Epilepsy Clinic Research Articles

Impact of physical activity on quality of life in patients with epilepsy in a developing country: A cross-sectional, survey-based study

RationalePatients with epilepsy face different barriers based on ignorance and fear of themselves and others while exercising, this situation complicates attempts at exercise and promotes discrimination against patients. Physical activity has been associated with favorable results in the health of this population and can be used as a non-pharmacological treatment seeking to increase the health and improve living conditions of patients. Our study aims to explore how physical activity impacts quality-of-life perception in these patients. MethodsWe performed a cross-sectional, survey-based study conducted at the outpatient Epilepsy Clinic in the National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”. Patients between 17 and 65 years of age and with an established diagnosis of epilepsy were considered for participation. A 31-item questionnaire was administered to all participants face-to-face or by telephone. The questions included in the survey were selected from the Global Physical Activity Questionnaire and the Quality of Life in Epilepsy Inventory to assess the level of exercise and perceived quality of life of participants. Descriptive and inferential Mann-Whitney U test statistical analysis was done using IBM SPSS Statistics 23.0 software. ResultsParticipants' mean age was 35.69 ± 11.93 years, 45 % were male and 55 % female. Significant differences were found in the domain of perceived quality of life in the self-reported physically active participants (p = 0.0256; 95 % IC: 1.00–15.22), with a mean score of 75.78 ± 16.64 in the active group vs. 67.66 ± 15.86 in the sedentary group. In those who complied with the exercise recommendations according to the WHO, there was significant evidence of improvement in the general quality of life (p = 0.0032; 95 % IC:4.9–23.9), with a mean score of 75.22 ± 15.92 in the active group vs. 60.76 ± 17.836 in the sedentary group. ConclusionsPhysical activity is associated with a significant impact on how patients with epilepsy perceive their quality of life. In addition, it improves memory and concentration in the tasks they perform in their daily lives.

Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions

PurposeAnti-seizure medications (ASM) can lower the efficacy of hormonal birth control (BC), while estrogen-containing BC can increase ASM metabolism, altering seizure frequency. Despite these adverse interactions, many youth with epilepsy demonstrate inadequate knowledge about this topic. Thus, there is a need to develop tools that empower youth with epilepsy to make more informed contraceptive decisions. This study assesses the use of a video-based educational tool to raise awareness of BC and ASM interactions in this population. MethodsWe created a video that gives an overview of possible interactions between certain BC methods and ASMs, mainly increased risk of pregnancy and change in seizure frequency. The video was shown to female patients aged 12 and older with epilepsy in a child neurology clinic and followed by a discussion with their treating neurologist. Fifteen patients completed two surveys that collected demographics, ASM regimen, BC history, and assessed exposure to and understanding of the subject matter before and after viewing the educational tool using 11-point Likert scales. We received seven responses from provider opinion surveys that were administered after the visit to assess the practicality of the video tool in teaching patients about their medication interactions. Data was analyzed with descriptive statistics and one-tailed paired t-tests (α = 0.05). ResultsPatients ranged from ages 16 to 24, with 46.7 % being in the 16 to 18 year-old range, 26.7 % in the 19 to 21 year-old range, and 26.7 % in the 22 to 24 year-old range. The median age was 19. 33 % of the patients reported having used BC, with 27 % reporting current interest in using BC. 33 % of patients were taking ASM that could reduce BC efficacy, and 27 % were on ASM with efficacy that can be reduced by BC. While 80 % of patients endorsed having previously discussed BC and ASM interactions with a doctor, patients rated their knowledge of the subject pre-video as moderately low with high interest in learning more about the topic. Patients’ understanding of how BC and ASM interactions can increase risk of pregnancy showed a significant increase post-video. Patients also indicated a high likelihood that they would think of the video when choosing a BC method and that they are more likely to start a discussion with their doctor about BC and ASM interactions because of the video. Treating neurologists showed high agreement that the video is useful in teaching their patients about BC and ASM interactions. ConclusionYouth with epilepsy deserve engaging resources that empower them to make informed decisions about BC. Despite most of our patients having had prior education about BC and ASM interactions, our results support the need for educational tools beyond patient-provider discussion and the efficacy of video as a tool to enhance understanding of this topic. The tool also showed potential to influence future patient decision making regarding BC and to empower patients to take an active role in discussing BC with their doctor. Our findings support a role for educational videos as an effective way to teach youth with epilepsy about reproductive health concerns and to promote active participation in decision making.

