medical records and clinical interviews with parents. Findings revealed significant, overall FEP impairments and reduced social competence in children with GGE and TLE compared to controls. The magnitude of FEP impairment (i.e., across all emotions) was comparable in the two epilepsy groups, yet different emotions were impaired in each group: children with GGE were impaired in recognizing anger and disgust, whereas children with TLE were impaired in sadness and disgust, compared to controls. Contrary to expectations, total FEP accuracy was not significantly correlated with social competence in either epilepsy group. In conclusion, children with GGE and TLE have significant impairments recognizing emotional expressions on faces. Further research is needed to examine whether underlying FEP impairments relate to social and emotional functioning in children with epilepsy.
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Affiliation(s)
- Elizabeth Stewart
- School of Psychology, The University of Sydney, 94 - 100 Mallett Street, Camperdown, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Australia
| | - Linda Gonzalez
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Australia
| | - Deepak Gill
- T.Y Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, Sydney, Australia
| | - Richard Webster
- T.Y Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, Sydney, Australia
| | - John Lawson
- Department of Neurology, Sydney Children's Hospital, High Street Randwick, Sydney, Australia
| | - Mark Sabaz
- Department of Psychology, Sydney Children's Hospital, High Street Randwick, Sydney, Australia
| | - Anna Mandalis
- Department of Psychology, Sydney Children's Hospital, High Street Randwick, Sydney, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, Sydney, Australia
| | - Samantha McLean
- T.Y Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and Hainsworth Street, Westmead, Sydney, Australia
| | - Suncica Lah
- School of Psychology, The University of Sydney, 94 - 100 Mallett Street, Camperdown, Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.
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Thieux M, Jung J, Bouet R, Gerard D, Bauer PR, Bertrand O, Perrone-Bertolotti M, Arzimanoglou A, Kahane P, Lachaux JP, De Bellescize J, Herbillon V. BLAST paradigm: A new test to assess brief attentional fluctuations in children with epilepsy, ADHD, and normally developing children. Epilepsy Behav 2019; 99:106470. [PMID: 31430660 DOI: 10.1016/j.yebeh.2019.106470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pure attentional deficits are still underdiagnosed in children with epilepsy. While attention-deficit hyperactivity disorder (ADHD) is historically the most studied cause of attentional disorders, an important number of children with epilepsy and attentional complaints do not fully meet the DSM-V (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) criteria for ADHD and may be excluded from specific care. Clinical tools currently available are insufficient to detect more subtle but clinically relevant attentional fluctuations. OBJECTIVE/METHODS The recently developed Bron-Lyon Attention Stability Test (BLAST) was used to evaluate brief attentional fluctuations with a high temporal precision. Drawing on two new attentional indices, we evaluated spontaneous fluctuations of response accuracy and timing, underlying attentional stability. The main objective was to assess attentional stability in children with i) epilepsy with comorbid ADHD, ii) epilepsy without comorbid ADHD, iii) ADHD not medicated and without epilepsy, and iv) normal development. Further objectives were to assess the main determinants of attentional stability in those groups, including the effect of factors related to the epileptic condition. RESULTS In 122 children with epilepsy (67 with comorbid ADHD), 52 children with ADHD, and 53 healthy controls, we demonstrated lower attentional stability in both the groups with epilepsy and ADHD compared with healthy children. In children with epilepsy, BLAST scores were negatively associated with earlier seizure onset and AED (antiepileptic drug) polytherapy, while the seizure frequency, epilepsy duration, or type did not influence BLAST scores. CONCLUSIONS This study demonstrates that attentional stability is impaired in children with epilepsy and/or ADHD. Bron-Lyon Attention Stability Test seems to be a sensitive test to detect attentional stability deficit in children with epilepsy and with attentional complaints who did not meet all criteria of ADHD. We propose that BLAST could be a useful clinical neuropsychological tool to assess attentional disorders in children.
