Frequency Of Epileptic Seizures Research Articles

Rheumatoid meningitis: a case series report and review of modern therapeutic schemes and outcome.

Rheumatoid meningitis (RM) is an extremely rare extra-articular complication of rheumatoid arthritis (RA), with approximately 165 cases reported world-wide. RM exhibits a broad range of symptoms, with stroke-like episodes and seizures being the most common manifestations. The primary differential diagnoses include vascular and infectious diseases. The influence of immunomodulatory medications on the pathophysiology of RM remains unclear. There are no consensus guidelines on therapeutic regimen. We present four patients with prior history of RA that developed different neurological syndromes in correlation to radiological leptomeningitis. Clinical presentations, comorbid conditions, supplementary diagnostic assessments, treatments, and prognosis are provided. A literature review of recent immunosuppressive management in RM patients was performed. Three patients presented to hospital with recurrent focal seizures. Only two suffered meningism, reporting headache and fever. Magnetic resonance imaging (MRI) showed different grades of leptomeningitis across all cases. Notably, three cases demonstrated bilateral involvement extending to the pachymeninges. Two patients exhibited pronounced CSF mononuclear inflammation while extended microbiological evaluations yielded negative results. Two patients required biopsy for confirmation. The initiation of immunosuppressive therapy marked a turning point for three patients who previously exhibited progressive deterioration. Mortality was absent in all cases. Our experience remarks the elusive nature of RM. Rigorous exclusionary diagnostics are imperative to differentiate RM from mimicking conditions. Clinical manifestations oscillate between transient episodes and progressive neurological impairments, punctuated by frequent epileptic seizures. In scenarios where clinical worsening persists or where clinical and radiological evaluations are inconclusive, aggressive immunosuppressive therapy is recommended.

Current state of clinical ultrasound neuromodulation.

Unmatched by other non-invasive brain stimulation techniques, transcranial ultrasound (TUS) offers highly focal stimulation not only on the cortical surface but also in deep brain structures. These unique attributes are invaluable in both basic and clinical research and might open new avenues for treating neurological and psychiatric diseases. Here, we provide a concise overview of the expanding volume of clinical investigations in recent years and upcoming research initiatives concerning focused ultrasound neuromodulation. Currently, clinical TUS research addresses a variety of neuropsychiatric conditions, such as pain, dementia, movement disorders, psychiatric conditions, epilepsy, disorders of consciousness, and developmental disorders. As demonstrated in sham-controlled randomized studies, TUS neuromodulation improved cognitive functions and mood, and alleviated symptoms in schizophrenia and autism. Further, preliminary uncontrolled evidence suggests relieved anxiety, enhanced motor functions in movement disorders, reduced epileptic seizure frequency, improved responsiveness in patients with minimally conscious state, as well as pain reduction after neuromodulatory TUS. While constrained by the relatively modest number of investigations, primarily consisting of uncontrolled feasibility trials with small sample sizes, TUS holds encouraging prospects for treating neuropsychiatric disorders. Larger sham-controlled randomized trials, alongside further basic research into the mechanisms of action and optimal sonication parameters, are inevitably needed to unfold the full potential of TUS neuromodulation.

ФАКТОРЫ РИСКА РЕЗИСТЕНТНОСТИ ЮНОШЕСКОЙ МИОКЛОНИЧЕСКОЙ ЭПИЛЕПСИИ

Abstract. Introduction. Juvenile myoclonic epilepsy is the most common form of genetic generalized epilepsy, which is included in the group of idiopathic generalized epilepsies. The etiology of drug-resistant forms of juvenile myoclonic epilepsy, which represent a serious clinical problem, is currently a controversial issue. Aim. To reveal the most significant risk factors of resistance in juvenile myoclonic epilepsy. Materials and Methods. The observational retrospective study included 56 patients, 46 (82%) women and 10 (18%) men. Inclusion criteria: patients diagnosed with juvenile myoclonic epilepsy based on the criteria of the International League Against Epilepsy, treatment for at least 2 years. The type and frequency of epileptic seizures, the onset and course of the disease, concomitant diseases, family history, all available results of 1-2 hours video electroencephalographic monitoring with sleep, and magnetic resonance imaging results were analyzed. Depending on the treatment effect, all patients were divided into two groups: 1 – without seizures, 2 – with seizures. Lack of complete seizure control for at least 2 years was considered intractable epilepsy. Risk ratios as outcomes for dichotomous variables in two compared groups for various characteristics and their confidence intervals were calculated using the Review Manager program (v5.3). Differences were considered significant at P<0.05. Results and Discussion. As a result, there were obtained data on the resistance of juvenile myoclonic epilepsy depending on the age of disease onset, the type of epileptic seizures, changes in the electroencephalogram, and the type of antiepileptic treatment. Conclusions. The most significant risk factors of resistance in juvenile myoclonic epilepsy have been identified: frequent generalized tonic-clonic seizures (more than 5 times a year) accompanying the basic disease, depression, anxiety, and lack of response to the treatment with valproic acid. At the same time, non-compliance, sleep disturbances, consumption of alcohol and energy drinks during therapy are factors that can be controlled during the physician’s individual work with the patient aimed at the explanation and prevention of risks in treatment.

