Clinical Characteristics Of Epilepsy Research Articles

Relationship between epilepsy and patent foramen ovale

This study aimed to investigate the prevalence and clinical characteristics of epilepsy in patients with patent foramen ovale (PFO) and the effect of PFO closure on seizures. Patients diagnosed with PFO were recruited and underwent brain magnetic resonance imaging, electrocardiography, transesophageal echocardiography, and transthoracic echocardiography with right ventriculography. In patients with epilepsy, electroencephalography was performed. A total of 110 patients completed the assessment. A chief complaint of chest tightness or palpitations was proportionately higher in patients aged<18 years, whereas headaches and seizures were higher in patients aged≥18 years (χ2=4.69,P<0.05). Comorbid epilepsy was observed in 20.9% of patients with PFO. The age at admission in the epileptic group (14-66(27±14)years) was significantly lower than that in the non-epileptic group (16-81(38±21)years) and that in patients with headache as the chief complaint (16-68(39±12)years) (t=3.29, P<0.05). The multivariate analysis found no risk factors related to the prognosis of epilepsy. The incidence of epilepsy was significantly higher in patients with PFO than in the general population.

Clinical profile of epilepsy in western Algeria

BackgroundEpilepsy is one of the most common neurological diseases that affects people of different ages, ethnicities, and geographical locations. The objective of the present study was to determine the demographic and clinical characteristics of epilepsy in west Algerian population.Patients and methodsWe enrolled 226 patients with epilepsy and collected data from medical records. We analyzed socio-demographic data, personal and family history, age at onset, seizure types, neurological and psychological findings, etiologies, syndromic classification and comorbidities.ResultsIn our cohort, the mean age was 27.26 ± 17.57 years and there was no gender predominance. The mean age of seizure onset was 17.11 ± 16.27 years. Genetic epilepsy was the most observed (45.13%). Focal seizures (69.02%) were more frequent than generalized seizures which were mostly represented by absence and tonic–clonic seizures. We reported 51.45% of patients with comorbidities and 16.65% with a history of traumatic brain injury.ConclusionThis is the first report describing the clinical profile and the socio-demographic features in a cohort of patients with epilepsy in the western Algeria. Our results could help to offer personalized care to our patients based on the clinical particularities of their epileptic disorders.

Epilepsy in cardiofaciocutaneous syndrome: Clinical burden and response to anti-seizure medication.

Treatment-resistant epilepsy is among the most serious complications of cardiofaciocutaneous syndrome (CFCS), a rare disorder caused by germline variants in the RAS-MAPK signaling pathway. This study analyzed the clinical characteristics of epilepsy and response to anti-seizure medications (ASMs) in a multinational CFCS cohort. A caregiver survey provided data regarding seizure history, use of ASMs and other treatment approaches, adverse effects, caregiver perception of treatment response, and neurological disease burden impact among individuals with CFCS. Results from 138 survey responses were quantitatively analyzed in conjunction with molecular genetic results and neurological records. The disease burden impact of CFCS was higher among individuals with epilepsy (n = 74/138), especially those with more severe seizure presentation. Oxcarbazepine, a sodium-channel blocker, had the best seizure control profile with relatively infrequent adverse effects. The most commonly prescribed ASM, levetiracetam, demonstrated comparatively poor seizure control. ASM efficacy was generally similar for individuals with BRAF and MAP2K1 gene variants. The high proportion of patients with CFCS who experienced poor seizure control despite use of multiple ASMs highlights a substantial unmet treatment need. Prospective study of ASM efficacy and clinical trials of therapies to attenuate RAS-MAPK signaling may improve avenues for clinical management.

The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months

BackgroundAccumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. MethodsA total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. ResultsAn SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. ConclusionsThis study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.