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Kaushik JS, Kadwa RA, Sahu JK, Sharma S, Mittal R. Association of Child Neurology-Indian Epilepsy Society Consensus Document on Social and Legal Aspects of Childhood Epilepsy (SOLACE). Indian J Pediatr 2019; 86:599-607. [PMID: 30945236 DOI: 10.1007/s12098-019-02927-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/07/2019] [Accepted: 03/01/2019] [Indexed: 11/24/2022]
Abstract
Epilepsy is a chronic neurological disorder which affects not only the health of the affected child, but also has an economic, psychological and emotional impact on the family as a whole. In the transition from Person with Disability (PWD) act (1995) to Rights of Persons with Disabilities act (RPWD act) (2016), which covers all aspects of life of a person with any disability, epilepsy has been excluded from the list of disorders, resulting in a loss of many of the benefits that were earlier available to persons with epilepsy, causing concern to all caregivers of persons with epilepsy. Additionally, physicians/ pediatricians/ neurologists are not really aware of the benefits that are available to persons with epilepsy, especially children. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators legal experts, parents, and teachers was held. The implication of epilepsy being dropped as a disability, was discussed, and most of the experts concurred that epilepsy should be considered as a disability, depending of the type of seizures or the epilepsy syndrome. Also, the current status of income tax benefits, child care benefits, travel concession, schooling and health insurance for children with epilepsy in India were also discussed. The importance of creating awareness on these issues was stressed on. Here authors present the group consensus statement on these legal and social aspects about the care of children with epilepsy.
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Affiliation(s)
- Jaya Shankar Kaushik
- Department of Pediatrics, Pt B D Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Razia Adam Kadwa
- Department of Pediatric Neurology, Ankura Hospital for Women and Children, Hyderabad, Telengana, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, Delhi, India
| | - Rekha Mittal
- Department of Pediatric Neurology, Madhukar Rainbow Children's Hospital, Malviya Nagar, Delhi, 110017, India.
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Pan PJ, Ullman HE, Mathern GW, Salamon N. Physical Growth of the Contralateral Cerebrum is Preserved After Hemispherotomy in Childhood. Pediatr Neurol 2019; 96:48-52. [PMID: 30928301 DOI: 10.1016/j.pediatrneurol.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/07/2019] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemispherotomy can be an effective treatment for refractory childhood epilepsy. However, the extent of postoperative brain development after hemispherotomy remains incompletely understood. This study aims to provide an anatomic foundation in assessing development of the contralateral hemisphere, by measuring volumetric growth after hemispherotomy. METHODS Eleven patients with hemimegalencephaly, Rasmussen's encephalitis, and cerebral infarction who underwent hemispherotomy before age 12 years, an immediate preoperative magnetic resonance imaging, and at least three years of follow-up magnetic resonance imagings were retrospectively analyzed. The volume of the contralateral hemisphere was measured before and after surgery. Growth curves were compared with those of healthy individuals from an open database. The growth rate relative to the healthy individuals ("catch-up rate") was calculated. RESULTS A positive volumetric growth of the contralateral hemisphere was observed across all pathologies. The hemimegalencephaly subgroup underwent hemispherotomy at the earliest time and had the largest postoperative growth rate, which exceeded that of healthy individuals. The Rasmussen subgroup underwent surgery at the second earliest time and had an intermediate growth rate, which was similar to that of healthy individuals. The infarction subgroup underwent surgery at the latest time and had the slowest growth rate, which was less than that of healthy individuals. CONCLUSIONS The contralateral hemisphere continues to increase in volume after hemispherotomy in childhood. Further studies with a larger sample size and correlation with cognitive outcomes may aid in characterizing the prognosis after hemispherotomy.
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Affiliation(s)
- Patrick J Pan
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Henrik E Ullman
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Gary W Mathern
- Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noriko Salamon
- Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Brown DMY, Mahlberg N, Pohl D, Timmons BW, Bray SR, Streiner DL, Ferro MA, Hamer S, Rosenbaum PL, Ronen GM. Can behavioral strategies increase physical activity and influence depressive symptoms and quality of life among children with epilepsy? Results of a randomized controlled trial. Epilepsy Behav 2019; 94:158-166. [PMID: 30939411 DOI: 10.1016/j.yebeh.2019.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 10/03/2018] [Revised: 01/30/2019] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE This study examined whether increasing physical activity (PA) through 6 months of behavioral counseling positively influenced depressive symptoms and quality of life (QoL) over 12 months among children with epilepsy (CWE). METHODS A longitudinal multisite randomized controlled trial (RCT) was conducted with 8-14-year-old children with active epilepsy. Participants wore a pedometer to track daily PA and completed 3 measures at 4 time points to examine depressive symptoms and QoL. Stratified by site and activity level, participants were randomized to an intervention or control group. The 6-month intervention included 11 behavioral counseling sessions targeting self-regulation of PA. To assess the associations among PA, depression scores, and QoL, primary analysis involved mixed-effects models. RESULTS We recruited 122 CWE, of whom 115 were randomized (Mage = 11 ± 2; 50% female) and included in the analysis. The intervention did not increase PA in the treatment compared with the control group. No differences were found between groups over time during the subsequent 6 months, where PA decreased among all participants. Results did not show differences between the groups and over time for measures of depressive symptoms and QoL. SIGNIFICANCE The intervention did not improve or sustain PA levels over 12 months. Both groups demonstrated declines in PA over one year, but there were no changes in depression scores or QoL. As most participants were already nearly reaching the Canadian average of step counts of children their age, with a baseline daily step count of over 9000, there may be a challenge for further increasing PA over a longer period.