Anxiety and depression in people with epilepsy during andone year after the COVID-19 pandemic.

Compare the prevalence and severity of anxiety and depression among people with epilepsy (PWE) evaluated by telemedicine during the initial stages of the COVID-19 pandemic and follow up on their status 15 months later. We conducted a prospective, observational, and analytical study at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico City during the COVID-19 pandemic. HADS-A and HADS-D instruments were administered to adult patients diagnosed with epilepsy, initially through telemedicine and later through in-person visits or phone calls after one year. A sample of 115 patients was obtained, with 62.5% being women. The mean age of the patients was 33.6 years (± 12), and the mean age of epilepsy onset was 16.82 years (± 13.82). The majority of patients had focal epilepsy (78.3%), and only 42% reported being seizure-free. The results from the HADS-A scale showed that 48.69% of the patients had anxiety. On the HADS-D scale, 29.56% of the patients were found to have depression. At follow-up, the HADS-A results indicated that 50.64% of the patients had anxiety, and the HADS-D results showed that 36.36% had depression. An analysis of associations between sociodemographic or clinical variables and the presence of anxiety and/or depression in PWE revealed no statistically significant results, except for the clinical variable of patients taking anxiolytic or antidepressant medications during the assessment. These patients had lower HADS-A and HADS-D scores, with a statistically significant p-value of 0.0001. Comparing these findings with a previously published paper by our group showed a significant increase in both depression and anxiety, which were already prevalent in the earlier study. In conclusion, PWE exhibited high levels of anxiety and depression during and one year after the pandemic, despite receiving appropriate treatment. These symptoms, present before the pandemic, have been further exacerbated and continue to persist. This study examined anxiety and depression in patients with epilepsy (PWE) during the COVID-19 pandemic at the National Institute of Neurology and Neurosurgery in Mexico. Using the HADS-A and HADS-D scales, 115 patients were assessed over a year. Results showed that 48.69% had anxiety and 29.56% had depression, with both increasing to 50.64% and 36.36%, respectively, after one year. The only significant finding was that patients on anxiolytic or antidepressant medication had lower scores for anxiety and depression. The study concludes that anxiety and depression in PWE worsened during the pandemic and persisted despite treatment.

Association of Seizure Foci and Location of Tau and Amyloid Deposition and Brain Atrophy in Patients With Alzheimer Disease and Seizures.

Alzheimer disease (AD) is associated with a 2 to 3-fold increased risk of developing late-onset focal epilepsy, yet it remains unclear how development of focal epilepsy in AD is related to AD pathology. The objective of this study was to examine spatial relationships between the epileptogenic zone and tau deposition, amyloid deposition, and brain atrophy in individuals with AD who developed late-onset, otherwise unexplained focal epilepsy. We hypothesized that if network hyperexcitability is mechanistically linked to AD pathology, then there would be increased tau and amyloid deposition within the epileptogenic hemisphere. In this cross-sectional study, we performed tau and amyloid PET imaging, brain MRI, and overnight scalp EEG in individuals with early clinical stages of AD who developed late-onset, otherwise unexplained focal epilepsy (AD-Ep). Participants were referred from epilepsy and memory disorders clinics at our institutions. We determined epilepsy localization based on EEG findings and seizure semiology. We quantified tau deposition, amyloid deposition, and atrophy across brain regions and calculated asymmetry indices for these measures. We compared findings in AD-Ep with those in a control AD group without epilepsy (AD-NoEp). The AD-Ep group included 8 individuals with a mean age of 69.5 ± 4.2 years at PET imaging. The AD-NoEp group included 14 individuals with a mean age of 71.7 ± 9.8 years at PET imaging. In AD-Ep, we found a highly asymmetric pattern of tau deposition, with significantly greater tau in the epileptogenic hemisphere. Amyloid deposition and cortical atrophy were also greater in the epileptogenic hemisphere, although the magnitudes of asymmetry were reduced compared with tau. Compared with AD-NoEp, the AD-Ep group had significantly greater tau asymmetry and trends toward greater asymmetry of amyloid and atrophy. AD-Ep also had significantly greater amyloid burden bilaterally and trends toward greater tau burden within the epileptogenic hemisphere, compared with AD-NoEp. Our results reveal a spatial association between the epileptogenic focus and tau deposition, amyloid deposition, and neurodegeneration in early clinical stages of AD. Within the limitations of a cross-sectional study with small sample sizes, these findings contribute to our understanding of the clinicopathologic heterogeneity of AD, demonstrating an association between focal epilepsy and lateralized pathology in AD.