Prevalence of epilepsy in the onchocerciasis endemic middle belt of Ghana after 27 years of mass drug administration with ivermectin

BackgroundIn onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission, a high prevalence of epilepsy has been reported. This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration (MDA).MethodsBetween October 2020 and August 2021, cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana. In the first stage, a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire. Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification. Community O. volvulus microfilarial infection status and Ov16 seropositivity were also determined. Ninety-five confidence intervals (95% CI) for prevalence values were calculated using the Wilson Score Interval.ResultsOf the 971 participants, 500 (51.5%) were females, and the median age (interquartile range) was 26 (15‒43) years. Fourteen participants (1.4%, 95% CI: 1.0‒2.0) were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type (85.7%, 12/14). The overall microfilarial prevalence of O. volvulus was 10.3% (November 2020) and 9.9% (August 2021); the Ov16 seroprevalence was 22.2% (June 2021). Only 63.2% took ivermectin in the last round of MDA distribution in March 2021.ConclusionsThe 1.4% prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa. However, the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.Graphical

Psychiatric comorbidity in relation to clinical characteristics of epilepsy: A retrospective observational study

PurposePrevalence 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. MethodParticipants 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. ResultsIn 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. ConclusionJust 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.

Case analysis of epilepsy, neurodevelopmental disorder, and motor disorders associated with mutations in the dehydrodolichyl diphosphate synthase gene

The objective of this study is to analyze the role of dehydrodolichyl diphosphate synthase (DHDDS), a crucial enzyme in the mevalonate pathway, and its encoded mutations in the onset of developmental delay and seizures, with or without movement abnormalities. Its genotype-phenotype characteristics are still inconclusive. We analyzed the clinical characteristics of epilepsy, and neurodevelopmental and motor disorders related to DHDDS gene mutations and report the genotype-phenotype characteristics of a child with epilepsy caused by DHDDS gene mutation, providing a summary and a statistical analysis of epilepsy cases associated with DHDDS gene mutation up until February 2022.Methods: Using "DHDDS; epilepsy; neurodevelopmental disorder" as the keywords, the literature relevant to DHDDS gene mutations up until February 2022 was reviewed. A total of 25 cases were retrieved, among which 21 cases with complete data were included in the chi-squared test. The clinical characteristics of DHDDS gene-related cases were summarized and analyzed.Results: The onset of epilepsy caused by mutations of the DHDDS gene typically occurs during infancy. Predominantly, the mutation occurs in the locus of c.632G>A p.R211Q. Myoclonus is frequently the initial manifestation of epilepsy; it frequently coexists with neurodevelopmental disorder and intellectual disability, and patients have no specific type of motor disorder. Cranial magnetic resonance imaging (MRI) reveals no abnormalities, whereas electroencephalogram (EEG) frequently exhibits abnormalities. Valproic acid (VPA) yields good curative effects.Conclusion: Mutations in the DHDDS gene are associated with congenital glycosylation disorder, autosomal recessive retinitis pigmentosa, and epilepsy. According to statistical analysis using the chi-squared test, for pediatric patients with mutations in this gene locus, most of the epilepsy types are myoclonic epilepsies with intellectual disability and neurodevelopmental disorders. They have normal brain MRIs and abnormal EEGs. VPA produces beneficial therapeutic results and the differences are all statistically significant. The current diagnosis still relies on next-generation sequencing or whole-exome sequencing.

Evaluation of Event-Related Potentials in Assessing Cognitive Functions of Adult Patients with Epilepsy of Unknown Etiology.

Cognitive impairment (CI) is an important consequence of epilepsy. The aim of the study was to assess cognitive performance in patients with epilepsy, using neuropsychological tests (NT) and event-related potentials (ERPs), with regard to demographic and clinical data. The study comprised 50 patients with epilepsy of unknown etiology and 46 healthy controls. Based on the NT results, the patients were divided into subgroups with/without CI. Parameters of P300 potential were compared between the patients and controls. P300 parameters and NT results were referred to demographics and clinical characteristics of epilepsy. Based on the NT, 66% of patients were assigned as cognitively impaired. Median P300 latency was significantly (p < 0.0002) prolonged in the study group. Subgroups of patients with and without CI significantly (p < 0.034) differed in education level and vocational activity, duration of epilepsy, age at its onset and frequency of polytherapy. P300 parameters showed significant (p < 0.03) relationships with duration of epilepsy, type and frequency of seizures and polytherapy. Cognitive impairment and ERPs abnormalities occur in a majority of patients with epilepsy of unknown etiology. Characteristics of epilepsy and socioeconomic status are related to cognitive performance. ERPs may complement neuropsychological methods in the assessment of cognition in patients with epilepsy.