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Affiliation(s)
- Denver M Y Brown
- Department of Kinesiology, McMaster University, 1280 Main Street W, Hamilton, ON L8S 4L8, Canada.
| | - Nadilein Mahlberg
- Department of Pediatrics, McMaster University, 1400 Main Street W, Institute for Applied Health Sciences, Room 408, Hamilton, ON L8S 1C7, Canada.
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.
| | - Brian W Timmons
- Department of Pediatrics, McMaster University, 1400 Main Street W, Institute for Applied Health Sciences, Room 408, Hamilton, ON L8S 1C7, Canada.
| | - Steven R Bray
- Department of Kinesiology, McMaster University, 1280 Main Street W, Hamilton, ON L8S 4L8, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, ON L9C 3N6, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
| | - Mark A Ferro
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue W, Waterloo, ON N2L 3G1, Canada.
| | - Sabrina Hamer
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Research Institute Building 2, Room R2109, Ottawa, ON K1H 8L1, Canada.
| | - Peter L Rosenbaum
- Department of Pediatrics, McMaster University, 1400 Main Street W, Institute for Applied Health Sciences, Room 408, Hamilton, ON L8S 1C7, Canada.
| | - Gabriel M Ronen
- Department of Pediatrics, McMaster University, 1400 Main Street W, Institute for Applied Health Sciences, Room 408, Hamilton, ON L8S 1C7, Canada.
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Aliyu MH, Abdullahi AT, Iliyasu Z, Salihu AS, Adamu H, Sabo U, Garcia JP, Abdullahi SU, Mande A, Xian H, Yakasai HM, Schootman M, Ingles DJ, Patel AA, Yakasai A, Curry-Johnson S, Wudil UJ, DeBaun MR, Trevathan E. Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies. Contemp Clin Trials Commun 2019; 15:100362. [PMID: 31049462 PMCID: PMC6484289 DOI: 10.1016/j.conctc.2019.100362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/11/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa.
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Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aminu T Abdullahi
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Auwal S Salihu
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Halima Adamu
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Umar Sabo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Juanita Prieto Garcia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shehu U Abdullahi
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Aliyu Mande
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Hong Xian
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Hafizu M Yakasai
- Centre for Nigerian Languages and Folklore, Bayero University, Kano, Nigeria
| | - Mario Schootman
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Archana A Patel
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abubakar Yakasai
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Stacy Curry-Johnson
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
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Karalok ZS, Genc HM, Taskin BD, Ceylan N, Guven A, Yarali N. Risk factors and motor outcome of paediatric stroke patients. Brain Dev 2019; 41:96-100. [PMID: 30037586 DOI: 10.1016/j.braindev.2018.07.004] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/20/2018] [Accepted: 07/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Childhood stroke causes significant morbidity and mortality. In this study, we aimed to define the presenting findings, causes, risk factors and motor outcomes of our patients. METHODS We retrospectively analysed patients aged from 1 month to 18 years who were diagnosed as having the first onset of stroke between January 2006 and December 2015. Presenting features, causes, risk factors, recurrence rate and motor outcomes were recorded. Motor outcome was evaluated by the gross motor function classification system. RESULTS Forty-seven children were included in the study. Thirty-eight (78.7%) children had an arterial stroke, 9 (19.1%) had a venous stroke. The median age at the time of presentation was 60 months (3-214). Thirty-two patients (68%) presented with a focal neurological sign and 9 presented with seizure (19.1%). Patients who had a venous stroke presented with more diffuse neurological symptoms than those who had an arterial stroke. At least one risk factor for stroke was identified in 74.5% of the patients; the most common causative factor was prothrombotic state seen in 16 patients (33.5%). Stroke recurred in 5 patients (10.6%); coexistence of multiple factors was a risk factor for recurrence. Presenting with seizure was not a facilitator for epilepsy. Thirty-two (68%) patients had a favourable motor outcome. Younger age (24 months versus 114 months) and presenting with focal neurological signs were related to non-favourable motor outcome. CONCLUSION Our cohort demonstrates that most of the children had a risk factor for stroke and have had favourable motor outcome. However, younger age and presenting with focal seizures are related to non-favourable motor outcome.
