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Alencar SD, Cendes F, de Morais ABCG, Ribeiro VCAF, Frota NAF, Pinto LF. Déjà vu in idiopathic generalized epilepsy: A systematic review. Seizure 2024; 118:53-57. [PMID: 38640571 DOI: 10.1016/j.seizure.2024.03.015] [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: 09/15/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Déjà vu (DV), a French term meaning "already seen," refers to inappropriate sensation of familiarity in the present moment, as if it had been experienced before without a specific recollection of when or where. Traditionally, DV has been closely associated with focal seizures originating from the medial temporal lobe. However, there are occasional reports of DV occurring in idiopathic generalized epilepsies (IGEs). The objective of our study was to assess the presence and frequency of DV in individuals with IGE. METHODS We used the Preferred Reporting Items for Systematic Review and Meta-Analysis for protocols (PRISMA-P) and searched PubMed and Embase from January 2000 to July 2022. RESULTS 5 studies were included with a total of 1177 IGE and 1026 with temporal lobe epilepsy (TLE) patients. The frequency of DV in IGE ranged from 0 to 11 %, and the average was 3 %, compared to 19.6 % in TLE. Broadly, 40 % of patients with IGE reported some type of aura. EEG correlation of DV in IGE was not appropriately evaluated in the studies. CONCLUSION Clinicians should be aware that individuals with IGE may experience DV and other types of auras. Recognizing these auras is crucial in order to avoid misdiagnosing IGE as focal epilepsy. This is important to prevent unnecessary investigations and incorrect treatment decisions.
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Cengiz DU, Çolak SC, Özdemir EA, Adıgüzel A. Effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy. Epilepsy Behav 2024; 151:109622. [PMID: 38219606 DOI: 10.1016/j.yebeh.2024.109622] [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: 09/26/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND It is reported that antiepileptic drugs have an effect on balance functions. The aim of the study was to evaluate and compare the effects of valproic acid and levetiracetam monotherapy on balance functions in patients with generalized epilepsy using objective test methods. METHODS The study included 43 generalized epilepsy patients aged 18-60 years, including 20 patients receiving valproic acid monotherapy, 23 patients receiving levetiracetam monotherapy, and 25 healthy individuals as controls, in the Neurology Clinic of a university hospital in eastern Turkey. The demographic data form was filled out and the Video Head Impulse Test and Vestibular Evoked Myogenic Potentials test were performed. RESULTS Statistically significant differences were obtained between the groups in lateral, posterior, and anterior semicircular canal gains and RALP and LARP asymmetry values in the V-HIT test (p < 0.05). Statistically significant differences were obtained between the groups in P1, N1 latency and asymmetry values in the C-VEMP test and in N1, P1 latency, amplitude, and asymmetry values in the o-VEMP test (p < 0.05). CONCLUSION Valproic acid and levetiracetam may affect the vestibulocular and vestibulocolic reflex pathways negatively. In this cohort, valproic acid had more pronounced adverse effects on balance functions as compared to levetiracetam.
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Affiliation(s)
- Deniz Uğur Cengiz
- Department of Audiology, Faculty of Health Sciences, İnönü University, Malatya, Turkey.
| | - Sanem Can Çolak
- Department of Audiology, Faculty of Health Sciences, İnönü University, Malatya, Turkey.
| | - Emre Akgün Özdemir
- Department of Audiology, Institute of Health Sciences, İnönü University, Malatya, Turkey.
| | - Ahmet Adıgüzel
- Department of Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey.
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Abstract
Intracranial neuromodulation is an evolving therapy for patients with drug-resistant epilepsy (DRE). Deep brain stimulation (DBS) is now available as a therapy for patients with DRE and focal-onset seizures in select health care systems; however, there remains a substantial need of efficacy data before DBS can be more widely adopted into routine clinical practice. This review and commentary focuses on a particular shifting paradigm: DBS as a therapy for children with generalized-onset seizures.
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Affiliation(s)
- Rory J Piper
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Neurosurgery, Great Ormond Street Hospital, London, UK.
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Martin M Tisdall
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK; Department of Neurosurgery, Great Ormond Street Hospital, London, UK
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Lyu J, Wang JB, Quan Y, Zhang X, Gong SP, Qu JQ, Huang SP. Effectiveness of vagus nerve stimulation for drug-resistant generalized epilepsy in children aged six and younger. Neurochirurgie 2023; 69:101500. [PMID: 37742915 DOI: 10.1016/j.neuchi.2023.101500] [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: 02/08/2023] [Revised: 05/28/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND To explore a novel scoring system to evaluate the efficacy of vagus nerve stimulation (VNS) in children with drug-resistant generalized epilepsy (DRGE) aged six and younger. BASIC PROCEDURES The data of twelve children with DRGE under the age of 6 years who accepted VNS and have been followed up for at least 3 years were retrospectively reviewed. The outcome was evaluated with the McHugh Classification System and a novel scoring system we proposed. MAIN FINDINGS Based on the McHugh Classification System, the total response rate was 91.67% (11/12) and the rate of Grade I was 41.67% (5/12). A novel scoring system involving seizure frequency, seizure duration and quality of life (QOL) was proposed, by which the outcome was scored from -3 to 11 and graded from IV to I. Based on the novel scoring system, the total response rate was 91.67% (11/12) and the rate of Grade I was 33.33% (4/12). The incidence of complication was 16.67% (2/12). The efficacy of VNS appeared a gradually improving trend with plateau or fluctuation over time. Shorter course of epilepsy prior to VNS may be related to better outcome. PRINCIPAL CONCLUSIONS VNS could effectively reduce the seizure frequency and improve the QOL of children with DRGE aged six and younger. The novel scoring system was comprehensive and feasible to evaluate the efficacy of VNS. The time pattern of the long-term efficacy of VNS requires further investigation.
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Affiliation(s)
- Jian Lyu
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Ju-Bo Wang
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Yu Quan
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Xi Zhang
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Shou-Ping Gong
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Jian-Qiang Qu
- Neurosurgical Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
| | - Shao-Ping Huang
- Pediatric Department, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710004, China
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5
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Revdal E, Kolstad BP, Winsvold BS, Selmer KK, Morken G, Brodtkorb E. Psychiatric comorbidity in relation to clinical characteristics of epilepsy: A retrospective observational study. Seizure 2023; 110:136-143. [PMID: 37379699 DOI: 10.1016/j.seizure.2023.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
PURPOSE Prevalence of psychiatric disorders in people with epilepsy is high. However, diagnostic validity and information about the nature of the seizure disorders are often poor in population-based studies. In a well validated and classified patient sample, we investigated psychiatric comorbidity according to clinical characteristics. METHOD Participants in The Trøndelag Health Study (HUNT) with ≥ 2 diagnostic epilepsy codes during 1987-2019 were identified. Medical records were reviewed, and epilepsy was validated and classified according to ILAE. Psychiatric comorbidity was defined by ICD-codes. RESULTS In 448 individuals with epilepsy, 35% had at least one psychiatric disorder (anxiety and related disorders 23%, mood disorders 15%, substance abuse and personality disorders 7%, and psychosis 3%). Comorbidity was significantly higher in women than in men (p = 0.007). The prevalence of psychiatric disorders was 37% in both focal and generalized epilepsy. In focal epilepsy, it was significantly lower when etiology was structural (p = 0.011), whereas it was higher when the cause was unknown (p = 0.024). Comorbidity prevalence was 35% both in patients achieving seizure freedom and in those with active epilepsy but 38% among 73 patients with epilepsy resolved. CONCLUSION Just over one third of people with epilepsy had psychiatric comorbidities. The prevalence was equal in focal and generalized epilepsy but was significantly higher in focal epilepsy of unknown cause compared to lesional epilepsy. Comorbidity was independent of seizure control at last follow-up but was slightly more common in those with resolved epilepsy, often having non-acquired genetic etiologies possibly linked to neuropsychiatric susceptibility.
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Affiliation(s)
- Eline Revdal
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway.
| | - Bjørn Patrick Kolstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway; Department of Public Health and Nursing, NTNU, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kaja Kristine Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Division of Clinical Neuroscience, National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Gunnar Morken
- Department of Psychiatry, St Olav University Hospital, Trondheim, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim N-7491, Norway
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Videira G, Raimundo R, Chorão R. Epilepsy with myoclonic absences: A case series. Seizure 2023; 106:162-163. [PMID: 36893512 DOI: 10.1016/j.seizure.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- Gonçalo Videira
- Department of Neurophysiology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto 4099-001, Portugal.
| | - Rita Raimundo
- Department of Neurology, Centro Hospitalar Trás-os-Montes e Alto Douro, Portugal
| | - Rui Chorão
- Department of Neurophysiology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto 4099-001, Portugal
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Abstract
Motor semiology is a major component of epilepsy evaluation, which provides essential information on seizure classification and helps in seizure localization. The typical motor seizures include tonic, clonic, tonic-clonic, myoclonic, atonic, epileptic spasms, automatisms, and hyperkinetic seizures. Compared to the "positive" motor signs, negative motor phenomena, for example, atonic seizures and Todd's paralysis are also crucial in seizure analysis. Several motor signs, for example, version, unilateral dystonia, figure 4 sign, M2e sign, and asymmetric clonic ending, are commonly observed and have significant clinical value in seizure localization. The purpose of this chapter is to review the localization value and pathophysiology associated with the well-defined motor seizure semiology using updated knowledge from intracranial electroencephalographic recordings, particularly stereoelectroencephalography.
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Affiliation(s)
- Shasha Wu
- Department of Neurology and the Comprehensive Epilepsy Center, The University of Chicago, Chicago, IL, United States.
| | - Douglas R Nordli
- Department of Pediatrics and the Comprehensive Epilepsy Center, The University of Chicago, Chicago, IL, United States
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8
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Ripatti L, Puustinen L, Rautava P, Koivisto M, Haataja L. Impact of epilepsy on the risk of hospital-treated injuries in Finnish children. Epilepsy Behav Rep 2023; 21:100587. [PMID: 36935841 PMCID: PMC10015441 DOI: 10.1016/j.ebr.2023.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Objectives To study the effect of epilepsy on the risk of injury in children. Methods All first-born singleton children (n = 133055) born in 2001 - 2006 in Finland were included. Data was collected from national registers up to the first hospital-treated injury during the five years following the onset of epilepsy. Four matched controls were chosen for every subject. Results Epilepsy had been diagnosed in 0.66 % of children. During follow-up, 12 % of 884 children with epilepsy and 9 % of 3536 controls were hospitalized for injuries (HR 1.387 [95 % CI 1.115 - 1.725]; p = 0.0033). Risk for injuries was higher in boys than girls (p = 0.0057). Mean age at the first injury was 6.8 years (SD 3.3, median 7, range 0-13) in subjects and 7.2 years (SD 3.2, median 8, range 1-13) in controls (p = 0.272). The rate of hospitalization did not differ according to the type of epilepsy. The risks of subjects compared to controls were not significantly different concerning the nature of injury or survival. Conclusions Children with epilepsy are at increased risk for hospital-treated injuries. The spectrum of injuries and the risk for death due to injuries are not different in children with and without epilepsy.