The effect of COVID-19 vaccination on epileptic seizures in patients with epilepsy: A clinical observation in China

ABSTRACT This observational retrospective study was conducted on patients with epilepsy (PWE) in China who had at least one dose of COVID-19 vaccine and it investigated the safety of vaccination by analyzing changes in epileptic seizures and their influencing factors. Consecutive PWE who were followed up in the epilepsy clinic between June 2021 and May 2022 were enrolled. Data on vaccine type, demographic information, clinical characteristics of epilepsy, and treatment were collected through a questionnaire survey and retrospectively analyzed. PWE were divided into a stable seizure group and a worsening seizure group based on seizure episodes at least 90 days after the first vaccine dose. A total of 79 PWE were included. After vaccination, 14 patients (17.7%) had worsening seizures, 92.9% of whom had an increased seizure frequency. Compared with patients in the stable seizure group, patients in the worsening seizure group had significant differences in baseline monthly seizure frequency (P = .012), improper antiseizure medication (ASM) administration (P = .003) and a disrupted sleep routine (P = .016). Multivariate logistic regression analysis showed that improper ASM administration (OR 6.186, 95% confidence interval [CI] 1.312–29.170; p = .021) and a disrupted sleep routine (OR 6.326, 95% CI 1.326–30.174; p = .021) were significantly associated with seizure worsening. In short, COVID-19 vaccination is safe for PWE, and only those with poor seizure control have the possibility of seizure exacerbation after COVID-19 vaccination. The vaccination per se does not represent a major influencing factor, but the improper use of ASMs and a disrupted sleep routine may be correlated with seizure aggravation after vaccination.

Primary headache disorders in epileptic adults

BackgroundEpilepsy and primary headache disorders are two relatively common neurological disorders and their relationship is still a matter of debate. We aimed to estimate the prevalence and clinical features of primary headache disorders in patients with epilepsy.Methods62 subjects aged ≥ 18 years were recruited from the hospital’s neurology outpatient clinic in the period from January to April 2018. The subjects were further divided into two equal groups, epileptics and non-epileptics. They underwent a semi-structured interview including the ILAE 2017 epilepsy classification and the ICHD III-beta criteria for headache. Patients' demographic data and clinical characteristics of epilepsy and headache and temporal relationships between them were assessed. Patients who experienced headaches were grouped based on the type of headaches and on whether their headaches occurred in the pre-ictal, post-ictal or inter-ictal period.ResultsPrimary headache disorders were more common in epileptic group (61.3%) than the non-epileptic group (32.2%) (p = 0.021). The tension-type headache was the most common (45.2%) followed by migraine-type headache (12.9%) in the epileptic group. Post-ictal headache was the most common type (29%). Inter-ictal headaches were significantly related to "focal to bilateral tonic–clonic" seizures (p = 0.046). The prevalence of headache among patients on polytherapy (69.2%) was higher than that of patients on monotherapy (52.9%).ConclusionsIn this study, headache was more common in epileptic patients. TTH was the most represented type of headache in patients with epilepsy. Headache occurred in patients with epilepsy most frequently during the post-ictal period.

Glymphatic system dysfunction in temporal lobe epilepsy patients with hippocampal sclerosis.

ObjectiveThis study aimed to evaluate glymphatic system function in temporal lobe epilepsy (TLE) patients with hippocampal sclerosis (HS) in comparison to healthy controls, using diffusion tensor imaging (DTI)‐analysis along the perivascular space (ALPS) method. We hypothesized that there is glymphatic system dysfunction in TLE patients with HS.MethodsWe retrospectively enrolled 25 TLE patients with HS and 26 age‐ and sex‐matched healthy controls. All participants underwent DTI with the same 3T magnetic resonance imaging scanner, and the DTI‐ALPS index was calculated. We evaluated the differences in the DTI‐ALPS index between TLE patients with HS and healthy controls. Moreover, we evaluated the correlation between the DTI‐ALPS index and clinical characteristics of epilepsy, including age, age at seizure onset, duration of epilepsy, and number of anti‐seizure medications (ASMs).ResultsThere was a difference in the DTI‐ALPS index between TLE patients with HS and healthy controls. The DTI‐ALPS index in TLE patients with HS was lower than that in healthy controls (1.497 vs. 1.668, P = .015). However, there was no difference in the DTI‐ALPS index between the newly diagnosed TLE patients with HS and the chronic TLE patients with HS. The DTI‐ALPS index was negatively correlated with age (r = −0.420, P = .036). However, the DTI‐ALPS index was not correlated with other clinical characteristics, including age at seizure onset, duration of epilepsy, and number of ASMs.SignificanceOur findings showed that the DTI‐ALPS index was significantly lower in TLE patients with HS than in healthy controls, indicating the presence of glymphatic system dysfunction in TLE patients with HS. Our study also suggests that the DTI‐ALPS method may be useful for evaluating glymphatic system function in epilepsy.