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Affiliation(s)
- Zeynep Selen Karalok
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey.
| | - Hulya Maras Genc
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Birce Dilge Taskin
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Nesrin Ceylan
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Alev Guven
- Department of Pediatric Neurology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Nese Yarali
- Department of Pediatric Hematology, Ankara Children's Hematology-Oncology Training and Research Hospital, Ankara, Turkey
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Farghaly WM, Abd Elhamed MA, Hassan EM, Soliman WT, Yhia MA, Hamdy NA. Prevalence of childhood and adolescence epilepsy in Upper Egypt (desert areas). Egypt J Neurol Psychiatr Neurosurg 2018; 54:34. [PMID: 30532513 PMCID: PMC6245138 DOI: 10.1186/s41983-018-0032-0] [Citation(s) in RCA: 12] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background A high prevalence of epilepsy in children is frequently found in developing countries. Objective This study aimed to determine the prevalence and clinical pattern of childhood and adolescence epilepsy in Upper Egypt. Methods This is a door-to-door study conducted on all inhabitants < 18 years in Al Kharga district and Al Qusier city (36,195 subjects). The study was conducted through two stages; every stage consisted of two phases (screening and diagnostic). Results Lifetime prevalence of childhood and adolescence epilepsy (children < 18 years) in Upper Egypt was 9.7/1000, with higher prevalence among children < 12 years (10.8/1000) than adolescents (7.2/1000). The age-specific prevalence was highest in early childhood (12.01/1000) and least at adolescence (7.2/1000). More than half of the patients (59.4%) had idiopathic epilepsy. The most frequent etiology for structural/metabolic epilepsy was perinatal complications, particularly in infancy, followed by central nervous system (CNS) infections, in childhood, and post-traumatic epilepsy in adolescence. Partial seizures were more frequent in infancy, while generalized seizures were more frequent in late childhood and adolescence. Generalized tonic-clonic seizures (GTCS) were the most frequent type of seizures. Conclusion Prevalence of childhood and adolescence epilepsy in Upper Egypt was not so much different from other developing countries. Idiopathic epilepsy was more prevalent than structural/metabolic cases. Perinatal complications, CNS infections, and head injury were the most frequent etiologies, and generalized tonic-clonic seizures were the most frequent seizure type. Electronic supplementary material The online version of this article (10.1186/s41983-018-0032-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Enas M Hassan
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Wael T Soliman
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Mohamed A Yhia
- 2Department of Neurology, Minia University, Minya, Egypt
| | - Nermin A Hamdy
- 2Department of Neurology, Minia University, Minya, Egypt
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Okamoto K, Fukuda M, Saito I, Horiuchi I, Okazawa T, Ishii E. Incidence of childhood epilepsy: A population-based study in rural Japan. Brain Dev 2018; 40:904-908. [PMID: 29934113 DOI: 10.1016/j.braindev.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/10/2017] [Accepted: 06/05/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Epilepsy is a common childhood neurological condition and a major public health concern worldwide. A higher incidence of epilepsy is reported in low- and middle-income countries, particularly in rural areas. However, no Japanese reports on the incidence of childhood epilepsy have been published in the past 25 years. We estimated the annual incidence of epilepsy in children aged 1-14 years in Uwajima, a city in a rural, relatively isolated area of Japan. METHODS Candidates were extracted from Japan's public insurance database following the International Classification of Diseases code for epilepsy. Epilepsy was defined as two or more unprovoked seizures more than 24 hours apart, as per the International League Against Epilepsy definition. The study sample was divided into three cohorts based on age at diagnosis: 1-4, 5-9, and 10-14 years. The incidence of epilepsy was calculated as the number of children with epilepsy divided by the person-years in each cohort. RESULTS The annual incidence rate of epilepsy in children aged 1-14 years was 70.4/100,000 children (95% confidence interval, 44.8-96.0). There was no significant difference in incidence between boys and girls. This rate was similar to those reported in other countries, although the incidence in children aged 1-4 years was slightly higher in our study than in other countries. CONCLUSION The annual incidence of childhood epilepsy in rural areas of Japan is generally comparable with rates of childhood epilepsy reported in other countries.