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Affiliation(s)
- Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital and University of Turku, Turku, Finland
- Corresponding author at: Department of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, PL 52, FI-20520 Turku, Finland.
| | - Laura Puustinen
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Leena Haataja
- Children's Hospital, Pediatric Research Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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9
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Suzgun MA, Demirbilek V. Isolated Unilateral EEG Findings in Juvenile Myoclonic Epilepsy: A Case Report. J Epilepsy Res 2022; 12:74-77. [PMID: 36685744 PMCID: PMC9830026 DOI: 10.14581/jer.22014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
Juvenile myoclonic epilepsy (JME) has well-defined clinical and electrophysiological features. On the other hand, large case series have shown that focal and asymmetrical discharges may accompany generalized epileptiform activities in JME. Although it is known that these non-generalized electrophysiological findings do not exclude the diagnosis of this syndrome, some findings may create confusion in the differential diagnosis. In this case report, a case of JME with electroencephalographic findings characterized by isolated unilateral epileptiform activities without typical generalized discharges was discussed. The current case clinically presented with involuntary jerk movements in the bilateral upper extremities. It has been determined that these movements are uni/bilateral myoclonic beats based on home video recordings. Metabolic, toxic and structural problems were excluded in the investigations for the etiology of myoclonus. In the electrophysiological examination performed for epileptic processes, epileptiform discharges localized to the isolated right hemisphere were observed. JME was considered primarily due to clinical findings in the patient, and effective seizure control was achieved in a 4-year follow-up under anti-seizure treatment. The peculiarity of the case is the presence of electrophysiology recordings of isolated unilateral epileptiform activity during the 4-year follow-up period. It should be emphasized that there is no case of JME diagnosed with isolated unilateral epileptiform activity in the absence of generalized spike-slow waves or multiple spike-slow waves in the literature.
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Affiliation(s)
- Merve Aktan Suzgun
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Veysi Demirbilek
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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10
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Gurses AA, Genc E, Gurses KM, Altiparmak T, Yildirim I, Genc BO. QT interval alterations in epilepsy: A thorough investigation between epilepsy subtypes. J Clin Neurosci 2022; 104:113-117. [PMID: 36027652 DOI: 10.1016/j.jocn.2022.08.014] [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: 05/04/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Cardiac disturbances and rhythm abnormalities which potentially lead sudden unexpected death in epilepsy, have been extensively studied in focal epilepsies. However, studies including generalized epilepsies are scarce and it is not clear whether electrocardiogram parameters reflecting vulnerability to ventricular arrhythmias differ between these groups. METHODS Medical records of patients who were followed in epilepsy department of a tertiary center between October 2015 and September 2016 were retrospectively reviewed. 66 generalized and 64 focal epilepsy patients with eligible electrophysiological data were analyzed. QTc interval, QTcd and other electrocardiographic indices were compared between patients with focal vs generalized epilepsy. Another analysis was performed in order to disclose any difference between patients with epilepsy (n:130) and psychogenic non-epileptic seizures. A two-tailed p value < 0.05 was considered significant. RESULTS There was no difference in terms of QTc and QTcd between patients with focal and generalized epilepsy [median: 406 ms vs 404 ms, p = 0.119; and median: 46 ms vs 44 ms, p = 0.497, respectively]. However patients with epilepsy were found to have longer QTc and QTcd when compared to ones with psychogenic non-epileptic seizures (p = 0.035 and p < 0.001, respectively). CONCLUSION Current findings demonstrate that patients with epilepsy have longer QTc and QTcd than patients with pure psychogenic non-epileptic seizures. Since there was no difference between patients with focal and generalized epilepsy; QTc interval, QTcd and potential susceptibility to cardiac arrhythmias as a result, could be a consequence of epilepsy itself regardless of origin.
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Affiliation(s)
- Asli Akyol Gurses
- Gazi University School of Medicine, Department of Neurology (Division of Clinical Neurophysiology), 906560 Ankara, Turkey.
| | - Emine Genc
- Necmettin Erbakan University, Meram School of Medicine, Department of Neurology, 9042080 Konya, Turkey
| | - Kadri Murat Gurses
- Konya Training and Research Hospital, Cardiology Clinic, 9042080 Konya, Turkey
| | - Taylan Altiparmak
- Gazi University School of Medicine, Department of Neurology (Division of Clinical Neurophysiology), 906560 Ankara, Turkey
| | - Irem Yildirim
- Gazi University School of Medicine, Department of Neurology (Division of Clinical Neurophysiology), 906560 Ankara, Turkey
| | - Bulent Oguz Genc
- Necmettin Erbakan University, Meram School of Medicine, Department of Neurology, 9042080 Konya, Turkey
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11
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Abstract
PURPOSE OF REVIEW To summarize current evidence and recent developments in the surgical treatment of drug-resistant generalized epilepsy. RECENT FINDINGS Current surgical treatments of drug-resistant generalized epilepsy include vagus nerve stimulation (VNS), deep brain stimulation (DBS) and corpus callosotomy (CC). Neurostimulation with VNS and/or DBS has been shown to be effective in reducing seizure frequency in patients with generalized epilepsy. DBS for generalized epilepsy is primarily consisted of open-loop stimulation directed at the centromedian (CM) nucleus in the thalamus, though closed-loop stimulation and additional targets are being explored. CC can be effective in treating some seizure types and can be performed using traditional surgical techniques or with the less invasive methods of laser ablation and radiosurgery. This current literature supports the use of VNS, DBS and CC, alone or in combination, as palliative treatments of drug-resistant generalized epilepsy.
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12
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Gesche J, Cornwall CD, Delcomyn L, Rubboli G, Beier CP. Pseudoresistance in idiopathic/genetic generalized epilepsies - Definitions, risk factors, and outcome. Epilepsy Behav 2022; 130:108633. [PMID: 35306367 DOI: 10.1016/j.yebeh.2022.108633] [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: 12/20/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the study was to determine risk factors associated with pseudoresistance in a large, representative cohort of patients with Idiopathic/Genetic Generalized Epilepsy (IGE) and the impact of pseudoresistance on socioeconomic parameters. METHODS We performed a literature review on definitions of pseudoresistance in IGE. In an established cohort of patients with IGE from Funen, patients with current or previous pseudoresistant seizures were retrospectively identified based on a comprehensive evaluation of the patients' medical records and direct patient contact, if required. In addition, clinical characteristics, socioeconomic, and demographic data were assessed. Personal interviews were used to determine the brief version of Barratts (BIS-8) impulsivity score. RESULTS The literature review provided the following definition of pseudoresistance: Seizures due to (I) lacking adherence to antiseizure medication (ASM), (II) incompliance to general rule of conduct, (III) psychogenic nonepileptic seizures (PNES), (IV) inadequate choice of ASM/dosage, and (V) incorrect classification of epilepsy. Applying criteria I-III to a cohort of patients with IGE (n = 499), 73 patients (14.6%) were currently pseudoresistant and 62 (12.4%) were previously pseudoresistant, but currently seizure free. Current pseudoresistance was associated with younger age, drug/alcohol abuse, lower rate of full-time employment, and higher BIS-8 scores. We found no associations of pseudoresistance with juvenile myoclonic epilepsy, psychiatric disease, specific seizure types, or number of seizure types. Patients with previously pseudoresistant seizures have tried more ASMs and were characterized by male preponderance, higher BIS-8, and higher rates of abuse. Surrogate markers for social outcome did not differ. SIGNIFICANCE In IGE, pseudoresistance may be defined as PNES or insufficient adherence to medication/conduct and is associated with younger age, drug/alcohol abuse, and higher scores for impulsivity. If transient, its impact on socioeconomic status remains limited but may be associated with a risk of overtreatment with ASM.
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Affiliation(s)
- Joanna Gesche
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Camilla Dyremose Cornwall
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Line Delcomyn
- Department of Neurology, Odense University Hospital, Denmark
| | - Guido Rubboli
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Epilepsy Centre, Dianalund, Denmark
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark; OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
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13
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Yang X, Chen Z, Wang Z, He G, Li Z, Shi Y, Gong N, Zhao B, Kuang Y, Takahashi E, Li W. A natural marmoset model of genetic generalized epilepsy. Mol Brain 2022; 15:16. [PMID: 35144651 PMCID: PMC8832845 DOI: 10.1186/s13041-022-00901-2] [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: 12/28/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Epilepsy has been extensively studied as a common neurological disease. Efforts have been made on rodent and other animal models to reveal the pathogenic mechanisms of epilepsy and develop new drugs for treatment. However, the features of current epilepsy models cannot fully mimic different types of epilepsy in humans, hence non-human primate models of epilepsy are required. The common marmoset (Callithrix jacchus) is a New World monkey that is widely used to study brain function. Here, we present a natural marmoset model of generalized epilepsy. In this unique marmoset family, generalized epilepsy was successfully induced by handling operations in some individuals. We mapped the marmoset family with handling-sensitive epilepsy and found that the epileptic phenotype can be inherited. These marmosets were more sensitive to the epilepsy inducers pentylenetetrazol. Using electrocorticogram (ECoG) recordings, we detected epileptiform discharge in marmosets with a history of seizures. In summary, we report a family of marmosets with generalized seizures induced by handling operations. This epileptic marmoset family provides insights to better understand the mechanism of generalized epilepsy and helps to develop new therapeutic methods.
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Affiliation(s)
- Xiangyu Yang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhitang Chen
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Ziying Wang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Guang He
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Neng Gong
- Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Binglei Zhao
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yifang Kuang
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Eiki Takahashi
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Weidong Li
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders (Ministry of Education), Shanghai Key Laboratory of Psychotic Disorders, and Brain Science and Technology Research Center, Institute of Psychology and Behavioral Sciences, Shanghai Jiao Tong University, Shanghai, 200240, China. .,WLA Laboratories, World Laureates Association, Shanghai, 201203, China.
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14
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Dharan AL, Bowden SC, Lai A, Peterson ADH, Cheung MWL, Woldman W, D'Souza WJ. Source data from a systematic review and meta-analysis of EEG and MEG studies investigating functional connectivity in idiopathic generalized epilepsy. Data Brief 2021; 39:107665. [PMID: 34934781 DOI: 10.1016/j.dib.2021.107665] [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: 10/27/2021] [Revised: 11/27/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
This article describes source data from a systematic review and meta-analysis of electroencephalography (EEG) and magnetoencephalography (MEG) studies investigating functional connectivity in idiopathic generalized epilepsy. Data selection, analysis and reporting was performed according to PRISMA guidelines. Eligible studies for review were identified from human case-control, and cohort studies. Twenty-two studies were included in the review. Extracted descriptive data included sample characteristics, acquisition of EEG or MEG recordings and network construction. Reported differences between IGE and control groups in functional connectivity or network metrics were extracted as the main outcome measure. Qualitative group differences in functional connectivity were synthesized through narrative review. Meta-analysis was performed for group-level, quantitative estimates of common network metrics clustering coefficient, path length, mean degree and nodal strength. Six studies were included in the meta-analysis. Risk of bias was assessed across all studies. Raw and synthesized data for included studies are reported, alongside effect size and heterogeneity statistics from meta-analyses. Network neurosciences is a rapidly expanding area of research, with significant potential for clinical applications in epilepsy. This data article provides novel, statistical estimates of brain network differences from patients with IGE relative to healthy controls, across the existing literature. Increasing data accessibility supports study replication and improves study comparability for future reviews, enabling a better understanding of network characteristics in IGE.