Brain Abscess Causes Brain Damage With Long-Lasting Focal Cerebral Hypoactivity that Correlates With Abscess Size: A Cross-Sectional 18F-Fluoro-Deoxyglucose Positron Emission Tomography Study.

Bacterial brain abscesses may have long-term clinical consequences, eg, mental fatigue or epilepsy, but long-term structural consequences to the brain remain underexplored. We asked if brain abscesses damage brain activity long term, if the extent of such damage depends on the size of the abscess, and if the abscess capsule, which is often left in place during neurosurgery, remains a site of inflammation, which could explain long-lasting symptoms in patients with brain abscess. 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT), electroencephalography, and MRI were performed 2 days to 9 years after neurosurgery for bacterial brain abscess. FDG-PET/CT revealed hypometabolism in the neocortex or cerebellum overlying the previous bacterial abscess in 38 of 40 patients. The larger the abscess, the greater was the extent of the subsequent hypometabolism (r = 0.63; p = 3 × 10-5). In 9 patients, the extent of subsequent hypometabolism seemed to coincide with the extent of peri-abscess edema in the acute phase. Follow-up MRI after ≥1 year in 9 patients showed focal tissue loss and gliosis. In 13 patients with abnormal electroencephalography recordings, abnormalities extended beyond the cerebral lobe affected by the abscess, indicating damage to wider brain networks. The abscess capsule had an FDG signal indicating inflammation only during the first week after neurosurgical pus drainage. The bigger a brain abscess is allowed to grow, the more extensive is the long-term focal reduction in brain activity. This finding emphasizes the need for rapid neurosurgical intervention. The abscess capsule does not display long-lasting inflammation and probably does not explain long-term symptoms after brain abscess.

Latent cognitive phenotypes in juvenile myoclonic epilepsy: Clinical, sociodemographic, and neuroimaging associations.

Application of cluster analytic procedures has advanced understanding of the cognitive heterogeneity inherent in diverse epilepsy syndromes and the associated clinical and neuroimaging features. Application of this unsupervised machine learning approach to the neuropsychological performance of persons with juvenile myoclonic epilepsy (JME) has yet to be attempted, which is the intent of this investigation. A total of 77 JME participants, 19 unaffected siblings, and 44 unrelated controls, 12 to 25 years of age, were administered a comprehensive neuropsychological battery (intelligence, language, memory, executive function, and processing speed), which was subjected to factor analysis followed by K-means clustering of the resultant factor scores. Identified cognitive phenotypes were characterized and related to clinical, family, sociodemographic, and cortical and subcortical imaging features. Factor analysis revealed three underlying cognitive dimensions (general ability, speed/response inhibition, and learning/memory), with JME participants performing worse than unrelated controls across all factor scores, and unaffected siblings performing worse than unrelated controls on the general mental ability and learning/memory factors, with no JME vs sibling differences. K-means clustering of the factor scores revealed three latent groups including above average (31.4% of participants), average (52.1%), and abnormal performance (16.4%). Participant groups differed in their distributions across the latent groups (p < 0.001), with 23% JME, 22% siblings, and 2% unrelated controls in the abnormal performance group; and 18% JME, 21% siblings, and 59% unrelated controls in the above average group. Clinical epilepsy variables were unassociated with cluster membership, whereas family factors (lower parental education) and abnormally increased thickness and/or volume in the frontal, parietal, and temporal-occipital regions were associated with the abnormal cognition group. Distinct cognitive phenotypes characterize the spectrum of neuropsychological performance of patients with JME for which there is familial (sibling) aggregation. Phenotypic membership was associated with parental (education) and imaging characteristics (increased cortical thickness and volume) but not basic clinical seizure features.