The effect of oral zonisamide treatment on serum phenobarbital concentrations in epileptic dogs.

Zonisamide is used in dogs for the treatment of epileptic seizures. It is predominantly metabolised by CYP450 hepatic enzymes. When used concurrently with phenobarbital (PB), zonisamide clearance is increased and its elimination half-life decreases. However, the effect that zonisamide may have on serum PB concentrations in dogs has not been previously described. Eight dogs diagnosed with idiopathic epilepsy and two dogs with structural epilepsy commenced zonisamide at 8.0 mg/kg/12 h [7.4-10 mg/kg/12 h] following an increase in the frequency of epileptic seizures. Nine dogs were receiving PB every 12 h (4.2 mg/kg/12 h [3.8-6 mg/kg/12 h]), and one dog was receiving PB every 8 h (6 mg/kg/8 h). Following the addition of zonisamide and despite no increase in PB dosage, an increase in phenobarbital serum PB concentration was observed in 9 out of 10 dogs in subsequent measurements. In five dogs, phenobarbital serum concentrations were raised to concentrations higher than the reported hepatotoxic concentrations (trough>35 mg/L). This required a reduction in daily doses of PB. This case series suggests that zonisamide affects the metabolism of PB and causes an increase in PB serum concentrations over time.

Relationship of epileptic seizures with lunar cycle and seasons

Background and objectives: Various factors facilitate seizures in patients with epilepsy. The relationship between the phases of the moon and neuropsychiatric conditions has been a matter of curiosity. The present study investigated whether patient presentations to the emergency department with epileptic seizures vary according to the phases of the moon, seasons, and daily air temperature. Materials and method: The study retrospectively included patients who presented to the emergency department with epileptic seizures over a one-year period. Patients with provoked seizures (head trauma, intracranial hemorrhage, etc.), pregnant women, and patients aged under 18 years were excluded. Patients’ age, gender, date and time of presentation to the emergency department were recorded. The effects of the phases of the moon and seasons on these presentations were investigated. Results:Total 255 patients (176 male, 79 female) met the inclusion criteria of the study. The majority of patients (67.1%) were aged 18-44 years. Majority of the patients (41.2%) did not previously used epileptic medication. The laboratory tests ​​showed that the mean blood pH and lactate values were 7.31±0.11 and 4.59±4.12 mmol/L respectively. No statistically significant (p>0.05) relationship was observed regarding frequency of presentations of epileptic seizures and the season and phases of the moon. Conclusion: The results of this study showed that the phases of the moon, air temperature, and seasons did not affect the frequency of epileptic seizures. July 2024; Vol. 18(2):006 DOI: https://doi.org/10.55010/imcjms.18.018 *Correspondence: Erdal Yavuz, Department of Emergency Medicine, Adiyaman University Medical Faculty, Adiyaman, Turkey. Email: erdal_yavuz15@hotmail.com

α-linolenic acid ameliorates pentylenetetrazol-induced neuron apoptosis and neurological impairment in mice with seizures via down-regulating JAK2/STAT3 pathway.