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Affiliation(s)
- Anita L Dharan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.,Department of Clinical Neurosciences, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Alan Lai
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Andre D H Peterson
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
| | - Mike W-L Cheung
- Department of Psychology, National University of Singapore, Singapore
| | - Wessel Woldman
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Edgbaston, United Kingdom
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia
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15
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Vajda FJE, Brien TJO, Graham JE, Hitchcock AA, Perucca P, Lander CM, Eadie MJ. The control of treated generalized and focal epilepsies during pregnancy. Epilepsy Behav 2021; 125:108406. [PMID: 34775246 DOI: 10.1016/j.yebeh.2021.108406] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine factors contributing to failure to achieve full seizure control during pregnancy in women with anti-seizure medication (ASM) treated generalized epilepsy compared with focal epilepsy. RESULTS Full seizure control was not attained in 51.4% of 1223 pregnancies of women with focal epilepsies in the Australian Pregnancy Register, and in 38.7% of 1026 pregnancies in women with generalized epilepsy (P < 0.05). For convulsive seizures only, the corresponding figures of 20.8% and 22.9% were reasonably similar. Where seizures had occurred in the pre-pregnancy year, 82.5% of the focal epilepsy pregnancies were seizure affected, and 70.1% of the generalized epilepsy ones (P < 0.05). Where the pre-pregnancy year was seizure free, the corresponding figures were 22.6% and 16.4% (P < 0.05), a roughly four-fold lower rate. Maternal age, epilepsy onset age, and epilepsy duration also differed between the focal and generalized epilepsy pregnancies. Multivariate regression analysis showed that generalized epilepsy and younger maternal age were associated with statistically significant decreased risks of seizure-affected pregnancy, and having seizure-affected pre-pregnancy years with an increased risk. However, for convulsive seizures only, the risk of seizure-affected pregnancy appeared increased in generalized epilepsy. CONCLUSIONS The risk of seizure-affected pregnancy appears lower in women with generalized epilepsy, independently of pre-pregnancy seizure control, itself a major determinant of the risk. The risk of having only convulsive seizures in pregnancy was not lower in generalized epilepsy than in focal epilepsy. ASM therapy seemed less effective in controlling focal than generalized epileptic seizures during pregnancy.
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Affiliation(s)
- Frank J E Vajda
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia.
| | - Terence J O' Brien
- Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia.
| | - Janet E Graham
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050, Australia.
| | - Alison A Hitchcock
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050, Australia.
| | - Piero Perucca
- Departments of Medicine and Neurosciences, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria 3050, Australia; Department of Neuroscience, Monash University, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC 3004, Australia; Department of Medicine, Austin Health, the University of Melbourne, Heidelberg, VIC 3084, Australia; Comprehensive Epilepsy Program, Austin Health, Heidelberg, VIC 3084, Australia.
| | - Cecilie M Lander
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia.
| | - Mervyn J Eadie
- Royal Brisbane and Women's Hospital and School of Medicine and Biomedical Science, University of Queensland, Brisbane, QLD 4027, Australia.
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16
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Villanueva V, D'Souza W, Goji H, Kim DW, Liguori C, McMurray R, Najm I, Santamarina E, Steinhoff BJ, Vlasov P, Wu T, Trinka E; PERMIT pooled analysis participants. PERMIT study: a global pooled analysis study of the effectiveness and tolerability of perampanel in routine clinical practice. J Neurol 2021. [PMID: 34427754 DOI: 10.1007/s00415-021-10751-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
The PERaMpanel pooled analysIs of effecTiveness and tolerability (PERMIT) study was a pooled analysis of data from 44 real-world studies from 17 countries, in which people with epilepsy (PWE; focal and generalized) were treated with perampanel (PER). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness assessments included 50% responder rate (≥ 50% reduction in seizure frequency from baseline) and seizure freedom rate (no seizures since at least the prior visit); in PWE with status epilepticus, response was defined as seizures under control. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs. The Full Analysis Set included 5193 PWE. Retention, effectiveness and safety/tolerability were assessed in 4721, 4392 and 4617, respectively. Retention on PER treatment at 3, 6, and 12 months was 90.5%, 79.8%, and 64.2%, respectively. Mean retention time on PER treatment was 10.8 months. The 50% responder rate was 58.3% at 12 months and 50.0% at the last visit, and the corresponding seizure freedom rates were 23.2% and 20.5%, respectively; 52.7% of PWE with status epilepticus responded to PER treatment. Overall, 49.9% of PWE reported AEs and the most frequently reported AEs (≥ 5% of PWE) were dizziness/vertigo (15.2%), somnolence (10.6%), irritability (8.4%), and behavioral disorders (5.4%). At 12 months, 17.6% of PWEs had discontinued due to AEs. PERMIT demonstrated that PER is effective and generally well tolerated when used to treat people with focal and/or generalized epilepsy in everyday clinical practice.
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Abdelmesih SK, Elkhateeb N, Zakaria M, Girgis MY. Initial levetiracetam versus valproate monotherapy in antiseizure medicine (ASM)-naïve pediatric patients with idiopathic generalized epilepsy with tonic-clonic seizures. Seizure 2021; 91:263-70. [PMID: 34246881 DOI: 10.1016/j.seizure.2021.06.033] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Levetiracetam (LEV) is a second-generation antiseizure medicine (ASM) with broad-spectrum efficacy and tolerability. Few studies have compared the efficacy of valproate (VPA) and LEV as monotherapy in the pediatric population. Herein, we compare the efficacy, tolerability and safety of LEV monotherapy with those of VPA monotherapy in ASM-naïve pediatric patients with idiopathic generalized epilepsy with tonic-clonic (GTC) seizures. METHODS We retrospectively analyzed the clinical and electroencephalographic (EEG) data of these ASM-naïve pediatric patients who were treated with either oral VPA or oral LEV as monotherapy for over 2 years at our center. RESULTS This study included 60 patients with a seizure onset age between 2 months and 12 years. The patients on VPA (29 patients) and LEV monotherapy (31 patients) showed similar favorable 6-month treatment outcomes (complete seizure control in 79.31% vs 80.64%, p = 0.468052). Age at epilepsy onset, epilepsy syndrome, EEG features and ASM dose were not significant predictors of the 6-month treatment outcomes in either group. Lower seizure frequency at presentation was a predictor of favorable 6-month treatment outcomes in the LEV group but not in the VPA group. VPA and LEV treatment showed similar favorable 6-month treatment outcomes in the febrile seizures plus and patients with unidentified epilepsy syndrome subgroups. None of the patients discontinued VPA or LEV due to treatment-associated adverse effects. DISCUSSION Our study showed that compared to VPA monotherapy, LEV monotherapy in ASM-naïve infants and children with idiopathic generalized epilepsy with GTC seizures has a similarly favorable efficacy and tolerability, independent of age, EEG features and epilepsy syndrome.
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Torres Diaz CV, González-Escamilla G, Ciolac D, Navas García M, Pulido Rivas P, Sola RG, Barbosa A, Pastor J, Vega-Zelaya L, Groppa S. Network Substrates of Centromedian Nucleus Deep Brain Stimulation in Generalized Pharmacoresistant Epilepsy. Neurotherapeutics 2021; 18:1665-1677. [PMID: 33904113 PMCID: PMC8608991 DOI: 10.1007/s13311-021-01057-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 02/04/2023] Open
Abstract
Deep brain stimulation (DBS), specifically thalamic DBS, has achieved promising results to reduce seizure severity and frequency in pharmacoresistant epilepsies, thereby establishing it for clinical use. The mechanisms of action are, however, still unknown. We evidenced the brain networks directly modulated by centromedian (CM) nucleus-DBS and responsible for clinical outcomes in a cohort of patients uniquely diagnosed with generalized pharmacoresistant epilepsy. Preoperative imaging and long-term (2-11 years) clinical data from ten generalized pharmacoresistant epilepsy patients (mean age at surgery = 30.8 ± 5.9 years, 4 female) were evaluated. Volume of tissue activated (VTA) was included as seeds to reconstruct the targeted network to thalamic DBS from diffusion and functional imaging data. CM-DBS clinical outcome improvement (> 50%) appeared in 80% of patients and was tightly related to VTAs interconnected with a reticular system network encompassing sensorimotor and supplementary motor cortices, together with cerebellum/brainstem. Despite methodological differences, both structural and functional connectomes revealed the same targeted network. Our results demonstrate that CM-DBS outcome in generalized pharmacoresistant epilepsy is highly dependent on the individual connectivity profile, involving the cerebello-thalamo-cortical circuits. The proposed framework could be implemented in future studies to refine stereotactic implantation or the parameters for individualized neuromodulation.
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Affiliation(s)
| | - Gabriel González-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Rhine Main Neuroscience Network (rmn2), Mainz, Germany.
| | - Dumitru Ciolac
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Rhine Main Neuroscience Network (rmn2), Mainz, Germany
- Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu, State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Marta Navas García
- Department of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | | | - Rafael G Sola
- Department of Neurosurgery, University Hospital La Princesa, Madrid, Spain
| | - Antonio Barbosa
- Department of Neuroradiology, University Hospital La Princesa, Madrid, Spain
| | - Jesús Pastor
- Department of Clinical, Neurophysiology University Hospital La Princesa, Madrid, Spain
| | - Lorena Vega-Zelaya
- Department of Clinical, Neurophysiology University Hospital La Princesa, Madrid, Spain
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University Mainz, Rhine Main Neuroscience Network (rmn2), Mainz, Germany
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19
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Samuel P. Visual Motor and Executive Functioning in Adult Patients with Primary Generalized Epilepsy: A Pilot Study. J Epilepsy Res 2021; 10:62-68. [PMID: 33659197 PMCID: PMC7903041 DOI: 10.14581/jer.20010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/06/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
Background and Purpose Epilepsy is a neuropsychological disorder which can lead to various cognitive deficits of varying levels. Primary generalized epilepsy is characterized by bilateral ictal electroencephalography patterns and excessive neural activity found in both hemispheres of the brain. There is dearth of research on primary generalized epilepsy in adult population. The present study investigates the visual motor and executive functioning deficits in patients with primary generalized epilepsy. Methods Study was conducted on 30 participants (n=30) divided into target and normal control group. Target group consisted of patients diagnosed with primary generalized epilepsy with minimum 5 years of illness. Bender-Gestalt test (BGT) and Wisconsin's Card Sorting Test (WCST) was administered on both the groups. Results A significant difference was found between target group and control group's performances on BGT which indicates that visual motor functioning of control group was better than target group. A significant difference in executive functioning was found in performance of epilepsy patients and non-patients on the domains of WCST. Conclusions Both executive and visuomotor functioning are significantly affected in patients of primary generalized epilepsy in adult patients.