Clinical characteristics of low-grade tumor-related epilepsy and its predictors for surgical outcome.

ObjectivesLow‐grade tumors are the most common neoplasms inducing focal epilepsy; however, the short‐ and medium‐term efficacy of surgery in epilepsy patients with low‐grade tumors remains underappreciated. This study aims to summarize the clinical characteristics of epilepsy patients with low‐grade tumors and to identify factors associated with postsurgical seizure‐free outcomes.MethodsWe retrospectively reviewed consecutive patients with low‐grade tumors who underwent subsequent epilepsy surgery in our epilepsy center, between 2012 and 2018 with a minimum follow‐up of 1 year. Using Engel’s classification and Kaplan–Meier survival analysis, we assessed postoperative seizure freedom over time. Demographical, electroclinical, and other presurgical evaluations were then evaluated for association with postoperative seizure outcome.ResultsThe cohort included a total of 132 patients: 79 males and 53 females. Among them, 110 (83.33%) were seizure‐free through their last follow‐up. The Engel class I outcomes were 90.15%, 87.76%, 85.53%, 82.46%, and 73.17% at the end of the 1st, 2nd, 3rd, 4th, and 5th postoperative years, respectively. Multivariate logistic analysis revealed that longer epilepsy duration (p < 0.001, OR 1.091, 95% CI 1.040–1.144) and incomplete resection (p = 0.009, OR 3.673, 95% CI 1.393–9.684) were independently associated with seizure recurrence through the last follow‐up.ConclusionsSurgical treatment for seizure control in patients with low‐grade tumors provides excellent short‐ and median‐term outcomes.

Genetic polymorphisms of the serotonin transporter are not related with depression in temporal lobe epilepsy caused by hippocampal sclerosis

BackgroundMood disorders are the most frequent psychiatric disorders in patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS). The pathophysiological mechanisms in common between TLE and mood disorders include abnormalities in the serotonergic pathway. We aimed to evaluate the association between serotonin transporter genetic polymorphisms – 5-HTTLPR and 5-HTTVNTR – and the presence of mood disorders in patients with TLE-HS. MethodsWe evaluated 119 patients with TLE-HS, with and without psychiatric disorder; 146 patients diagnosed with major depressive disorder (MDD), and 113 healthy volunteers. Individuals were genotyped for the 5-HTTLPR and 5-HTTVNTR polymorphisms. ResultsNo difference was observed between the TLE-HS groups, healthy controls, and MDD without epilepsy. There was a correlation between the 12-allele of the 5-HTTVNTR and the family history of patients with epilepsy with TLE-HS (p = 0.013). ConclusionsIn this study conducted in two Brazilian centers, the serotonin transporter polymorphisms evaluated cannot be associated with depressive disorder in patients with TLE-HS. Still, they do have some influence over some clinical characteristics of epilepsy in TLE-HS. These data may not be reproduced in other populations with distinct ethnic characteristics.

Demographic and Clinical Characteristics of Epilepsy in Childhood: A Prospective Cross Sectional Study from Sudan