Epilepsy ranks fourth among neurological diseases, featuring spontaneous seizures and behavioral and cognitive impairments. Although anti-epileptic drugs are currently available clinically, 30% of epilepsy patients are still ineffective in treatment, and 52% of patients experience serious adverse reactions. In this work, the neuroprotective effect of α-linolenic acid (ALA, a nutrient) in mice and its potential molecular mechanisms exposed to pentylenetetrazol was assessed. The mice were injected with pentetrazol 37 mg/kg, and ALA was intra-gastrically administered for 40 days. The treatment with ALA significantly reduced the overall frequency of epileptic seizures and improved the behavior impairment and cognitive disorder caused by pentetrazol toxicity. In addition, ALA can not only reduce the apoptosis rate of brain neurons in epileptic mice, but also significantly reduce the content of brain inflammatory factors (IL-6, IL-1, and TNF-α). Furthermore, we predicted that the possible targets of ALA in the treatment of epilepsy were JAK2 and STAT3 through molecular docking. Finally, through molecular docking and Western Blot studies, we revealed the potential mechanism of ALA ameliorates pentylenetetrazol-induced neuron apoptosis and neurological impairment in mice with seizures by downregulating the JAK2/STAT3 pathway. This study aimed to investigate the antiepileptic and neuroprotective effects of ALA, as well as explore its potential mechanisms, through the construction of a chronic ignition mouse model via intraperitoneal PTZ injection. The findings of this research provide crucial scientific support for subsequent clinical application studies in this field.

Influence of UGT2B7, UGT1A4 and ABCG2 Polymorphisms on the Pharmacokinetics and Therapeutic Efficacy of Lamotrigine in Patients with Epilepsy.

A substantial inter-individual variability has been observed in the pharmacokinetics of lamotrigine. The aim of the study was to investigate the impact of genetic polymorphism of the metabolizing enzymes (UGT2B7, UGT1A4) and transporter (ABCG2) on the pharmacokinetics and therapeutic efficacy of lamotrigine in patients with epilepsy. The genetic analysis of single-nucleotide polymorphisms was conducted using polymerase chain reaction sequence. High-performance liquid chromatography/tandem mass spectrometry was employed to measure the plasma concentrations of lamotrigine. The efficacy of lamotrigine was assessed by evaluating the reduction rate of epileptic seizure frequency. This study included a cohort of 331 patients who were treated with lamotrigine as monotherapy. A linear correlation was observed between the lamotrigine concentration and daily dose taken (r = 0.58, p < 2.2e-16). Statistically significant differences were found in both the median plasma concentration and dose-adjusted concentration (C/D ratio) when comparing the ineffective to the effective group (p < 0.05). Multivariate analysis showed that UGT1A4 rs2011425, ABCG2 rs2231142 polymorphisms and age had a significant relationship with the lamotrigine concentrations (p < 0.05). Age was a predictive factor for C/D ratio (p < 0.001). Lamotrigine concentration and weight were good predictive factors for effective seizure outcomes (odds ratio [OR] = 0.715, 95% CI 0.658-0.776, p < 0.001; OR = 0.926, 95% CI 0.901-0.951, p < 0.001, respectively). The cut-off values of lamotrigine trough concentrations for clinical outcomes in the age-related groups were determined as 2.49μg/ml (area under the receiver-operating characteristic curve [AUC]: 0.828, 95% CI 0.690-0.966), 2.70μg/ml (AUC: 0.805, 95% CI 0.745-0.866) and 3.25μg/ml (AUC: 0.807, 95% CI 0.686-0.928) for the adult group, adolescent group, and toddler and school-age group, respectively. UGT1A4 rs2011425 and ABCG2 rs2231142 were correlated with lamotrigine concentrations. Lower lamotrigine trough concentration was found in the ineffective group and the troughs were associated with seizure outcomes.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies.

Epilepsy is a severe, relapsing, and multifactorial neurological disorder. Studies regarding the accurate diagnosis, prognosis, and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy. The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression, protein expression, ion channel activity, energy metabolites, and gut microbiota composition. Satisfactory results are lacking for conventional treatments for epilepsy. Surgical resection of lesions, drug therapy, and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy. Non-pharmacological treatments, such as a ketogenic diet, gene therapy for nerve regeneration, and neural regulation, are currently areas of research focus. This review provides a comprehensive overview of the pathogenesis, diagnostic methods, and treatments of epilepsy. It also elaborates on the theoretical basis, treatment modes, and effects of invasive nerve stimulation in neurotherapy, including percutaneous vagus nerve stimulation, deep brain electrical stimulation, repetitive nerve electrical stimulation, in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation. Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures. Additionally, many new technologies for the diagnosis and treatment of epilepsy are being explored. However, current research is mainly focused on analyzing patients' clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level, which has led to a lack of consensus regarding the mechanisms related to the disease.