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Affiliation(s)
- Priyanka Samuel
- School of Behavioural Science, National Forensic Sciences University, Gandhinagar, India
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20
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Kokkinos V, Urban A, Sisterson ND, Li N, Corson D, Richardson RM. Responsive Neurostimulation of the Thalamus Improves Seizure Control in Idiopathic Generalized Epilepsy: A Case Report. Neurosurgery 2021; 87:E578-E583. [PMID: 32023343 DOI: 10.1093/neuros/nyaa001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 09/16/2019] [Accepted: 12/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE At least 25% of patients with idiopathic generalized epilepsy do not obtain adequate seizure control with medication. This report describes the first use of responsive neurostimulation (RNS), bilaterally targeting the centromedian/ventrolateral (CM/VL) region in a patient with drug-refractory Jeavons syndrome (eyelid myoclonia with absences). CLINICAL PRESENTATION A patient, diagnosed with eyelid myoclonia with absences (EMA) and refractory to medication, was offered RNS treatment in the CM/VL region of the thalamus. Stimulation was triggered by thalamic neural activity having morphological, spectral, and synchronous features that corresponded to 3- to 5-Hz spike-wave discharges recorded on prior scalp electroencephalography. CONCLUSION RNS decreased daily absence seizures from a mean of 60 to ≤10 and maintained the patient's level of consciousness during the occurring episodes. This therapy should be evaluated further for its potential to treat patients with pharmaco-refractory generalized epilepsy.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alexandra Urban
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ningfei Li
- Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Danielle Corson
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, Pennsylvania.,Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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21
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Zhang Y, Huang G, Liu M, Li M, Wang Z, Wang R, Yang D. Functional and structural connective disturbance of the primary and default network in patients with generalized tonic-clonic seizures. Epilepsy Res 2021; 174:106595. [PMID: 33993017 DOI: 10.1016/j.eplepsyres.2021.106595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The present study aims to investigate the disturbance of functional and structural profiles of patients with generalized tonic-clonic seizures (GTCS). METHODS Resting-state fMRI and diffusion tensor imaging (DTI) data was collected from fifty-six patients and sixty-two healthy controls. Degree centrality (DC) of functional connectivity was first calculated and compared between groups using a two-sample t-test. Furthermore, the regions with significant alteration of DC in patients with GTCS were used as nodes to construct the brain network. Functional connectivity (FC) network was constructed using the Person's correlation analysis and structural connectivity (SC) network was obtained using deterministic tractography technology. Gray matter volume (GMV) and cortical thickness (CT) were computed and correlated with connective profiles. RESULTS The patients with GTCS showed increased DC in the primary network (PN), including bilateral precentral gyrus, supplementary motor areas (SMA), and visual cortex, and decreased DC in core regions of default mode network (DMN), bilateral anterior insular, and supramarginal gyrus. In the present study, 14 regions were identified to construct networks. In patients, the FC and SC were increased within the sensorimotor network (mainly linking with SMA) and decreased within DMN (mainly linking with the posterior cingulate cortex (PCC)). Except for the decreased FC and SC between cerebellum and SMA, patients demonstrated increased connectivity between DMN and PN. Besides, the insula demonstrated decreased FC with DMN and increased FC with PN, without significant SC alterations in patients with GTCS. Decreased GMV in bilateral thalamus and increased GMV in frontoparietal regions were found in patients. The decreased GMV of thalamus and increased GMV of SMA positively and negatively correlated with the FC between PCC and left superior frontal cortex, the FC between SMA and left precuneus respectively. CONCLUSION Hyper-connectivity within PN helps to understand the disturbance of primary functions, especially the motor abnormality in GTCS. The hypo-connectivity within DMN suggested abnormal network organization possibly related to epileptogenesis. Moreover, over-interaction between DMN and PN and unbalanced connectivity between them and insula provided potential evidence reflecting abnormal interactions between primary and high-order function systems.
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Affiliation(s)
- Yaodan Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China; Chengdu University of Traditional Chinese Medicine Affiliated Fifth People's Hospital, Chengdu, PR China
| | - Gengzhen Huang
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Meijun Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Mao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Zhiqiang Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Rongyu Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China
| | - Dongdong Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, PR China.
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22
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Haginoya K, Sekiguchi F, Munakata M, Yokoyama H, Hino-Fukuyo N, Uematsu M, Jin K, Nagamatsu K, Ando T, Miyake N, Matsumoto N, Kure S. A patient with a 6q22.1 deletion and a phenotype of non-progressive early-onset generalized epilepsy with tremor. Epilepsy Behav Rep 2021; 15:100405. [PMID: 33437959 DOI: 10.1016/j.ebr.2020.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/21/2022] Open
Abstract
We report a patient with a 6q22.1 deletion, who presented with a rare syndrome of generalized epilepsy, myoclonic tremor, and intellectual disability. There was no clinical progression after follow-up for more than 10 years. Our report presents the genetic basis for a phenotype involving a non-progressive generalized epilepsy with tremor. The efficacy of valproic acid for seizure control and the partial efficacy of deep brain stimulation with propranolol for myoclonic tremor is detailed.
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Aguado-Carrillo G, Velasco AL, Saucedo-Alvarado PE, Cuellar-Herrera M, Trejo-Martínez D, Navarro-Olvera JL, Heres-Becerril SD, Barrera-Domínguez ED, Velasco-Campos F. Radiofrequency ablation of the centromedian thalamic nucleus in the treatment of drug-resistant epilepsy. Epilepsy Behav 2021; 114:107560. [PMID: 33243680 DOI: 10.1016/j.yebeh.2020.107560] [Citation(s) in RCA: 2] [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: 06/24/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the usefulness and efficacy of radiofrequency ablations (RFA) of the Centromedian thalamic nucleus (CMN) to control primarily generalized or multifocal seizures in refractory epilepsy. METHODS Six patients with clinical diagnosis of multifocal or primarily generalized drug-resistant epilepsy were included. Bilateral RFA of the CMN was performed through a monopolar 1.8 mm. tip electrode with a temperature of 80 °C during 90 seconds. Patients were followed in every 3 months visit for 20 to 36 months and kept a monthly seizure count calendar. We also compared maximal paroxysmal electroencephalogram (EEG) activity and neuropsychological evaluation pre and 6 months postoperatively. RESULTS A significant reduction in the number of generalized seizures was observed in all subjects in the range of 79-98%, starting the first post-operative month. Although focal aware seizures remained unchanged throughout follow-up, there was an important reduction on paroxysmal activity between the pre and postoperative EEG. No major changes on cognitive status were detected. There was post-operative dysphagia and odynophagia lasting one week and there was no mortality in this group of patients. CONCLUSION Preliminary results of CMN RFA suggest safety and a trend toward reduction of some seizure types, it may reduce the seizure frequency like other palliative procedures since the first post-operative month, but a larger, controlled study would be needed to establish the value of this therapy.
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24
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Midzyanovskaya IS, Petrenko TE, Birioukova LM, Tuomisto LM. Reduced H3 histamine receptor binding densities in the upper layers of motor cortex in rats prone to audiogenic convulsive seizures. Epilepsy Res 2020; 170:106543. [PMID: 33387800 DOI: 10.1016/j.eplepsyres.2020.106543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 01/11/2023]
Abstract
Fits of audiogenic seizures in rodents are considered as a model for generalized convulsive epilepsies in humans. The laminar distribution of the H3 histamine receptor binding densities was quantified in the motor cortex of two strains of rats with genetically determined generalized epilepsies, namely KM rats with audiogenic seizures only, and WAGRij rats with both audiogenic seizures and absence seizures. It was found that H3 histamine receptor binding densities in layer 2/3d of the primary and secondary motor cortices of the rats that experienced audiogenic seizure fits were significantly lower than in the cortices of control rats. Possible explanations are discussed.
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Affiliation(s)
- I S Midzyanovskaya
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Russian Federation; University of Eastern Finland, School of Pharmacy, Finland.
| | - T E Petrenko
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Russian Federation; Pirogov Russian National Research Medical University, Russian Federation
| | - L M Birioukova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Russian Federation; University of Eastern Finland, School of Pharmacy, Finland
| | - L M Tuomisto
- University of Eastern Finland, School of Pharmacy, Finland
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Mastrangelo V, Minardi R, Baroni MC, Severi G, Ambrosini E, Toni F, Alvisi L, Licchetta L, Bisulli F, Tinuper P, Mostacci B. Epilepsy with eyelid myoclonias and Sotos syndrome features in a patient with compound heterozygous missense variants in APC2 gene. Seizure 2020; 83:169-171. [PMID: 33161245 DOI: 10.1016/j.seizure.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Vincenzo Mastrangelo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Raffaella Minardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
| | - Maria Chiara Baroni
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giulia Severi
- UO Genetica Medica, Policlinico di Sant'Orsola, Bologna, Italy
| | | | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy
| | - Lara Alvisi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Full Member of the ERN EpiCARE
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Togashi N, Fujita A, Shibuya M, Uneoka S, Miyabayashi T, Sato R, Okubo Y, Endo W, Inui T, Jin K, Matsumoto N, Haginoya K. Fifteen-year follow-up of a patient with a DHDDS variant with non-progressive early onset myoclonic tremor and rare generalized epilepsy. Brain Dev 2020; 42:696-699. [PMID: 32654954 DOI: 10.1016/j.braindev.2020.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Generalized epilepsy and tremor phenotypes have been reported in some genetic disorders. Among them benign adult familial myoclonus epilepsy (BAFME) has been confirmed as a clearly defined clinical and genetic entity. On the other hand, non-progressive tremor and generalized epilepsy phenotypes have also been reported in patients with DHDDS variants. CASE PRESENTATION We report on a long term follow-up of patient with de novo missense variant of DHDDS, who revealed non progressive nature. This 18-year-old woman presented non-progressive tremor since her early infancy. She had rare seizures. Her tremor was considered as cortical myoclonic tremor with giant somatosensory evoked potentials. CONCLUSION In patients with early onset, non-progressive tremor and rare generalized epilepsy phenotypes, DHDDS variants may be considered in the genetic differential diagnosis.
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Affiliation(s)
- Noriko Togashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Moriei Shibuya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Saki Uneoka
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Takuya Miyabayashi
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Ryo Sato
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Yukimune Okubo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Wakaba Endo
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Takehiko Inui
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Miyagi Children's Hospital, Sendai 989-3126, Japan.
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Byun JI, Kim DW, Kim KT, Yang KI, Lee ST, Seo JG, No YJ, Kang KW, Kim D, Kim JM, Cho YW. Treatment of epilepsy in adults: Expert opinion in South Korea. Epilepsy Behav 2020; 105:106942. [PMID: 32163888 DOI: 10.1016/j.yebeh.2020.106942] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/21/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to gather the expert opinions of Korean epileptologists regarding the treatment of adult patients with epilepsy. METHODS A total of 42 neurologists who specialized in epilepsy were surveyed. They completed an online questionnaire describing multiple patient scenarios. Using these scenarios, they evaluated treatment strategies and gave their preference for specific antiepileptic drugs (AEDs) used to treat genetically mediated generalized epilepsy and focal epilepsy. RESULTS Initial AED monotherapy, followed by a second form of alternative monotherapy or an add-on combination therapy, was the preferred treatment strategy. The experts reached consensus for 87.2% of the items. The most commonly selected AEDs for the initial monotherapy for patients with generalized epilepsy were levetiracetam or valproate. For those with focal epilepsy, levetiracetam, oxcarbazepine, or lamotrigine were the most popular selections. Ethosuximide was the treatment of choice only for patients with generalized epilepsy with prominent absence seizures. Levetiracetam was preferred as an add-on therapy for both generalized and focal epilepsy. For special populations of patients, such as elderly adults or those with comorbid diseases, levetiracetam or lamotrigine was selected as the treatment of choice. CONCLUSION Most of the survey results were in accordance with the US expert opinion survey published in 2016. This survey can assist clinicians in making clinical decisions when treating individual adult patients with epilepsy.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, School of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Keun Tae Kim
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, South Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Jae Moon Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea.