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Affiliation(s)
- Kentaro Okamoto
- Department of Regional Pediatrics and Perinatology, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan; Department of Pediatrics, Uwajima City Hospital, 1-1 Gotenmachi, Uwajima, Ehime 798-8510, Japan.
| | - Mitsumasa Fukuda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Isao Saito
- Department of Community Health Systems Nursing, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Isaku Horiuchi
- Department of Pediatrics, Asahigawasou South Ehime Hospital, 607, Naganoichi, Kihoku, Ehime 798-1333, Japan
| | - Tomoko Okazawa
- Okazawa clinic, 1976, Mishohirajo, Ainan, Ehime 798-4110, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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Ozanne A, Verdinelli C, Olsson I, Edelvik A, H Graneheim U, Malmgren K. Callosotomy in children - Parental experiences reported at long-term follow-up. Epilepsy Behav 2018; 86:91-97. [PMID: 30153937 DOI: 10.1016/j.yebeh.2018.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/18/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
Abstract
Callosotomy is a palliative surgery method for selected individuals with severe, drug-resistant epilepsy. The aim of this retrospective study was to explore parental experiences of the family's life situation before and long after their child had undergone callosotomy. Semistructured interviews of the parents of 12 children were analyzed using a combination of inductive and deductive qualitative content analysis. Before surgery, parents felt that they lived in a chaotic bubble with an unbearable situation; their child had severe and frequent seizures and had to be looked after constantly. Most parents were both satisfied and dissatisfied with the given support and information. However, if the child did not improve after surgery, parents often felt that the information before surgery had not been adequate. After surgery, they found a glimpse of hope. They felt that the family got a new life; the reduced seizure severity led to a better life situation for the family. The support was described as both good and poor. The family life situation was complex, and even if they were partly satisfied with the support, it was still not enough. However, the life situation was also very stressful because of remaining seizures, behavioral problems, and sometimes, adverse effects of surgery. The families lived in disappointment and difficulty and had to fight for their rights. This indicates that these families need more information and social service coordination both before and long after surgery. They need not only tools to manage the child's disabilities but also substantial help to care for the child and to receive the social support they need.
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Affiliation(s)
- Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg,Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 410, 405 30 Gothenburg, Sweden.
| | - Cecilia Verdinelli
- Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ingrid Olsson
- Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Edelvik
- Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 410, 405 30 Gothenburg, Sweden.
| | - Ulla H Graneheim
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden; Department of Health Sciences, University West, Trollhättan, Sweden.
| | - Kristina Malmgren
- Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 410, 405 30 Gothenburg, Sweden.
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Deopa B, Parakh M, Dara P, Payal V, Chordiya K, Panday A, Singh S, Parashar D. Effect of Folic Acid Supplementation on Seizure Control in Epileptic Children Receiving Long Term Antiepileptic Therapy. Indian J Pediatr 2018; 85:493-7. [PMID: 29368110 DOI: 10.1007/s12098-018-2608-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of folic acid supplementation on seizure control in folate deficient children receiving long term antiepileptic therapy. METHODS In a prospective interventional study, 140 children between age group 6 mo to 180 mo fulfilling the inclusion criteria were enrolled in study group, from October 2015 through November 2016. On the basis of serum folate, study group was divided into two subgroups by non randomization: Group A (<10 ng/ml) given folic acid supplementation for 3 mo and Group B (>10 ng/ml) was not supplemented. Response to folic acid supplementation in group A was compared with group B in terms of change in blood folate levels, frequency and duration of seizures after three months. RESULTS Mean age of study group was 73.58 ± 46.89 mo (72.14% boys and 27.85% girls). 67.85% children were in group A and 32.14% in group B. On 3 mo follow up, children supplemented with folic acid (Group A) had significant fall in mean seizure frequency while in non-supplemented children (Group B), no significant change was seen (p value <0.05). Similar reduction in duration of seizure episode was seen in group A as compared to group B. Serum and RBC folate levels improved from baseline in group A, while in group B there was significant fall in folate levels. CONCLUSIONS Folate deficiency is common in epileptic children on long term antiepileptic drugs (AEDs), contributes to poor seizure control and should be considered in the etiologic differentials of drug resistant epilepsy. Folate supplementation improves seizure control in these children.