Computed tomography of the head with and without contrast in imaging focal and unknown epilepsy – A prospective observational study

PurposeBrain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice? MethodsA prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed. ResultsTwo hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for >3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, p = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient. ConclusionWhen imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.

Mental healthcare in paediatric epilepsy clinics: implementation by non-mental health professionals

ObjectivesResearch has shown that children with epilepsy often experience mental health disorders but face barriers to effective care. One solution is to train healthcare professionals within paediatric epilepsy services to...

Focal granule cell bilamination of the dentate gyrus-its prevalence across the human age spectrum and review of the literature.

The prevalence of focal granule cell bilamination (FGCB) in the hippocampal dentate gyrus varies from 0% to 44%, depending on age and study population. FGCB is commonly thought to be a specific feature of temporal lobe epilepsy (TLE) but its prevalence in cases without TLE is unclear. Using formalin-fixed, paraffin-embedded hippocampal sections, this retrospective postmortem study evaluated the prevalence of FGCB and other granule cell pathologies in infants (1-12 months of age, n = 16), children (4-10 years, n = 6), and adults (28-91 years, n = 15) with no known history of epilepsy or seizures. We found FGCB in 6% of infants, 17% of children, and 27% of adults. We then compared our findings with those in published reports of sudden unexpected deaths in infancy (SUDI), childhood (SUDC), and epilepsy (SUDEP), and in surgical specimens from patients with TLE. The reported prevalence of FGCB in those studies was 6%-19% in infants, 0%-17% in children, and 0%-2% in adults in non-seizure-related cases and 9% in children and 3%-25% in adults with TLE. Our findings highlight the presence of FGCB in individuals with no known epilepsy/seizure-related histories in proportions similar to those reported in individuals with clinical epilepsy.

Neurological care and outcomes in a cohort of Canadian pregnant patients with epilepsy

PurposeTo characterize anti-seizure medication (ASM) use over time, therapeutic drug monitoring, ASM dose adjustments and gestational seizure frequency among Canadian people with epilepsy of childbearing potential seen in an urban tertiary care center. MethodsParticipants were retrospectively identified from the medical records of pregnant patients with epilepsy seen at the University Health Network Comprehensive Epilepsy Program between 2014 and 2021. A descriptive analysis of outcomes, a logistic regression analysis of the odds of patients being on three ASMs associated with higher rates of teratogenicity (i.e., valproate, carbamazepine, and topiramate) over time, and a second logistic regression for predictors of seizure freedom during pregnancy were performed. Results195 pregnancies were included: 52 % had a maternal diagnosis of generalized epilepsy and 92 % were prescribed at least one ASM, with 75 % on monotherapy. The majority underwent therapeutic drug monitoring (77 %) with approximately two-thirds requiring dose adjustments (69 %), typically dosage increases (82 %). The proportion of patients on either valproate, topiramate, or carbamazepine decreased over time (OR=0.80; p<0.01). Fifty-seven percent of pregnancies maintained seizure freedom, with seizure-freedom for ≥1 year prior to conception being the strongest predictor of this outcome (OR of gestational seizure recurrence=0.04; p < 0.01). ConclusionThe proportion of patients on three ASMs associated with higher rates of teratogenicity has decreased over the duration of this study. Seizure-freedom prior to conception was associated with a decreased risk of gestational seizure recurrence.