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Simmatis LER, Jin AY, Keiski M, Lomax LB, Scott SH, Winston GP. Assessing various sensorimotor and cognitive functions in people with epilepsy is feasible with robotics. Epilepsy Behav 2020; 103:106859. [PMID: 31918991 DOI: 10.1016/j.yebeh.2019.106859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Epilepsy is a common neurological disorder characterized by recurrent seizures, along with comorbid cognitive and psychosocial impairment. Current gold standards of assessment can quantify cognitive and motor performance, but may not capture all subtleties of behavior. Here, we study the feasibility of assessing various upper limb sensorimotor and cognition functions in people with epilepsy using the Kinarm robotic assessment system. We quantify performance across multiple behavioral domains and additionally consider the possible effects of epilepsy subtype and medication. METHODS We recruited individuals with a variety of epilepsy subtypes. Participants performed 8 behavioral tasks that tested motor, cognitive, and sensory domains. We collected data on the same tasks from a group of control participants that had no known neurological impairments. We quantified performance using Task Scores, which provide a composite measure of overall performance on a given task and are adjusted for age, sex, and handedness. RESULTS We collected data from 46 individuals with epilepsy and 92 control participants. The assessment was well-tolerated, with no adverse events recorded. Cognitive tasks testing spatial working memory, executive function, and motor response inhibition were the most frequently impaired in the epilepsy cohort, with 33/46 (72%) being outside the normal range on at least one of these tasks. Additionally, 29/46 (63%) were impaired on at least one task testing primarily motor skill, and 14/46 (30%) were impaired on a proprioceptive sensory task. People with either focal epilepsy or generalized epilepsy performed significantly worse on both motor and cognitive tasks than control participants after correcting for multiple comparisons. There were no statistical differences between generalized and focal epilepsy groups on Task Scores. Finally, individuals taking topiramate trended toward having worse performance on a spatial working memory task than other individuals with epilepsy who were not taking topiramate. CONCLUSIONS Kinarm robotic assessment is feasible in individuals with epilepsy and is well-tolerated. Our robotic paradigm can detect impairments in various sensorimotor and cognitive functions across the population with epilepsy. Future studies will explore the role of epilepsy subtype and medications.
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Affiliation(s)
- Leif E R Simmatis
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Michelle Keiski
- Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Lysa B Lomax
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Biomedical and Molecular Sciences, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Gavin P Winston
- Centre for Neuroscience Studies, Botterell Hall, 18 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Department of Medicine, Division of Neurology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, ON K7L 3N6, Canada; Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON K7L 2V7, Canada.
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Abarrategui B, Parejo-Carbonell B, García García ME, Gil-Nagel A, García-Morales I. Praxis induction and its relationship with cognition in genetic generalized epilepsy. Epilepsy Behav 2020; 102:106638. [PMID: 31805510 DOI: 10.1016/j.yebeh.2019.106638] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Praxis induction (PI) is a reflex trait defined as the precipitation of epileptic discharges (ED) or seizures by cognition-guided tasks that often involve visuomotor coordination and decision-making. This is a characteristic of genetic generalized epilepsy (GGE), and especially of juvenile myoclonic epilepsy (JME). Additionally, several studies have described dysexecutive traits in these patients. Our objective was to analyze PI in the different syndromes of GGE and explore the relationship between PI and cognitive performance. METHODS Sixty-one adult patients with GGE underwent video-electroencephalograph (EEG) during which a neuropsychological activation protocol (NPAP) was performed: reading, writing, calculations, crosswords, and tangram. Praxis induction was defined by the presence of ED during the NPAP with a persistence of at least twice seen on the basal EEG. All patients also underwent a comprehensive cognitive evaluation. RESULTS We observed PI in 22 out of 61 patients (36%). Grouped by syndrome, PI was more frequent in adult patients with persistent childhood or juvenile absence epilepsy (JAE, 60%), followed by JME (42.1%) and in a lesser grade in patients with only tonic-clonic generalized seizures (9%). Patients classified as having PI did not obtain worse results in the cognitive evaluation. The presence of ED during the performance of a test was associated with a trend to lower results in that specific test. SIGNIFICANCE Our study showed a relevant presence of PI in patients whose absence epilepsy persists into adulthood, and not only in JME, the syndrome classically associated with PI. According to our results, PI as a reflex trait does not imply necessarily a poorer cognitive phenotype, but the induction of frequent ED during the tasks could be associated with transient cognitive impairment.
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Affiliation(s)
- Belén Abarrategui
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | | | | | - Irene García-Morales
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Programa de Epilepsia Hospital Ruber Internacional, Madrid, Spain
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Fernandez-Baca Vaca G, Park JT. Focal EEG abnormalities and focal ictal semiology in generalized epilepsy. Seizure 2019; 77:7-14. [PMID: 31882201 DOI: 10.1016/j.seizure.2019.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/17/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
In clinical practice, the diagnosis of focal vs generalized epilepsy dictates the management of the patient. The distinction between generalized and focal epilepsy is at times imperfect and some epilepsies have features that fall in between these two extremes. An example is the occurrence of focal interictal and focal ictal abnormalities in generalized epilepsies. As a part of the special issue on "The epileptogenic zone in pediatric epilepsy surgery", this focused narrative review will discuss different focal abnormalities seen in generalized epilepsy. An overlap of focal and generalized epileptiform abnormalities may support a continuum between focal and generalized epilepsy. When evaluating patients in the "gray zone", other factors such as ictal semiology, neuroimaging, genetic testing and functional deficits may need to be considered to reach an accurate diagnosis. Being aware of possible occurrence of focal clinical and EEG features in generalized epilepsy will help clinicians select more preferred AED (s), avoiding potential iatrogenic side effects and inappropriate consideration for epilepsy surgery.
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Affiliation(s)
- G Fernandez-Baca Vaca
- Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Jun T Park
- Epilepsy Center, Neurological Institute, Department of Neurology, University Hospitals of Cleveland Medical Center, Cleveland, OH, USA; Division of Pediatric Epilepsy & Neurology, Department of Pediatrics, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Gunawan C, Seneviratne U, D'Souza W. The effect of antiepileptic drugs on epileptiform discharges in genetic generalized epilepsy: A systematic review. Epilepsy Behav 2019; 96:175-182. [PMID: 31150997 DOI: 10.1016/j.yebeh.2019.04.030] [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: 12/22/2018] [Revised: 02/02/2019] [Accepted: 04/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the current evidence regarding the effect of antiepileptic drugs (AEDs) on epileptiform discharge (ED) burden in genetic generalized epilepsy (GGE). METHODS We conducted a comprehensive literature search of PubMed, Embase, PsycINFO, and the Web of Science Core Collection databases using the keywords 'genetic generalized epilepsy', 'antiepileptic drugs' and 'epileptiform discharge'. Primary human studies published in English that reported the effect of AEDs on EDs captured on electroencephalogram (EEG) recordings of at least 24 h in duration in patients with GGE were included. RESULTS Six studies published between 1984 and 2017, which reported the effect of AEDs on EDs, involving a total of 116 patients with GGE, were analyzed. Our systematic review found a tendency for AEDs to reduce ED density, frequency, cumulative duration, and burst duration in GGE. Furthermore, we found evidence that the AED-mediated reduction in ED burden was associated with improved seizure control and cognitive outcomes. CONCLUSIONS Antiepileptic drugs tend to reduce ED burden in GGE, but the significance of this association remains uncertain.
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Affiliation(s)
- Claire Gunawan
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Wendyl D'Souza
- St Vincent's Clinical School, The University of Melbourne, Melbourne, Australia; Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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Abstract
Mutations in the neurite extension and migration factor (NEXMIF) gene are associated with X-linked intellectual disability. Thus far, all males reported with NEXMIF mutations have mild to profound intellectual disability with varying combinations of autistic features, poor or absent speech, epilepsy, facial dysmorphism, and strabismus. Affected females tend to have milder intellectual disability but severe, drug-resistant epilepsy. Here, we present a 32-month-old boy with a novel de novo frameshift NEXMIF pathogenic variant (p.Glu375ArgfsX21) who has mild motor delay, language delay, autistic features, and strabismus. In addition to these commonly described findings of NEXMIF mutations, his fundus exam revealed a very rare ophthalmologic abnormality, torpedo maculopathy. This finding has not previously been reported with NEXMIF mutation; however, on literature review, 7/15 males with NEXMIF mutations had other ophthalmologic abnormalities. This patient expands the phenotypic spectrum for males with NEXMIF mutations and suggests that NEXMIF may play an important role in ocular development.
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Affiliation(s)
- Tuğba Alarcon-Martinez
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Ayesha Khan
- Department of Ophthalmology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kenneth A Myers
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Abstract
PURPOSE OF REVIEW To summarize recent developments in therapeutic options, both medical and surgical, for patients with drug-resistant generalized epilepsy syndromes, which continue to be a multifaceted challenge for patients and physicians. RECENT FINDINGS Newer generation pharmaceutical options are now available, such as brivaracetam, rufinamide, lacosamide, perampanel, and cannabidiol. Less restrictive dietary options appear to be nearly as effective as classic ketogenic diet for amelioration of seizures. The latest implantable devices include responsive neurostimulation and deep brain stimulation. Corpus callosotomy is an effective treatment for some seizure types, and newer and less invasive approaches are being explored. Resective surgical options have demonstrated success in carefully selected patients despite generalized electrographic findings on electroencephalogram. The current literature reflects a widening range of clinical experience with newer anticonvulsant medications including cannabinoids, dietary therapies, surgical approaches, and neurostimulation devices for patients with intractable generalized epilepsy.
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Affiliation(s)
- Sean T Hwang
- Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA.
| | - Scott J Stevens
- Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Aradia X Fu
- Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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Bolden LB, Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Cortical excitability affects mood state in patients with idiopathic generalized epilepsies (IGEs). Epilepsy Behav 2019; 90:84-9. [PMID: 30517908 DOI: 10.1016/j.yebeh.2018.11.001] [Citation(s) in RCA: 5] [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: 07/30/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
Previously, we demonstrated an association between cortical hyperexcitability and mood disturbance in healthy adults. Studies have documented hyperexcitability in patients with idiopathic generalized epilepsies (IGEs; long-interval intracortical inhibition [LICI]) and high prevalence of mood comorbidities. This study aimed to investigate the influences of cortical excitability and seizure control on mood state in patients with IGEs. Single and paired-pulse transcranial magnetic stimulation (TMS) was applied to 30 patients with IGEs (16 controlled IGEs [cIGEs], 14 with treatment-resistant IGEs [trIGEs]), and 22 healthy controls (HCs) to assess cortical excitability with LICI. The Profile of Mood Sates (POMS) questionnaire was used to assess total mood disturbance (TMD), as well as, six mood domains: Depression, Confusion, Anger, Anxiety, Fatigue, and Vigor. To assess the effects of seizure control (HC vs. cIGEs vs. trIGEs) and LICI response (inhibitory vs. excitatory) on TMD, a two-way multivariate analysis of variance (MANOVA) was performed. Analyses revealed a significant main effect of long-interval intracortical inhibition (LICI) response on TMD (F(1, 46) = 4.69, p = 0.04), but not seizure control (F(2, 46) = 0.288, p = 0.75). Excitatory responders endorsed significantly higher TMD scores, indicating greater mood disturbance, than inhibitory responders (MD = -2.12; T (50) = -2.47, p = 0.04). Also, excitatory responders endorsed more items than inhibitory responders on the Depression (MD = -2.12; T (50) = -2.47, p = 0.04) and Fatigue (MD = -3.42; T (50) = -2.96, p = 0.03) subscales of the POMS. These findings provide further evidence of a relationship between hyperexcitability and mood disturbance, and indicate that cortical excitability may have greater influence on mood state than seizure control in patients with IGEs. Results also support theories for the underlying role of gamma-aminobutyric acid (GABA) network dysfunction in the etiology of depression. To better understand the clinical relevance and causal nature of these relationships, further investigation is warranted.