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Garcia-Tarodo S, Datta AN, Ramelli GP, Maréchal-Rouiller F, Bien CG, Korff CM. Circulating neural antibodies in unselected children with new-onset seizures. Eur J Paediatr Neurol 2018; 22:396-403. [PMID: 29291919 DOI: 10.1016/j.ejpn.2017.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/18/2017] [Revised: 10/04/2017] [Accepted: 12/11/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The role of autoimmunity and neural antibodies is increasingly recognized in different forms of seizures and epilepsy. Their prevalence in new-onset epilepsy has also recently been the focus of several clinical cohorts in the adult and pediatric population, with positive titers in 10-11% of cases. Our aim was to determine the seropositivity at the first seizure onset in a non-selective group of children. METHOD We conducted a prospective multicenter cohort study recruiting children aged 0-16 years with new-onset seizures presenting at the In- and Outpatient Pediatric Neurology Departments of three Children's Hospitals in Switzerland between September 2013 and April 2016. Neural antibodies were screened within the first 6 months of a first seizure and when positive, repeated at 1 month and 6 months follow-up. RESULTS A total of 103 children were enrolled with a mean age at presentation of 5 years (range 1 day-15 years 9 months). The majority (n = 75) presented with generalized seizures and 6 had status epilepticus lasting > 30 min. At the time of onset, 55% of patients had fever, 24% required emergency seizure treatment and 27% hospitalization. Epilepsy was diagnosed at follow-up in 18%. No specific antibody was found. Serum antibodies against the VGKC complex, without binding to the specific antigens LGI1 and CASPR2, were found in two patients. Four patients harbored not otherwise characterized antibodies against mouse neuropil. INTERPRETATION Specific neural antibodies are rarely found in an unselected population of children that present with a first seizure. Applying an extensive neuronal antibody profile in a child with new-onset seizures does not appear to be justified.
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Affiliation(s)
- Stephanie Garcia-Tarodo
- Paediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre N Datta
- Department of Pediatric Neurology and Developmental Medicine, University of Basel, Children's Hospital, Basel, Switzerland
| | - Gian P Ramelli
- Department of Paediatrics, Regional Hospital San Giovanni, Bellinzona, Switzerland
| | | | | | - Christian M Korff
- Paediatric Neurology Unit, Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
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Kobayashi K, Ohuchi Y, Shibata T, Hanaoka Y, Akiyama M, Oka M, Endoh F, Akiyama T. Detection of fast (40-150 Hz) oscillations from the ictal scalp EEG data of myoclonic seizures in pediatric patients. Brain Dev 2018; 40:397-405. [PMID: 29395662 DOI: 10.1016/j.braindev.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/31/2017] [Accepted: 01/15/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We explored fast (40-150 Hz) oscillations (FOs) from the ictal scalp electroencephalogram (EEG) data of myoclonic seizures in pediatric patients to obtain insight into the pathophysiological mechanisms involved in the generation of myoclonic seizures. SUBJECTS AND METHODS The participants were 21 children (11 boys, 10 girls; age ranging from 5 months to 17 years 2 months) with myoclonic seizures associated with generalized (poly)spike-wave bursts in the ictal EEG data. The patients had heterogeneous etiologies and epilepsy diagnoses. In the ictal data, we detected FOs that clearly showed oscillatory morphology in filtered EEG traces and an outstanding spectral blob in time-frequency analysis. RESULTS We identified FOs in 61 (88.4%) of all 69 myoclonic seizures. Every patient had at least one myoclonic seizure-associated FO. The observed FOs were embedded in the spike component of (poly)spike-wave discharges, and they had a focal distribution with frontal predominance. They ranged in frequency from 41.0 to 123.0 Hz and involved both the gamma and ripple bands, and their spectral peak frequencies were higher in the group of patients with a genetic background free of apparent fundamental brain pathology than in the group of other patients (p = 0.019). CONCLUSION FOs were found to represent at least part of the cortical pathophysiological process in the generation of myoclonic seizures that should involve the thalamocortical network system.