Pathogenesis, diagnosis, and treatment of epilepsy: electromagnetic stimulation-mediated neuromodulation therapy and new technologies.

Epilepsy is a severe, relapsing, and multifactorial neurological disorder. Studies regarding the accurate diagnosis, prognosis, and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy. The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression, protein expression, ion channel activity, energy metabolites, and gut microbiota composition. Satisfactory results are lacking for conventional treatments for epilepsy. Surgical resection of lesions, drug therapy, and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy. Non-pharmacological treatments, such as a ketogenic diet, gene therapy for nerve regeneration, and neural regulation, are currently areas of research focus. This review provides a comprehensive overview of the pathogenesis, diagnostic methods, and treatments of epilepsy. It also elaborates on the theoretical basis, treatment modes, and effects of invasive nerve stimulation in neurotherapy, including percutaneous vagus nerve stimulation, deep brain electrical stimulation, repetitive nerve electrical stimulation, in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation. Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures. Additionally, many new technologies for the diagnosis and treatment of epilepsy are being explored. However, current research is mainly focused on analyzing patients' clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level, which has led to a lack of consensus regarding the mechanisms related to the disease.

Ketogenic diet in pharmacoresistant epilepsies: a clinical nutritional assessment.

Epilepsies are among the most prevalent chronic neurological diseases, usually beginning in childhood. About 30% of children with epilepsies develop seizures that are difficult to control with medication. Recurrent epileptic seizures hinder diet intake, impairing the nutritional status. Although non-pharmacological interventions (e.g., ketogenic diet therapy) can improve epileptic seizure frequency, few studies analyzed their impact on the nutritional status of children and adolescents with epilepsies. The aim was to evaluate the effects of a ketogenic diet on the nutritional status and clinical course of patients with pharmacoresistant epilepsies. This cross-sectional study included patients under 18 years of age followed up at the Ketogenic Diet Ambulatory Clinic of the Instituto de Medicina Integral Prof. Fernando Figueira between December 2015 and December 2021. Socioeconomic, clinical, nutritional, and laboratory data were collected from medical records at different time points during the ketogenic diet. The sample comprised 49 patients aged between 5 months and 17 years (median = 4.4 years), mostly male (62.1%), and from Recife and the metropolitan region (51%). Underweight patients (BMI-for-age) improved their nutritional status in six months. However, patients who were normal weight and overweight maintained their nutritional status. Dyslipidemia was a common and short-term adverse effect. Moreover, the treatment decreased epileptic seizure frequency and antiseizure medication intake. The ketogenic diet prevented malnutrition from worsening and reduced epileptic seizures and antiseizure medication intake.

PerSurge (NOA-30) phase II trial of perampanel treatment around surgery in patients with progressive glioblastoma

BackgroundGlioblastoma is the most frequent and a particularly malignant primary brain tumor with no efficacy-proven standard therapy for recurrence. It has recently been discovered that excitatory synapses of the AMPA-receptor subtype form between non-malignant brain neurons and tumor cells. This neuron-tumor network connectivity contributed to glioma progression and could be efficiently targeted with the EMA/FDA approved antiepileptic AMPA receptor inhibitor perampanel in preclinical studies. The PerSurge trial was designed to test the clinical potential of perampanel to reduce tumor cell network connectivity and tumor growth with an extended window-of-opportunity concept.MethodsPerSurge is a phase IIa clinical and translational treatment study around surgical resection of progressive or recurrent glioblastoma. In this multicenter, 2-arm parallel-group, double-blind superiority trial, patients are 1:1 randomized to either receive placebo or perampanel (n = 66 in total). It consists of a treatment and observation period of 60 days per patient, starting 30 days before a planned surgical resection, which itself is not part of the study interventions. Only patients with an expected safe waiting interval are included, and a safety MRI is performed. Tumor cell network connectivity from resected tumor tissue on single cell transcriptome level as well as AI-based assessment of tumor growth dynamics in T2/FLAIR MRI scans before resection will be analyzed as the co-primary endpoints. Secondary endpoints will include further imaging parameters such as pre- and postsurgical contrast enhanced MRI scans, postsurgical T2/FLAIR MRI scans, quality of life, cognitive testing, overall and progression-free survival as well as frequency of epileptic seizures. Further translational research will focus on additional biological aspects of neuron-tumor connectivity.DiscussionThis trial is set up to assess first indications of clinical efficacy and tolerability of perampanel in recurrent glioblastoma, a repurposed drug which inhibits neuron-glioma synapses and thereby glioblastoma growth in preclinical models. If perampanel proved to be successful in the clinical setting, it would provide the first evidence that interference with neuron-cancer interactions may indeed lead to a benefit for patients, which would lay the foundation for a larger confirmatory trial in the future.Trial registrationEU-CT number: 2023-503938-52-00 30.11.2023.