Factors affecting employment status in people with epilepsy

Aim: People with epilepsy often face difficulties finding and keeping a job in India. This study aimed to determine the employment rate of people with epilepsy, compare it with that of people without epilepsy and to assess the various factors affecting theiremployment status. Methods: A comparative cross-sectional study was done by recruiting 140 people with epilepsy and 140 people without epilepsy (relatives of patients) from an epilepsy clinic in New Delhi, India. Demographic and clinical data were collected using questionnaires. Additionally, five items were added to measure self-perceived importance of work, ability to work and family support for working. Psychometric scales were used to measure the psychosocial variables affecting employment. Questionnaires were completed by people with epilepsy. Results: The employment rate of people with epilepsy was 59.3% as compared to 70.0% in those without epilepsy (P=0.045). Gender, younger age, having fewer family members, higher educational attainment, self-perceived importance of being employed for personal and financial reasons, and the ability to work and family support for working were some of the factors associated with employment status in people with epilepsy (P&lt;0.05). Among the psychosocial variables, epilepsy stigma and perceived social support were found to be significantly associated with being employed (P&lt;0.05). None of the clinical variables were found to be associated. Of those in the study, 56 out of 83 people with epilepsy, who had a job, felt they were underemployed. Conclusions: The employment rate of people with epilepsy was lower than the control population. The majority of those with jobs felt they were underemployed. A host of factors affect employment status in people with epilepsy. This suggests the need for vocational training, raised awareness among the general population, and counselling and other services for people with epilepsy.

Study of the Cardiovascular Effects of Ketogenic Diet Regimen in Epileptic Children

Abstract Background Ketogenic diet therapies (KDT) are well-established, non-pharmacologic treatments used for children with drug resistant epilepsy. Cardiac abnormalities have been reported in children on the KD, including cardiomyopathy and prolonged QT interval. ECG should be considered in any child with history of heart disease before starting ketogenic diet therapy. Aim of the Work To evaluate the impact of ketogenic diet therapy on the cardiovascular structure, diastolic function as well as assessment of carotid intima-media thickness for a group of children with drug resistant epilepsy. Patients and Methods This was a Prospective cohort study that was carried out at Ketogenic Diet Clinic and Epilepsy Clinic, Children’s Hospital, Faculty of Medicine, Ain Shams University on thirty infants and children with drug resistant epilepsy (DRE) aged from 6 months to 16 years old. Results There was no statistically significant difference in echocardiographic parameters, carotid intima media thickness (CIMT) or ECG after 6 months of Ketogenic diet therapy KDT inspite of hyperlipidemia and ketosis yet statistically significant negative correlation was found between serum cholesterol and triglyceride with ejection fraction and fractional shortening which could be explained by increased blood viscosity associated with hyperlipidemia. There was statistically significant decrease in seizure frequency and number of anti-epileptic drugs. There was significant increase in almost all anthropometric measurements, lipid profile and serum ketones. While no significant differences found in vital data, blood cells. Conclusion The six months ketogenic diet regimen appears to have no disturbing effect on the cardiovascular structure, diastolic functions as well as carotid intima-media thickness in children with drug resistant epilepsy inspite of hyperlipidemia. Cardiovascular monitoring is recommended for patients undergoing ketogenic diet therapy and further research is needed to fully understand the potential risks and benefits of this treatment on a larger population and longer period schedules.

Testing an online screening tool for epilepsy surgery evaluation.