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Rodrigues C, Chhun S, Chiron C, Dulac O, Rey E, Pons G, Jullien V. A population pharmacokinetic model taking into account protein binding for the sustained-release granule formulation of valproic acid in children with epilepsy. Eur J Clin Pharmacol 2018; 74:793-803. [PMID: 29564480 DOI: 10.1007/s00228-018-2444-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/06/2017] [Accepted: 03/12/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE The objective of this work was to develop a population pharmacokinetic model for a prolonged-release granule formulation of valproic acid (VPA) in children with epilepsy and to determine the doses providing a VPA trough concentration (Ctrough) within the target range (50-100 mg/L). METHODS Ninety-eight children (1-17.6 years, 325 plasma samples) were included in the study. The model was built with NONMEM 7.3. The probability to obtain Ctrough between 50 and 100 mg/L was determined by the Monte Carlo simulations for doses of 20, 30, 40, and 60 mg/kg/day and body weights between 10 and 70 kg. RESULTS A one compartment model, with first-order absorption and flip-flop parameterization and linear elimination, but taking protein binding into account, was used to describe the data. Typical values for unbound VPA clearance and distribution volume were 6.24 L/h/70 kg and 130 L/h/70 kg respectively. Both parameters were related to body weight via allometric models. The highest probability to obtain a Ctrough within the target range for 10-kg children was obtained with a 40 mg/kg daily dose, whereas daily doses of 30 and 20 mg/kg were found appropriate for 20 to 30- and ≥ 40-kg children respectively. However, for these same doses, the exposure to unbound VPA could differ by 40%. CONCLUSIONS If the present study supports the current dose recommendations of 20-30 mg/kg/day, except for children under 20 kg, who may need higher doses, it also highlights the need for further research on the pharmacokinetics/pharmacodynamic profile of unbound VPA.
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Affiliation(s)
| | - Stéphanie Chhun
- Hôpital Necker-Enfants Malades - Enfants Malades, Inserm U1151, INEM, Laboratoire d'immunologie biologique, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Catherine Chiron
- INSERM U1129, Paris Descartes University, CEA, Gif-sur-Yvette, Paris, France
| | - Olivier Dulac
- INSERM U1129, Paris Descartes University, CEA, Gif-sur-Yvette, Paris, France
| | - Elisabeth Rey
- INSERM U1129, Paris Descartes University, CEA, Gif-sur-Yvette, Paris, France
| | - Gérard Pons
- INSERM U1129, Paris Descartes University, CEA, Gif-sur-Yvette, Paris, France
| | - Vincent Jullien
- INSERM U1129, Paris Descartes University, CEA, Gif-sur-Yvette, Paris, France. .,Service de Pharmacologie, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
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Dal Canto G, Pellacani S, Valvo G, Masi G, Ferrari AR, Sicca F. Internalizing and externalizing symptoms in preschool and school-aged children with epilepsy: Focus on clinical and EEG features. Epilepsy Behav 2018; 79:68-74. [PMID: 29253677 DOI: 10.1016/j.yebeh.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Psychiatric and behavioral problems are frequent comorbidities of epilepsy, although their clinical and electroencephalographic (EEG) correlates remain uncertain. In this study, we have assessed the frequency of psychopathological problems in a cohort of children with epilepsy, and established their main clinical and EEG-associated features. METHODS One hundred fifty-nine young patients with epilepsy were recruited and assessed through the Child Behavior Checklist for preschool-aged children (CBCL 1 1/2-5) or for school-aged children (CBCL 6-18). Child Behavior Checklist (CBCL) results were then correlated to the main clinical and EEG data. RESULTS We found emotional and behavioral problems in about half of the children in our sample. Internalizing, social, and attention problems were more common than externalizing features. Moderate intellectual disability, a nonidiopathic etiology of epilepsy, a poor control of seizures, and antiepileptic polytherapies, as well as an early age at seizure-onset and a longer duration of the disorder, were all associated with specific behavioral and emotional problems. A temporal site of interictal EEG abnormalities also enhanced the risk for psychiatric comorbidities, especially in the externalizing domain. CONCLUSIONS Several clinical and EEG features are associated with an increased risk for emotional and behavioral comorbidities in children with epilepsy. Their identification may foster an early diagnosis and appropriate care, limiting the worsening of psychiatric symptoms and their impact on quality of life and health status. A better understanding of the underlying clinical and molecular mechanisms is needed to further improve prevention and treatment interventions.
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Affiliation(s)
- Giulia Dal Canto
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Simona Pellacani
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Giulia Valvo
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Gabriele Masi
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy
| | - Federico Sicca
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Via dei Giacinti 2, Calambrone, 56128 Pisa, Italy.
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