Clinical phenotypes of developmental and epileptic encephalopathy-related recurrent KCNH5 missense variant p.R327H in Chinese children

KCNH5 gene encodes for the voltage-gated potassium channel protein Kv10.2. Here, we investigated the clinical features of developmental and epileptic encephalopathy (DEE) in five Chinese pediatric patients with a missense mutation (p.R327H) in KCNH5 gene. These patients had undergone video EEG to evaluate background features and epileptiform activity, as well as 3.0 T MRI scans for structural analysis and intelligence assessments using the Gesell Developmental Observation or Wechsler Intelligence Scale for Children. Seizure onset occurs between 4 and 10 months of age, with focal and generalized tonic-clonic seizures being common. Initial EEG findings showed multiple multifocal sharp waves, sharp slow waves or spike slow waves, and spike waves. Brain MRI revealed widened extracerebral space in only one patient. Mechanistically, the KCNH5 mutation disrupts the two hydrogen bonds between Arg327 and Asp304 residues, potentially altering the protein’s structural stability and function. Almost 80 % of patients receiving add-on valproic acid (VPA) therapy experienced a reduction in epileptic seizure frequency. Altogether, this study presents the first Chinese cohort of pediatric DEE patients with the KCNH5 p.R327H mutation, highlighting focal seizures as the predominant seizure type and incomplete mutation penetrance. Add-on VPA therapy was likely effective in the early stages of DEE pathogenesis.

Automatic epileptic seizure detection based on EEG using a moth-flame optimization of one-dimensional convolutional neural networks.

Frequent epileptic seizures can cause irreversible damage to the brains of patients. A potential therapeutic approach is to detect epileptic seizures early and provide artificial intervention to the patient. Currently, extracting electroencephalogram (EEG) features to detect epileptic seizures often requires tedious methods or the repeated adjustment of neural network hyperparameters, which can be time- consuming and demanding for researchers. This study proposes an automatic detection model for an EEG based on moth-flame optimization (MFO) optimized one-dimensional convolutional neural networks (1D-CNN). First, according to the characteristics and need for early epileptic seizure detection, a data augmentation method for dividing an EEG into small samples is proposed. Second, the hyperparameters are tuned based on MFO and trained for an EEG. Finally, the softmax classifier is used to output EEG classification from a small-sample and single channel. The proposed model is evaluated with the Bonn EEG dataset, which verifies the feasibility of EEG classification problems that involve up to five classes, including healthy, preictal, and ictal EEG from various brain regions and individuals. Compared with existing advanced optimization algorithms, such as particle swarm optimization, genetic algorithm, and grey wolf optimizer, the superiority of the proposed model is further verified. The proposed model can be implemented into an automatic epileptic seizure detection system to detect seizures in clinical applications.

Model predicting the onset of antiepileptic drug resistance in women of reproductive age with epilepsy: analytical study

Introduction. In attempt to find an answer regarding the possible scenarios of epilepsy evolution in women of reproductive age (e.g. worsening, remission, antiepileptic drug resistance, status epilepticus occurence), preferably - objective, based on simple, replicable, observable indicators that can be included in a mathematical probability estimation model, could significantly improve their quality of life and increase the effectiveness of prescribed treatments. Materials and methods. Bidirectional, cohort, descriptive-analytical study, conducted between 2016-2020. Primary data were collected in the Diomid Gherman Institute of Neurology and Neurosurgery, the State Hospital of Republic of Moldova and the Excellence Private Medical Institution. Out of 366 unique parameters, which were recorded in the 159 patients enrolled in the study at each visit (total, 4 documentation visits over 5 years period), 10 parameters were selected for multivariate analysis, considered relevant for predicting clinically significant outcomes. Criteria for parameter relevance were: reaching p≤0.1 in univariate analysis, easy documentation. Subsequently, testing for multicollinearity (calculation of variance inflation factor) and the contribution of each parameter in the formula was performed using the Akaike informativeness criteria. The performance of the developed predictive models was expressed by the area under the ROC curve, positive and negative prognostic power. Statistical analysis: GraphPad Prism, v. 9 trial (Graph Pad Software, Boston, USA). Results. Age at onset of the disease 14.0±6.3 years; age at first referral to specialist 24.0±7.2 years. The developed predictive model, based on 3 parameters (depressive state, annual frequency of seizures, presence of brain lesions on MRI) has a positive predictive value of 83%, negative of 62%, with an area under the ROC curve of 0.72 (95%CI = 0.56 to 0.88) and a probability of occurrence of 96%. Conclusions. Depressed patients with documented structural lesions on MRI and a high frequency of epileptic seizures have a progressive, significant risk (an OR of 5.3-24.0) of developing resistance to antiepileptic drugs.