Epilepsy surgery is recognized for its effectiveness in controlling seizures in a significant number of patients with drug-resistant epilepsy. Despite this, there remains a notable deficiency in referring these patients for video-electroencephalogram (EEG) monitoring and surgical evaluation. Addressing this gap, the Canadian Appropriateness of Epilepsy Surgery (CASES), an online tool for epilepsy surgery evaluation (www.epilepsycases.com), was developed to aid physicians in the referral process of patients with refractory epilepsy to surgical assessments. The present study aimed to evaluate the utility of CASES in identifying candidates for epilepsy surgery, thereby facilitating clinical decision-making for patients with drug-resistant epilepsy. A cross-sectional analysis was conducted using the CASES platform to assess surgical candidacy among individuals with epilepsy. Participants were selected among those receiving care at the Epilepsy Clinic of the Neurology Service, Hospital de Clínicas de Porto Alegre, Brazil, over a 3-month period. The study cohort included 211 patients. Data were systematically extracted from patient medical records or collected during clinical appointments. Of the evaluated cohort, 59.6% were identified as potential candidates for video-EEG monitoring and subsequent surgical evaluation. Factors significantly associated with recommendations for video-EEG and surgical assessment included seizure frequency, the number of antiseizure medications (ASMs) trialed, and the occurrence of drug-related adverse effects. The CASES showed significant potential in guiding recommendations for video-EEG monitoring and facilitating referrals for epilepsy surgery. This tool may not only enhance patient treatments and outcomes but also contribute to cost savings in epilepsy management in both the short and long term.

Hope for the Best but Plan for the Worst: Seizure Action Plans in Adult Epilepsy Clinics.

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Clinical features, hemorrhage risk and epilepsy outcomes of familial cerebral cavernous malformation: A 20-year observational pragmatic single-center study

IntroductionFamilial Cerebral Cavernous Malformations (fCCMs) are rare, hereditary conditions characterized by multiple central nervous system lesions. Despite their rarity, CCMs can cause significant clinical challenges when symptomatic, manifesting as seizure and symptomatic hemorrhage (CASH). Guidelines suggest neurosurgical intervention for symptomatic or previously symptomatic lesions, while conservative management is recommended for new-onset epilepsy. However, the natural history and optimal management remain unclear, necessitating further research. ObjectiveThis study aims to provide a comprehensive analysis of the clinical features, hemorrhage risk, and epilepsy outcomes in fCCM patients over an extended follow-up period, offering a more precise estimate of CASH and epilepsy rates in this population. MethodsThis retrospective longitudinal cohort study included fCCM patients enrolled from 2001 to May 2024. Data collected included demographic information, new neurological symptoms, symptomatic hemorrhages, seizures, and modified Rankin Scale (mRS) scores. Incidence rates of first symptomatic events and Kaplan-Meier survival curves were calculated, with logistic and Cox-proportional hazard regression models used to evaluate outcomes. ResultsA total of 47 patients were included in this study, with a mean age at diagnosis of 37.51 years. At diagnosis, 68 % were symptomatic, with 30 % having CASH and 36 % experiencing seizures without CASH. During a median follow-up of 126.0 months (interquartile range, 110.5 months), 17 % had a new CASH event, 20 % had seizures without CASH, and 60 % remained asymptomatic. The bleeding rate was 1.02 % per patient-year, with new focal neurological symptoms at 2.045 per 1000 patient-years and new CASH at 10.225 per 1000 patient-years. Most patients maintained minimal or no disability (mRS 0 or 1). Presenting with epilepsy at baseline significantly increased the odds of future seizures (OR 18.13, p = 0.001). ConclusionThis study highlights the complex presentation and progression of fCCMs, emphasizing the necessity for long-term monitoring. Baseline epilepsy is a significant predictor of future seizures, underscoring the need for individualized management strategies. Future research with larger cohorts and standardized criteria is essential to refine the understanding and management of fCCMs.

Postoperative seizure outcomes and antiseizure medication utilization based on histopathological diagnosis: A retrospective cohort study