Background: Epilepsy is a common neurological disorder affecting around 1% of children. The incidence in Sudan is likely to be higher given the high rate of genetic disorders related to consanguity and acquired disorders caused by CNS infection and birth injury. Epilepsy can be idiopathic or non-idiopathic, symptomatic epilepsy indicates a known cause while cryptogenic epilepsy implies a presumed unknown cause. Objective: To understand the demographic and clinical characteristics of epilepsy in children in the setting of a tertiary epilepsy clinic in Khartoum, Sudan. Methods: This is a hospital-based cross sectional study recruiting patients with epilepsy attending a tertiary pediatric neurology clinic. All patients attending the clinic in the 6 month period were included. Data was collected by medical students and was analyzed on IBM SPSS Version 20.0 in a descriptive fashion. Results: 284 Children were recruited. The mean age for children with epilepsy was 5.74 (range 0-12 Years). Females constituted 59.9%; while 94.7% of patients were of low socioeconomic status. The most common type of seizures found were generalized tonic clinic at 51.8% (147/284), followed by focal seizures at 21.1% (60/284). 71% of our patients (201/284) had no identifiable cause (idiopathic), while 29% were non-idiopathic. Of the non-idiopathic group; 41% were due to congenital anomalies, followed by HIE at 24.1%, infections at 16.9% trauma at 10.8% and tumors at 7.2%. Only 18.3% (52/284) had a positive family history of epilepsy. Conclusions: There appears to be a higher incidence of epilepsy in Children with low socio – economic status with a slight female predominance. The incidence of idiopathic epilepsy appears to be similar to inter-national figures. We recommend broader community based and long-term studies for better understanding of epilepsy in Sudan.

Clinical Characteristics of Epilepsy and Its Risk Factors in Neurofibromatosis Type 1: A Single-Center Study

Clinical Characteristics of Epilepsy and Its Risk Factors in Neurofibromatosis Type 1: A Single-Center Study

Thalamohippocampal atrophy in focal epilepsy of unknown cause at the time of diagnosis.

Patients with chronic focal epilepsy may have atrophy of brain structures important for the generation and maintenance of seizures. However, little research has been conducted in patients with newly diagnosed focal epilepsy (NDfE), despite it being a crucial point in time for understanding the underlying biology of the disorder. We aimed to determine whether patients with NDfE show evidence of volumetric abnormalities of subcortical structures. Eighty-two patients with NDfE and 40 healthy controls underwent magnetic resonance imaging scanning using a standard clinical protocol. Volume estimation of the left and right hippocampus, thalamus, caudate nucleus, putamen and cerebral hemisphere was performed for all participants and normalised to whole brain volume. Volumes lower than two standard deviations below the control mean were considered abnormal. Volumes were analysed with respect to patient clinical characteristics, including treatment outcome 12months after diagnosis. Volume of the left hippocampus (p(FDR-corr) =0.04) and left (p(FDR-corr) =0.002) and right (p(FDR-corr) =0.04) thalamus was significantly smaller in patients relative to controls. Relative to the normal volume limits in controls, 11% patients had left hippocampal atrophy, 17% had left thalamic atrophy and 9% had right thalamic atrophy. We did not find evidence of a relationship between volumes and future seizure control or with other clinical characteristics of epilepsy. Volumetric abnormalities of structures known to be important for the generation and maintenance of focal seizures are established at the time of epilepsy diagnosis and are not necessarily a result of the chronicity of the disorder.

Clinical characteristics of Idiopathic Epilepsy in Greater Swiss Mountain Dogs in Switzerland

Background: Little is known about idiopathic Epilepsy in Greater Swiss Mountain Dogs. Until now this breed is not listed as a predisposed breed for idiopathic epilepsy. The aim of this study was to estimate the prevalence of idiopathic epilepsy in Greater Swiss Mountain Dogs in Switzerland and to describe the clinical characteristics of epilepsy in this breed including seizures semiology and response to treatment. Material and Methods: Records of the Swiss Kennel Club for Greater Swiss Mountain Dogs were searched for reported cases of epileptic seizures between 1999-2019. The total number of reported cases and the signalment was reviewed. Furthermore, all owners of Greater Swiss Mountain Dogs registered to the breeding club were invited to complete an online questionnaire. Results: In total 600 Greater Swiss Mountain Dog's live in Switzerland: 70-90 puppies are born each year. Between 1999 and 2019 34 dogs (2%) were announced with seizures. Of the 400 owners invited to answer the questionnaire 128 completed the questionnaire. 20 of these 128 dogs were suffering from idiopathic epilepsy. The prevalence for idiopathic epilepsy based on the questionnaire was therefore 15,6%. All affected dogs showed generalized tonic-clonic seizures. Cluster seizures and status epilepticus occurred in 5 (41,6%) and 6 (50%) of the dogs. Long term seizure control was only achieved in 10% of the dogs. Five dogs (25%) died or were euthanized because of insufficient seizure control. Only one dog (5%) showed clinical remission. Conclusion: Prevalence of idiopathic epilepsy is higher in Greater Swiss Mountain Dogs in Switzerland compared to the general dog population. Seizure control seems to be difficult to achieve in this breed and remission-rate is low.