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Abarrategui B, Parejo-Carbonell B, García García ME, Di Capua D, García-Morales I. The cognitive phenotype of idiopathic generalized epilepsy. Epilepsy Behav 2018; 89:99-104. [PMID: 30408705 DOI: 10.1016/j.yebeh.2018.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 07/31/2018] [Revised: 10/07/2018] [Accepted: 10/07/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Dysexecutive traits have been described in idiopathic generalized epilepsy (IGE), but studies mainly focused on juvenile myoclonic epilepsy (JME). To better understand the neuropsychology of IGE, more research is needed on syndromes other than JME, controlling potential confounding factors as the cognitive effects of valproate and epileptic discharges (ED). We describe the neuropsychological profile of a group of patients with different syndromes of IGE including simultaneous video electroencephalography (EEG). METHODS We performed a comprehensive cognitive and neuropsychiatric evaluation with video-EEG on 61 adults with IGE (JME 19; IGE with generalized tonic-clonic seizures [GTCS] alone [IGE-GTCS] 22; childhood absence epilepsy [CAE] or juvenile absences epilepsy [JAE] persisting in adulthood 20). We compared results between patients (globally and by syndrome) and a control group of 21 individuals (similar age, educational level); p-values were adjusted for multiple testing according to a 0.05 false discovery rate. RESULTS Patients obtained significantly lower results than controls on visuospatial working memory, processing speed, cognitive flexibility and strategy, abstract visuospatial reasoning, arithmetic, and acquired knowledge. While CAE/JAE showed the lowest scores on cognitive assessment and highest anxiety index, IGE-GTCS showed the most favorable scores. Most tests were not influenced by valproate intake, and the dose did not correlate with cognitive performance in the test that yielded differences between patients and controls. Epileptic discharges during assessment were not frequent (10 patients, 1-4 tests). SIGNIFICANCE Our findings suggest that patients with IGE have significantly lower abilities in various executive functions and acquired knowledge, compared to population of same age and education. The low frequency of ED on simultaneous video-EEG and absence of correlation of scores with valproate dose reinforce that the obtained results are due to a cognitive phenotype in IGE. This phenotype may be influenced by syndrome, and patients with CAE/JAE persisting in the adult may have a wider neuropsychiatric impairment.
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Affiliation(s)
- Belén Abarrategui
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | | | - Daniela Di Capua
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
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Bolden LB, Griffis JC, Nenert R, Allendorfer JB, Szaflarski JP. Cortical excitability and seizure control influence attention performance in patients with idiopathic generalized epilepsies (IGEs). Epilepsy Behav 2018; 89:135-142. [PMID: 30415135 DOI: 10.1016/j.yebeh.2018.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/30/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 02/05/2023]
Abstract
We recently found that higher cortical excitability is associated with poorer attention performance in healthy adults. While patients with idiopathic generalized epilepsies (IGEs), previously termed genetic generalized epilepsies, are known to demonstrate increased cortical excitability and cognitive deficits, a relationship between these variables in IGEs has not been investigated. Therefore, we aimed to characterize the effects of cortical excitability and seizure control on cognitive performance in IGEs. We studied 30 patients with IGEs (16 patients with controlled IGEs (cIGEs) and 14 patients with treatment-resistant IGEs (trIGEs)) and 24 healthy controls (HCs). Transcranial magnetic stimulation (TMS) was used to measure cortical excitability, including long-interval intracortical inhibition (LICI). Attention was assessed with the Digit Span Forwards, Digit Span Backwards, Trails A, and Flanker tasks. Executive functioning was assessed using Trails B, Stroop Color and Word, and the Wisconsin Card Sorting Task. Two-way multivariate analyses of variance (MANOVAs) were conducted to assess the influences of seizure control (HCs vs. cIGEs vs. trIGEs) and cortical excitability (inhibitory vs. excitatory) on composite measures of attention and executive functions. Attention performance was significantly affected by cortical excitability and seizure control. Participants with primarily excitatory LICI responses, indicating higher cortical excitability, performed worse than inhibitory responders on composite attention (Wilks' lambda = 0.748, F(4, 44) = 3.72, p = 0.011). While participants with cIGEs and trIGEs did not significantly differ in attention performance, participants with trIGEs performed worse on the Digit Forwards (False Discovery Rate (FDR)p < 0.001), Digit Backwards (FDRp = 0.015), and Flanker (FDRp = 0.0075) tasks compared with HCs. These results provide support for the relationship between cortical excitability and attention dysfunction in IGEs. Further investigation is needed to determine whether there is a causal relationship between these variables and whether intracortical gamma-aminobutyric acid (GABA)B networks may be targeted to improve attention deficits in clinical populations with decreased LICI. Findings also suggest that additional research directly comparing cognition in patients with cIGEs and trIGEs is warranted.
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Affiliation(s)
- Lauren B Bolden
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Joseph C Griffis
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rodolphe Nenert
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Orozco-Hernández JP, Quintero-Moreno JF, Marín-Medina DS, Valencia-Vásquez A, Villada HC, Lizcano A, Martínez JW. Multivariable prediction model of drug resistance in adult patients with generalized epilepsy from Colombia: A case-control study. Epilepsy Behav 2018; 88:176-180. [PMID: 30290326 DOI: 10.1016/j.yebeh.2018.09.025] [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: 07/12/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Patients with drug-resistant epilepsy (DRE) account for most of the burden of epilepsy, and they have poor prognosis in seizure control, higher morbidity, and mortality. OBJECTIVES The objective of the study was to develop a prognostic model of drug resistance in adult patients with generalized epilepsy from Colombia. METHODS In this case-control study of patients with generalized epilepsy, patients were separated into two groups: one group with DRE (cases) according to the new International League Against Epilepsy (ILAE) definition after a complete evaluation performed by an epileptologist and the other group without DRE (control). Variables were analyzed to identify statistical differences between groups and were then selected to construct a prognostic model from a logistic regression. RESULTS One hundred thirty-three patients with generalized epilepsy were studied. Thirty-eight (28.5%) patients had DRE, and 95 (71.5%) did not have DRE. History of status epilepticus, abnormal findings from neurological examination, aura, any degree of cognitive impairment, epileptic seizures at any moment of the day, and any comorbidity were risk factors. The presence of seizures only in the waking state and idiopathic etiology were protective factors. A prognostic model was constructed with previously reported risk factors for DRE and other variables available in the population of this study. In the multivariable analysis, the history of status epilepticus (odds ratio (OR): 5.6, confidence interval (CI): 1.1-20.0, p = 0.031), abnormal findings from neurological examination (OR: 5.7, CI: 2.3-13.9, p = 0.000), and aura (OR: 6.1, CI: 1.8-20.8, p = 0.003) were strongly associated with DRE. CONCLUSIONS In adult patients with generalized epilepsy, aura, abnormal findings from neurological examination, and history of status epilepticus were predictive factors for DRE.
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Affiliation(s)
- Juan Pablo Orozco-Hernández
- Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia.
| | - Juan Felipe Quintero-Moreno
- Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia
| | - Daniel Stiven Marín-Medina
- Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia
| | - Aníbal Valencia-Vásquez
- Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia
| | - Hans Carmona Villada
- Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia
| | - Angélica Lizcano
- Applied Neuroscience Research Group, Neurocentro S.A., Instituto de Epilepsia y Parkinson del eje cafetero, Pereira, Risaralda, Colombia
| | - José William Martínez
- Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
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Smith KM, Youssef PE, Wirrell EC, Nickels KC, Payne ET, Britton JW, Shin C, Cascino GD, Patterson MC, Wong-Kisiel LC. Jeavons Syndrome: Clinical Features and Response to Treatment. Pediatr Neurol 2018; 86:46-51. [PMID: 30082241 DOI: 10.1016/j.pediatrneurol.2018.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 04/16/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Jeavons syndrome is an underreported epileptic syndrome characterized by eyelid myoclonia, eyelid closure-induced seizures or electroencephalography paroxysms, and photosensitivity. Drug-resistant epilepsy is common, but the prognostic factors and clinical course leading to drug resistance have not been well characterized. METHODS We identified 30 patients who met the diagnostic criteria of Jeavons syndrome at a single institution between January 1, 2000 and December 15, 2016. Criteria for Jeavons syndrome included all of the following: (1) eyelid myoclonia with or without absences, (2) eye-closure-induced seizures or electroencephalography paroxysms, and (3) seizure onset after 12 months of age. We reviewed and described the epilepsy history, antiepileptic drug trials, and response to treatments. RESULTS Mean age at seizure onset was 7.3 years, and 80% were female. Absence seizures (63%) and generalized tonic-clonic seizures (23%) were most common at onset. Diagnosis was delayed by an average of 9.6 years. After a median follow-up of two years, 80% of patients had drug resistant epilepsy and 70% experienced generalized tonic-clonic seizures. Generalized tonic-clonic seizures and seizure types other than absence seizures increased the risk of drug-resistant epilepsy (P values 0.049 and 0.03, respectively). Valproic acid, lamotrigine, ethosuximide, and levetiracetam were the most effective in reducing seizures by more than 50%. CONCLUSIONS The diagnosis of Jeavons syndrome is often delayed. Generalized tonic-clonic seizures and seizure types other than absence seizures may be predictors of drug-resistant epilepsy among patients with Jeavons syndrome.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Paul E Youssef
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Eric T Payne
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Cheolsu Shin
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Campos MSA, Ayres LR, Morelo MRS, Carizio FAM, Pereira LRL. Comparative efficacy of antiepileptic drugs for patients with generalized epileptic seizures: systematic review and network meta-analyses. Int J Clin Pharm 2018; 40:589-98. [PMID: 29744790 DOI: 10.1007/s11096-018-0641-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/19/2018] [Indexed: 12/26/2022]
Abstract
Background Valproate is a widely prescribed antiepileptic drug for generalized epilepsies, due to the extensive knowledge on its efficacy since it is on the market for many decades. However, a large number of new antiepileptic medicines was introduced into clinical practice and may be better options for treatment, considering that these medicines differ in terms of efficacy spectrum. Despite extensive research, questions regarding which medicine would constitute the first option for the monotherapy treatment of generalized epilepsy remain. Aim of the Review To compare the relative efficacy of all available antiepileptic drugs in the monotherapy treatment of generalized epileptic seizures; and also to compare all antiepoileptig drugs with valproate, which is the current first-line treatment for generalized epilepsy. Methods A systematic review for randomized controlled clinical trials was performed. Network meta-analyses used Bayesian random effects model. Sensitivity analyses determined the results´ robustness. The relative probability of two efficacy outcomes ("Seizure free" and "Therapeutic inefficacy") to happen for each medcicine was calculated using the Surface Under the Cumulative Ranking Curve. Results Seven papers (1809 patients) studied the efficacy of valproate, lamotrigine, phenytoin, carbamazepine, topiramate, levetiracetam, and phenobarbital in the treatment of generalized tonicclonic, tonic, and clonic seizures. Phenytoin demonstrated to be inferior to valproate in leaving the patient free of these seizures types [OR: 0.50 (95% CrI 0.27, 0.87)]. Lamotrigine (61%) showed the highest probability of presenting the outcome "Seizure free", followed by levetiracetam (47%), topiramate (44%), and valproate (38%) in the treatment of generalized tonic-clonic, tonic, and clonic seizures. Meanwhile, valproate exhibited greater chance of presenting the outcome "Therapeutic inefficacy" (62%). Regarding absence seizures itself, there was no difference in the efficacy of lamotrigine and ethosuximide when compared to valproate. However, the ranking indicates that ethosuximide (52%) and valproate (47%) are both more likely than lamotrigine to keep the patient free of seizures. Conclusions Lamotrigine, levetiracetam, and topiramate are as effective as valproate for treating generalized tonic-clonic, tonic, and clonic seizures. Meanwhile, valproate and ethosuximide are the best options for the treatment of absence seizures promoting better control of seizures, which is the primary goal of pharmacotherapy.