ObjectiveAnalyze the association between histopathology, seizure outcomes, and drug load of antiseizure medications (ASMs) 5–8 years after epilepsy surgery to inform preoperative decision-making and consultation. MethodsIn this retrospective, non-interventional, single-center study, patients who visited the epilepsy clinic at West China Hospital, Sichuan University from Jan 1, 2015 to Dec 31, 2020 were assessed. Patients with postoperative histopathology after epilepsy resection were included and categorized into 13 etiological groups. The primary outcomes were achieving Engel class 1 at 1, 2, 3, 5, and 8 years postoperative. Secondary outcomes included the use of ASMs and comparison of postoperative seizure outcomes between adults and children. Univariate and multivariable analyses were conducted to explore the association between clinical characteristics such as histopathology and seizure outcomes. ResultsA total of 315 patients were include. Patients with embryonic dysplastic neuroepithelial tumor (DNT) achieved the best seizure outcomes (84.6 % Engel class 1). DNT (odds ratio, OR=0.103, 95 %CI=0.012–0.899), cavernous hemangiomas (OR=0.140, 95 %CI=0.024–0.819) and meningioma (OR=0.137, 95 %CI=0.021–0.910) were independently associated with a higher probability of seizure-free outcome. The results of epileptic seizures in adult and pediatric groups with different pathologies were significantly different, and the preoperative and postoperative ASM dosages were also different among adult patients with various etiologies. Additionally, multivariate analysis showed that early age at onset (adjusted hazard ratio (HR) = 1.754, 95 % CI=1.049–2.934, P=0.032), late surgical age (HR=0.569, 95 %CI=0.339–0.954, P=0.032), and longer duration from seizure onset to surgery (HR=1.735, 95 % CI=1.028–2.928, P=0.039) were independent predictors of unfavorable outcomes in epileptic seizures. Conclusionswe demonstrated that the seizure outcomes of focal epilepsy have high pathological specificity, with histopathological diagnosis serving as a crucial and independent determinant of seizure outcome. Surgical assessment should be contemplated for all patients with presumed refractory focal epilepsy, irrespective of their age.

The role of genetic testing in adult patients with unexplained epilepsy.

Genetic causes are often overlooked in patients with epilepsy of unknown etiology, particularly in adults. We aimed to evaluate clinical features of genetic epilepsy and the utility of genetic testing. We retrospectively screened consecutive unrelated adult epilepsy patients at an epilepsy clinic from April 2022 to May 2023. Patients with unknown etiology or special brain lesions were classified as unexplained epilepsy. In them, patients with young-onset seizures or family history of seizures who were recommended for and ultimately underwent genetic testing using either panel next-generation sequencing (NGS) or whole-exome sequencing (WES) were enrolled. A definite or probable genetic diagnosis was established through genotype-phenotype correlation. We compared the demographic characteristics between genetic epilepsy and other etiologies. Of the 374 adult epilepsy patients, 258 were classified as unexplained epilepsy, 129 were suspected of having genetic epilepsy due to young-onset seizures or a positive family history, 33 underwent genetic testing; 13 harbored variants classified as pathogenic, and 6 reached a definite genetic diagnosis, resulting in a yield of 18%. Among the 27 patients without a definite genetic diagnosis, 7 had a nongenetic structural etiology. Patients with genetic etiology exhibited greater multisystem involvement particularly multiple structural anomalies and early childhood-onset seizures, but wasn't directly correlated with young-onset seizures or a positive family history. The diagnostic yield was comparable between panel NGS and WES. In adult patients with unexplained epilepsy, genetic epilepsy is more associated with multisystem involvement and multiple structural anomalies but not family history of seizures or young-onset seizures.

Annotation of epilepsy clinic letters for natural language processing

BackgroundNatural language processing (NLP) is increasingly being used to extract structured information from unstructured text to assist clinical decision-making and aid healthcare research. The availability of expert-annotated documents for the development and validation of NLP applications is limited. We created synthetic clinical documents to address this, and to validate the Extraction of Epilepsy Clinical Text version 2 (ExECTv2) NLP pipeline.MethodsWe created 200 synthetic clinic letters based on hospital outpatient consultations with epilepsy specialists. The letters were double annotated by trained clinicians and researchers according to agreed guidelines. We used the annotation tool, Markup, with an epilepsy concept list based on the Unified Medical Language System ontology. All annotations were reviewed, and a gold standard set of annotations was agreed and used to validate the performance of ExECTv2.ResultsThe overall inter-annotator agreement (IAA) between the two sets of annotations produced a per item F1 score of 0.73. Validating ExECTv2 using the gold standard gave an overall F1 score of 0.87 per item, and 0.90 per letter.ConclusionThe synthetic letters, annotations, and annotation guidelines have been made freely available. To our knowledge, this is the first publicly available set of annotated epilepsy clinic letters and guidelines that can be used for NLP researchers with minimum epilepsy knowledge. The IAA results show that clinical text annotation tasks are difficult and require a gold standard to be arranged by researcher consensus. The results for ExECTv2, our automated epilepsy NLP pipeline, extracted detailed epilepsy information from unstructured epilepsy letters with more accuracy than human annotators, further confirming the utility of NLP for clinical and research applications.