Clinical characteristics of epilepsy in resource-limited communities in Punjab, Northwest India.

ObjectivesTo describe clinical characteristics of a community‐based epilepsy cohort from resource‐limited communities in Punjab, Northwest India.MethodsThe cohort was gathered following a two‐stage screening survey. We cross‐sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness.ResultsThe cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug‐resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years.SignificanceExisting classifications schemes should be better suited to field conditions in resource‐limited communities in low‐ and middle‐income countries. The finding of drug‐resistant epilepsy in nearly at least a third in a community‐based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.

Continuous epileptiform discharges during sleep as an evolutionary pattern in patients with congenital Zika virus syndrome.

Congenital Zika virus syndrome (CZVS) is associated with severe neurological deficits. Clinical characteristics of epilepsy and the electroencephalographic (EEG) pattern in CZVS were documented in infancy. In this study, we aimed to describe the EEG findings observed during the follow-up of children with CZVS. Seventy-six EEGs of 55 children (60% female; mean age = 50months) with confirmed CZVS were analyzed, considering the background, interictal, and ictal epileptiform discharges. Continuous (or almost continuous) epileptiform discharges during non-rapid eye movement sleep were identified in 22 (40%) patients. In 20 (90.1%) patients, the pattern was symmetrical, with an anterior predominance of the epileptiform activity. All patients with this pattern had epilepsy, which was severe in 15 (68.2%) and demanded polytherapy in 19 (86.4%). Subcortical calcifications (77.3%) and multifocal EEGs (72.8%) in earlier ages occurred more often in patients with this pattern. Other unspecific interictal EEG patterns were focal epileptiform discharges in 23 (41.8%) and multifocal activity in six (10.9%). In CZVS, continuous (or almost continuous) epileptiform discharges during sleep emerge as a pattern after the second year of life. This was associated with severe and drug-resistant epilepsy, but not necessarily with an apparent regression. Subcortical calcifications and multifocal epileptiform discharges in infancy are associated with this pattern.

Behavioral phenotypes of childhood idiopathic epilepsies.

To characterize the presence and nature of discrete behavioral phenotypes and their correlates in a cohort of youth with new and recent onset focal and generalized epilepsies. The parents of 290 youth (age = 8-18 years) with epilepsy (n=183) and typically developing participants (n=107) completed the Child Behavior Checklist for children aged 6-18 from the Achenbach System of Empirically Based Assessment. The eight behavior problem scales were subjected to hierarchical clustering analytics to identify behavioral subgroups. To characterize the external validity and co-occurring comorbidities of the identified subgroups, we examined demographic features (age, gender, handedness), cognition (language, perception, attention, executive function, speed), academic problems (present/absent), clinical epilepsy characteristics (epilepsy syndrome, medications), familial factors (parental intelligence quotient, education, employment), neuroimaging features (cortical thickness), parent-observed day-to-day executive function, and number of lifetime-to-date Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. Hierarchical clustering identified three behavioral phenotypes, which included no behavioral complications (Cluster 1, 67% of epilepsy cohort [n=122]), nonexternalizing problems (Cluster 2, 11% of cohort [n=21]), and combined internalizing and externalizing problems (Cluster 3, 22% of cohort [n=40]). These behavioral phenotypes were characterized by orderly differences in personal characteristics, neuropsychological status, history of academic problems, parental status, cortical thickness, daily executive function, and number of lifetime-to-date DSM-IV diagnoses. Cluster 1 was most similar to controls across most metrics, whereas Cluster 3 was the most abnormal compared to controls. Epilepsy syndrome was not a predictor of cluster membership. Youth with new and recent onset epilepsy fall into three distinct behavioral phenotypes associated with a variety of co-occurring features and comorbidities. This approach identifies important phenotypes of behavior problem presentations and their accompanying factors that serve to advance clinical and theoretical understanding of the behavioral complications of children with epilepsy and the complex conditions with which they co-occur.