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Myers KA, White SM, Mohammed S, Metcalfe KA, Fry AE, Wraige E, Vasudevan PC, Balasubramanian M, Scheffer IE. Childhood-onset generalized epilepsy in Bainbridge-Ropers syndrome. Epilepsy Res. 2018;140:166-170. [PMID: 29367179 DOI: 10.1016/j.eplepsyres.2018.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 01/30/2023]
Abstract
Bainbridge-Ropers syndrome is a genetic syndrome caused by heterozygous loss-of-function pathogenic variants in ASXL3, which encodes a protein involved in transcriptional regulation. Affected individuals have multiple abnormalities including developmental impairment, hypotonia and characteristic facial features. Seizures are reported in approximately a third of cases; however, the epileptology has not been thoroughly studied. We identified three patients with pathogenic ASXL3 variants and seizures at Austin Health and in the DECIPHER database. These three patients had novel de novo ASXL3 pathogenic variants, two with truncation variants and one with a splice site variant. All three had childhood-onset generalized epilepsy with generalized tonic-clonic seizures, with one also having atypical absence seizures. We also reviewed available clinical data on five published patients with Bainbridge-Ropers syndrome and seizures. Of the five previously published patients, three also had generalized tonic-clonic seizures, one of whom also had possible absence seizures; a fourth patient had absence seizures and possible focal seizures. EEG typically showed features consistent with generalized epilepsy including generalized spike-wave, photoparoxysmal response, and occipital intermittent rhythmic epileptiform activity. Bainbridge-Ropers syndrome is associated with childhood-onset generalized epilepsy with generalized tonic-clonic seizures and/or atypical absence seizures.
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Abarrategui B, García-García ME, Toledano R, Parejo-Carbonell B, Gil-Nagel A, García-Morales I. Lacosamide for refractory generalized tonic-clonic seizures of non-focal origin in clinical practice: A clinical and VEEG study. Epilepsy Behav Case Rep 2017; 8:63-65. [PMID: 28948142 PMCID: PMC5602820 DOI: 10.1016/j.ebcr.2017.08.001] [Citation(s) in RCA: 11] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/06/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022]
Abstract
7 of 9 patients with GGE reduced ≥ 50% their tonic–clonic seizure frequency on LCM. All 7 patients remained seizure free for > 1 year, and 2 of them for > 5 years. In 2 of the 9 patients, both with Juvenile Absence Epilepsy, absences aggravated. One aggravation consisted on a myoclonia and absence status, in a patient with no history of myoclonia. VEEG paralleled clinical improvement but didn't change in a case of absence worsening.
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Affiliation(s)
- Belén Abarrategui
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - María Eugenia García-García
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Rafael Toledano
- Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain.,Epilepsy Unit, Department of Neurology, Hospital Ramon y Cajal, Ctra M-607 Colmenar Viejo, 910, 28034 Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Department of Neurology, Hospital Clínico San Carlos, Profesor Martín Lagos s/n, 28040 Madrid, Spain.,Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, La Masó 38, Mirasierra, 28034 Madrid, Spain
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Becker F, Reid CA, Hallmann K, Tae HS, Phillips AM, Teodorescu G, Weber YG, Kleefuss-Lie A, Elger C, Perez-Reyes E, Petrou S, Kunz WS, Lerche H, Maljevic S. Functional variants in HCN4 and CACNA1H may contribute to genetic generalized epilepsy. Epilepsia Open 2017; 2:334-342. [PMID: 29588962 PMCID: PMC5862120 DOI: 10.1002/epi4.12068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Accepted: 06/23/2017] [Indexed: 01/11/2023] Open
Abstract
Objective Genetic generalized epilepsy (GGE) encompasses seizure disorders characterized by spike‐and‐wave discharges (SWD) originating within thalamo‐cortical circuits. Hyperpolarization‐activated (HCN) and T‐type Ca2+ channels are key modulators of rhythmic activity in these brain regions. Here, we screened HCN4 and CACNA1H genes for potentially contributory variants and provide their functional analysis. Methods Targeted gene sequencing was performed in 20 unrelated familial cases with different subtypes of GGE, and the results confirmed in 230 ethnically matching controls. Selected variants in CACNA1H and HCN4 were functionally assessed in tsA201 cells and Xenopus laevis oocytes, respectively. Results We discovered a novel CACNA1H (p.G1158S) variant in two affected members of a single family. One of them also carried an HCN4 (p.P1117L) variant inherited from the unaffected mother. In a separate family, an HCN4 variant (p.E153G) was identified in one of several affected members. Voltage‐clamp analysis of CACNA1H (p.G1158S) revealed a small but significant gain‐of‐function, including increased current density and a depolarizing shift of steady‐state inactivation. HCN4 p.P1117L and p.G153E both caused a hyperpolarizing shift in activation and reduced current amplitudes, resulting in a loss‐of‐function. Significance Our results are consistent with a model suggesting cumulative contributions of subtle functional variations in ion channels to seizure susceptibility and GGE.
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Affiliation(s)
- Felicitas Becker
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain-Research University of Tübingen Tübingen Germany.,RKU-University Neurology Clinic of Ulm Ulm Germany
| | - Christopher A Reid
- The Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
| | - Kerstin Hallmann
- Department of Neurology and Epileptology University of Bonn Medical Center Bonn Germany
| | - Han-Shen Tae
- The Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia.,Present address: Illawarra Health and Medical Research Institute (IHMRI) University of Wollongong Wollongong New South Wales Australia
| | - A Marie Phillips
- The Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia.,School of Biosciences The University of Melbourne Melbourne Victoria Australia
| | - Georgeta Teodorescu
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain-Research University of Tübingen Tübingen Germany
| | - Yvonne G Weber
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain-Research University of Tübingen Tübingen Germany
| | - Ailing Kleefuss-Lie
- Department of Neurology and Epileptology University of Bonn Medical Center Bonn Germany
| | - Christian Elger
- Department of Neurology and Epileptology University of Bonn Medical Center Bonn Germany
| | - Edward Perez-Reyes
- Department of Pharmacology University of Virginia Charlottesville Virginia U.S.A
| | - Steven Petrou
- The Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
| | - Wolfram S Kunz
- Department of Neurology and Epileptology University of Bonn Medical Center Bonn Germany
| | - Holger Lerche
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain-Research University of Tübingen Tübingen Germany
| | - Snezana Maljevic
- Department of Neurology and Epileptology Hertie-Institute for Clinical Brain-Research University of Tübingen Tübingen Germany.,The Florey Institute of Neuroscience and Mental Health Melbourne Victoria Australia
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Werner FM, Coveñas R. Classical neurotransmitters and neuropeptides involved in generalized epilepsy in a multi-neurotransmitter system: How to improve the antiepileptic effect? Epilepsy Behav 2017; 71:124-129. [PMID: 25819950 DOI: 10.1016/j.yebeh.2015.01.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 11/16/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 12/20/2022]
Abstract
Here, we describe in generalized epilepsies the alterations of classical neurotransmitters and neuropeptides acting at specific subreceptors. In order to consider a network context rather than one based on focal substrates and in order to make the interaction between neurotransmitters and neuropeptides and their specific subreceptors comprehensible, neural networks in the hippocampus, thalamus, and cerebral cortex are described. In this disease, a neurotransmitter imbalance between dopaminergic and serotonergic neurons and between presynaptic GABAergic neurons (hypoactivity) and glutaminergic neurons (hyperactivity) occurs. Consequently, combined GABAA agonists and NMDA antagonists could furthermore stabilize the neural networks in a multimodal pharmacotherapy. The antiepileptic effect and the mechanisms of action of conventional and recently developed antiepileptic drugs are reviewed. The GASH:Sal animal model can contribute to examine the efficacy of antiepileptic drugs. The issues of whether the interaction of classical neurotransmitters with other subreceptors (5-HT7, metabotropic 5 glutaminergic, A2A adenosine, and alpha nicotinic 7 cholinergic receptors) or whether the administration of agonists/antagonists of neuropeptides might improve the therapeutic effect of antiepileptic drugs should be addressed. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".
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Affiliation(s)
- Felix-Martin Werner
- Höhere Berufsfachschule für Altenpflege und Ergotherapie der Euro Akademie Pößneck, Pößneck, Germany; Institute of Neurosciences of Castilla y León (INCYL), Laboratory of Neuroanatomy of the Peptidergic Systems (Lab. 14), University of Salamanca, Salamanca, Spain.
| | - Rafael Coveñas
- Institute of Neurosciences of Castilla y León (INCYL), Laboratory of Neuroanatomy of the Peptidergic Systems (Lab. 14), University of Salamanca, Salamanca, Spain.
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Shih JJ, Whitlock JB, Chimato N, Vargas E, Karceski SC, Frank RD. Epilepsy treatment in adults and adolescents: Expert opinion, 2016. Epilepsy Behav 2017; 69:186-222. [PMID: 28237319 DOI: 10.1016/j.yebeh.2016.11.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [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: 09/02/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There are over twenty anti-seizure medications and anti-seizure devices available commercially in the United States. The multitude of treatment options for seizures can present a challenge to clinicians, especially those who are not subspecialists in the epilepsy field. Many clinical questions are not adequately answered in double-blind randomized controlled studies. In the presence of a knowledge gap, many clinicians consult a respected colleague with acknowledged expertise in the field. Our survey was designed to provide expert opinions on the treatment of epilepsy in adults and adolescents. METHOD We surveyed a group of 42 physicians across the United States who are considered experts based on publication record in the field of epilepsy, or a leadership role in a National Association of Epilepsy Centers comprehensive epilepsy program. The survey consisted of 43 multiple-part patient scenario questions and was administered online using Redcap software. The experts provided their opinion on 1126 treatment options based on a modified Rand 9-point scale. The patient scenarios focused on genetically-mediated generalized epilepsy and focal epilepsy. The scenarios first focused on overall treatment strategy and then on specific pharmacotherapies. Other questions focused on treatment of specific patient populations (pregnancy, the elderly, patients with brain tumors, and post organ transplant patients), epilepsy patients with comorbidities (renal and hepatic disease, depression), and how to combine medications after failure of monotherapy. Statistical analysis of data used the expert consensus method. RESULTS Valproate was considered a drug of choice in all genetically-mediated generalized epilepsies, except in the population of women of child-bearing age. Ethosuximide was a drug of choice in patient with absence seizures, and levetiracetam was a drug of choice in patients with genetic generalized tonic-clonic seizures and myoclonic seizures. Lamotrigine, levetiracetam and oxcarbazepine were considered drugs of choice for initial treatment of focal seizures. Lamotrigine and levetiracetam were the drugs of choice for women of child-bearing age with either genetic generalized epilepsy or focal epilepsy. Lamotrigine and levetiracetam were the drugs of choice in the elderly population. Lamotrigine was preferred in patients with co-morbid depression. Levetiracetam was the drug of choice in treating patients with hepatic failure, or who have undergone organ transplantation. Compared to the 2005 and 2001 surveys, there was increased preference for the use of levetiracetam and lamotrigine, and decreased preference for the use of phenytoin, gabapentin, phenobarbital and carbamazepine. DISCUSSION The study presented here provides a "snapshot" of the clinical practices of experts in the treatment of epilepsy. The experts were very often in agreement, and reached consensus in 81% of the possible responses. However, expert opinion does not replace the medical literature; instead, it acts to supplement existing information. Using the study results is similar to requesting an expert consultation. Our findings suggest options that the clinician should consider to achieve best practice.