Extracting seizure control metrics from clinic notes of patients with epilepsy: A natural language processing approach

ObjectivesMonitoring seizure control metrics is key to clinical care of patients with epilepsy. Manually abstracting these metrics from unstructured text in electronic health records (EHR) is laborious. We aimed to abstract the date of last seizure and seizure frequency from clinical notes of patients with epilepsy using natural language processing (NLP). MethodsWe extracted seizure control metrics from notes of patients seen in epilepsy clinics from two hospitals in Boston. Extraction was performed with the pretrained model RoBERTa_for_seizureFrequency_QA, for both date of last seizure and seizure frequency, combined with regular expressions. We designed the algorithm to categorize the timing of last seizure (“today”, “1–6 days ago”, “1–4 weeks ago”, “more than 1–3 months ago”, “more than 3–6 months ago”, “more than 6–12 months ago”, “more than 1–2 years ago”, “more than 2 years ago”) and seizure frequency (“innumerable”, “multiple”, “daily”, “weekly”, “monthly”, “once per year”, “less than once per year”). Our ground truth consisted of structured questionnaires filled out by physicians. Model performance was measured using the areas under the receiving operating characteristic curve (AUROC) and precision recall curve (AUPRC) for categorical labels, and median absolute error (MAE) for ordinal labels, with 95 % confidence intervals (CI) estimated via bootstrapping. ResultsOur cohort included 1773 adult patients with a total of 5658 visits with reported seizure control metrics, seen in epilepsy clinics between December 2018 and May 2022. The cohort average age was 42 years old, the majority were female (57 %), White (81 %) and non-Hispanic (85 %). The models achieved an MAE (95 % CI) for date of last seizure of 4 (4.00–4.86) weeks, and for seizure frequency of 0.02 (0.02–0.02) seizures per day. ConclusionsOur NLP approach demonstrates that the extraction of seizure control metrics from EHR is feasible allowing for large-scale EHR research.

The relationship between perceived stress, spiritual well-being and alexithymia in people with epilepsy: A path analysis

AimThe present study was performed to investigate the associations among perceived stress, spiritual well-being, and alexithymia in people with epilepsy. MethodThe study was performed with 140 patients diagnosed with epilepsy in the neurology clinic of a training and research hospital between May and December 2022. Personal Information Form, Perceived Stress Scale (PSS-14), Spiritual Well-Being Scale (FACIT Sp-12), and Toronto Alexithymia Scale (TAS-20) were used to collect the data. Descriptive statistical methods, simple and multiple regression analyses, and path analysis were used to analyze the data. ResultsThe mean scores of the patients were 25.51±9.42 for PSS-14, 29.77±8.33 for FACIT Sp-12, and 56.55±16.87 for TAS-20. Concerning direct effects, a negative association was found between perceived stress and spiritual well-being, a positive association between perceived stress and alexithymia, and a negative association between spiritual well-being and alexithymia. The confirmed mediating effect was the role of spiritual well-being in the association between perceived stress and alexithymia. Perceived stress explained 28 % of spiritual well-being. In addition, the model explained 34 % of alexithymia in total. ConclusionPerceived stress levels of people with epilepsy were low, while alexithymia and spiritual well-being levels were found to be moderate. It was found that as the stress levels perceived by people with epilepsy increased, alexithymia levels also increased. It was also found that the negative impact of perceived stress on alexithymia was reduced through spiritual well-being. The study shows how important spiritual well-being is in decreasing the negative impacts of perceived stress on alexithymia in people with epilepsy.