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Affiliation(s)
- Jerry J Shih
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
| | - Julia B Whitlock
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Nicole Chimato
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
| | - Emily Vargas
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
| | - Steven C Karceski
- Department of Neurology, Weill Cornell Medical Center, New York, NY, United States
| | - Ryan D Frank
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
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Climans SA, Mirsattari SM. Generalized epilepsy in Baraitser-Winter cerebrofrontofacial syndrome. Epilepsy Behav Case Rep 2017; 7:58-60. [PMID: 28413780 PMCID: PMC5385583 DOI: 10.1016/j.ebcr.2017.03.003] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 11/28/2022]
Abstract
Baraitser–Winter cerebrofrontofacial syndrome (BWMS) is caused by actin gene mutations. Key features of BWMS are ptosis, hypertelorism, iris colobomata, and mental retardation. Generalized epilepsy is seen in half of those with BWMS. Seizures in BWMS can be absence, myoclonic, tonic, or tonic–clonic.
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Affiliation(s)
- Seth Andrew Climans
- Department of Clinical Neurological Sciences, The University of Western Ontario, London, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences, The University of Western Ontario, London, Canada.,Department of Medical Imaging, The University of Western Ontario, London, Canada.,Department of Medical Biophysics, The University of Western Ontario, London, Canada.,Department of Psychology, The University of Western Ontario, London, Canada
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Gomez-Ibañez A, McLachlan RS, Mirsattari SM, Diosy DC, Burneo JG. Prognostic factors in patients with refractory idiopathic generalized epilepsy. Epilepsy Res 2017; 130:69-73. [PMID: 28157601 DOI: 10.1016/j.eplepsyres.2017.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 01/12/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Idiopathic generalized epilepsy (IGE) is an epileptic condition with good response to antiepileptic drugs (AED). Major syndromes are epilepsy with generalized tonic-clonic seizures (GTCS) alone, absence epilepsy and juvenile myoclonic epilepsy. However, clinical practice shows drug-resistant patients. Endpoint is to identify clinical features related with refractoriness in IGE and in its each individual syndrome. METHODS We retrospectively collected 279 consecutive patients with IGE assessed in the Epilepsy Clinic of our institution. We defined drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. We classified patients in two groups: drug-resistant and drug-responsive. Clinical features were compared among these groups, in the whole IGE group as well as in each syndrome. RESULTS There were 122 drug-resistant, 105 drug- responsive; 52 were undefined and excluded from the analysis. After multivariate analysis, early seizures onset (age <13), long-time epilepsy, several generalized seizure types, status epilepticus, EEG with generalized epileptiform activity, mainly polyspikes, and side effects with AED brought up as poor outcome factors. Additionally, 50.6% identified modifiable seizure triggers. Regarding syndromes, epilepsy with generalized tonic-clonic seizures alone had the same factors except several seizure types; presence of additional GTCS, polyspikes, history of AED side effects and psychiatric disorder were poor factors for absence epilepsy; only psychiatric comorbidity revealed significance in juvenile myoclonic epilepsy. SIGNIFICANCE Refractoriness in IGE and its major syndromes is associated with clinical and electrographic parameters. Moreover, lifestyle advices from neurologists to the patients might help them to achieve a better seizure control.
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Affiliation(s)
- A Gomez-Ibañez
- Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada; Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avda. Fernando Abril Martorell, 106. 46026 Valencia, Spain.
| | - R S McLachlan
- Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada.
| | - S M Mirsattari
- Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada.
| | - D C Diosy
- Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada.
| | - J G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, London Health Sciences Centre,Western University. 339 Windermere Road, London, N6A5A5 ON, Canada.
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Strigaro G, Matino E, Falletta L, Pizzamiglio C, Tondo G, Badawy R, Cantello R. Defective interhemispheric inhibition in drug-treated focal epilepsies. Brain Stimul 2016; 10:579-587. [PMID: 28017318 DOI: 10.1016/j.brs.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/22/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Focal epilepsies (FEs) arise from a lateralized network, while in generalized epilepsies (GEs) there is a bilateral involvement from the outset. Intuitively, the corpus callosum is the anatomical substrate for interhemispheric spread. OBJECTIVE We used transcranial magnetic stimulation (TMS) to explore whether there are any physiological differences in the corpus callosum of drug-treated patients with FE and those with genetic GE (GGE), compared to healthy subjects (HS). METHODS TMS was used to measure the interhemispheric inhibition (IHI) from right-to-left primary motor cortex (M1) and viceversa in 16 patients with FE, 17 patients with GGE and 17 HS. A conditioning stimulus (CS) was given to one M1 10 and 50 ms before a test stimulus delivered to the contralateral M1. Motor evoked potentials (MEPs) were analysed both as a function of the side of stimulation and of the epileptic focus (left-right). RESULTS In HS, IHI was reproducible with suppression of MEPs at ISIs of 10 and 50 ms. Similar effects occurred in GGE patients. FE patients behaved differently, since IHI was significantly reduced bilaterally. When FE patients were stratified according to the side of their epileptic focus, the long-ISI IHI (=50 ms) appeared to be defective only when the CS was applied over the "focal" hemisphere. CONCLUSIONS FE patients had a defective inhibitory response of contralateral M1 to inputs travelling from the "focal" hemisphere that was residual to the drug action. Whilst IHI changes would not be crucial for the GGE pathophysiology, they may represent one key factor for the contralateral spread of focal discharges, and seizure generalization.
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Affiliation(s)
- Gionata Strigaro
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy; CRRF Mons. L. Novarese, Moncrivello, VC, Italy.
| | - Erica Matino
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Lina Falletta
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Chiara Pizzamiglio
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Giacomo Tondo
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Radwa Badawy
- Department of Medicine, Melbourne University, Victoria, Australia; Tamayoz Clinic, Cairo, Egypt
| | - Roberto Cantello
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
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Sirsi D, Dolce A, Greenberg BM, Thodeson D. Does Autoimmunity have a Role in Myoclonic Astatic Epilepsy? A Case Report of Voltage Gated Potassium Channel Mediated Seizures. Ann Clin Case Rep 2016; 1:1178. [PMID: 29308451 PMCID: PMC5754005] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is expanding knowledge about the phenotypic variability of patients with voltage gated potassium channel complex (VGKC) antibody mediated neurologic disorders. The phenotypes are diverse and involve disorders of the central and peripheral nervous systems. The central nervous system manifestations described in the literature include limbic encephalitis, status epilepticus, and acute encephalitis. PATIENT DESCRIPTION We report a 4.5 year-old boy who presented with intractable Myoclonic Astatic Epilepsy (MAE) or Doose syndrome and positive VGKC antibodies in serum. Treatment with steroids led to resolution of seizures and electrographic normalization. CONCLUSION This case widens the spectrum of etiologies for MAE to include autoimmunity, in particular VGKC auto-antibodies and CNS inflammation, as a primary or contributing factor. There is an evolving understanding of voltage gated potassium channel complex mediated autoimmunity in children and the role of inflammation and autoimmunity in MAE and other intractable pediatric epilepsy syndromes remains to be fully defined. A high index of suspicion is required for diagnosis and appropriate management of antibody mediated epilepsy syndromes.
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Affiliation(s)
- Deepa Sirsi
- Correspondence: Deepa Sirsi, Department of Neurology, Neurotherapeutics and Pediatrics, UT Southwestern Medical Center, 5323, Harry Hines Boulevard, Dallas, Texas, USA, 75390, Tel: (214) 456-8242; Fax: (214) 456-8990;
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Slinger G, Sinke MRT, Braun KPJ, Otte WM. White matter abnormalities at a regional and voxel level in focal and generalized epilepsy: A systematic review and meta-analysis. Neuroimage Clin 2016; 12:902-909. [PMID: 27882296 PMCID: PMC5114611 DOI: 10.1016/j.nicl.2016.10.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 12/24/2022]
Abstract
Objective Since the introduction of diffusion tensor imaging, white matter abnormalities in epilepsy have been studied extensively. However, the affected areas reported, the extent of abnormalities and the association with relevant clinical parameters are highly variable. We aimed to obtain a more consistent estimate of white matter abnormalities and their association with clinical parameters in different epilepsy types. Methods We systematically searched for differences in white matter fractional anisotropy and mean diffusivity, at regional and voxel level, between people with epilepsy and healthy controls. Meta-analyses were used to quantify the directionality and extent of these differences. Correlations between white matter differences and age of epilepsy onset, duration of epilepsy and sex were assessed with meta-regressions. Results Forty-two studies, with 1027 people with epilepsy and 1122 controls, were included with regional data. Sixteen voxel-based studies were also included. People with temporal or frontal lobe epilepsy had significantly decreased fractional anisotropy (Δ –0.021, 95% confidence interval –0.026 to –0.016) and increased mean diffusivity (Δ0.026 × 10–3 mm2/s, 0.012 to 0.039) in the commissural, association and projection white matter fibers. White matter was much less affected in generalized epilepsy. White matter changes in people with focal epilepsy correlated with age at onset, epilepsy duration and sex. Significance This study provides a better estimation of white matter changes in different epilepsies. Effects are particularly found in people with focal epilepsy. Correlations with the duration of focal epilepsy support the hypothesis that these changes are, at least partly, a consequence of seizures and may warrant early surgery. Future studies need to guarantee adequate group sizes, as white matter differences in epilepsy are small. White matter FA and MD are more affected in focal than in generalized epilepsy. Epilepsy subtypes show distinct patterns of affected white matter regions. White matter integrity is altered both ipsi- and contralaterally in focal epilepsy. White matter changes in focal epilepsy seem to be a consequence of seizures.
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Affiliation(s)
- Geertruida Slinger
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands
| | - Michel R T Sinke
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands
| | - Kees P J Braun
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Willem M Otte
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, The Netherlands; Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Seneviratne U, Boston RC, Cook M, D'Souza W. Temporal patterns of epileptiform discharges in genetic generalized epilepsies. Epilepsy Behav 2016; 64:18-25. [PMID: 27728899 DOI: 10.1016/j.yebeh.2016.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/23/2016] [Revised: 09/09/2016] [Accepted: 09/10/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We sought to investigate the temporal patterns and sleep-wake cycle-related epileptiform discharges (EDs) in genetic generalized epilepsies (GGEs). METHODS We studied 24-hour ambulatory electroencephalography (EEG) recordings of patients with GGE, diagnosed and classified according to the International League against Epilepsy criteria. We manually coded the type of discharge, time of occurrence, duration, and arousal state of each ED. We employed mixed effects Poisson regression modeling to study the temporal distribution of epileptiform discharges. Additionally, we used multinomial regression analysis to explore the significance of the relationship between different states of arousal and types of epileptiform discharges. RESULTS We analyzed 6923 EDs from 105 abnormal 24-hour EEGs. Mixed effects Poisson regression analysis demonstrated significant changes in ED counts across time blocks. This distribution was largely influenced by the state of arousal. Generalized fragments (duration<2s) and focal discharges were more frequent during non-REM sleep while paroxysms (duration≥2s) were more frequent in wakefulness. Overall, 67% of epileptiform discharges occurred in non-REM sleep and only 33% occurred in wakefulness. Twenty-four patients (23%) had ED exclusively in sleep. Epileptiform discharges peaked from 23:00 through 07:00h. SIGNIFICANCE There is a time-of-day dependency of ED with a significant influence exerted by the state of arousal. Our observations suggest that the generation of epileptiform discharges is not a random process but is the result of complex interactions among biological rhythms such as the sleep-wake cycle and the intrinsic circadian pacemaker. High density of ED in sleep suggests that 24-hour EEG recording with the capture of natural sleep may be more useful than routine EEG to diagnose GGE.
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Affiliation(s)
- Udaya Seneviratne
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; Department of Neuroscience, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Australia.
| | - Ray C Boston
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Mark Cook
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
| | - Wendyl D'Souza
- Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia.
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