Современные принципы в лечении эпилепсии

Epilepsy is an urgent social problem. Nowadays in Russia almost 450 thousand of patients have faced with this disease, the purpose of which therapy is to reduce the frequency of epileptic seizures. Most of the patients currently have a non-pharmacoresistant form of epilepsy which is available for conservative therapy, while for about a third of the total number of patients these methods are ineffective. For this reason, active work is underway to find new and more effective methods for the treatment of this disease. The article discusses the current principles of the epilepsy treatment.

Antiepileptic Drugs and the Relationship with the Intestinal Microbiota

This review of the literature examines the use of antiepileptic medications and how they relate to gut microbiota. Relationships exist between the makeup of the intestinal microbiota and the development and execution of the most fundamental physiological processes. Additionally, it affects the functioning of the central nervous system (CNS) by interacting with the microbiota-intestine-brain axis. The use of pharmaceutical medication is one of the factors that can alter the composition of the gut microbiota. When treating epilepsy, various drug types are used, each with a different mechanism of action. Among the medications in question are to piramate, primidone, phenytoin, carbamazepine, and phenobarbital. The similarity in structure and function between enteric and nerve cells establishes the connection between the brain and the gut. Valproic acid significantly reduced intestinal inflammation in research involving rats with colitis. Its limited ability to treat seizures in these circumstances may be due to the enterocytes limited ability to absorb this medicine. The study came to the conclusion that colitis patients and people with healthy gut, brain, and microbiota interactions typically respond better to antiepileptics and anticonvulsants than people with imbalances in this axis. These imbalances can result in a lower seizure threshold and an increased frequency of epileptic seizures.

Remarkable anecdotes illustrating the nature and effect of seizure-precipitating factors in Border Collies with idiopathic epilepsy.

Epilepsy is one of the most common chronic neurological syndromes in dogs and has serious implications for the quality of life of both the dogs and owners. Seizure-precipitating factors (SPFs) (also termed "triggers" or "provocative factors") have been studied and reported in both humans and dogs with idiopathic epilepsy. In dogs stress, hormones, sleep deprivation, and the weather have been reported as SPFs. The Border Collie (BC) is a breed of dog that is predisposed to idiopathic epilepsy, and the outcome is often poor. BC is described as a very sensitive dog with a strong focus on their owners, and this may have an influence on their and their owners' stress level. In this article, we described six unrelated BCs with idiopathic epilepsy in which several remarkable SPFs were identified, and avoiding them improved the outcome of these dogs. The possible SPFs were different for each dog. The SPFs were, among others, the other dog in the family, the lack of intellectual challenge, the presence of an autistic child, a busy street, the relation with the owner, and throwing a ball at the beach. These cases illustrate that recognizing the SPF(s) and taking measures with regard to management can lead to a reduction in epileptic seizure frequency or even achieving seizure freedom.

P11.61.B TUMOR ASSOCIATED EPILEPSY AND RESTRICTION OF DRIVING PRIVILEGES IN THE FIRST YEAR AFTER BRAIN TUMOR SURGERY

Abstract BACKGROUND In most countries, the risk of postoperative seizures prompts regulations restricting driving privileges at least temporarily following brain tumor operations. The present study investigated the frequency of epileptic seizures and driving habits in the first year after brain tumor operations in a prospective and a retrospective patient cohort. MATERIAL AND METHODS The authors studied overall 523 patients undergoing surgery for a brain tumor at the authors’ institution (prospective cohort, 09/2021-09/2022: N=313 and retrospective cohort, 01/2020-12/2020: N=210). Clinical data were obtained by reviewing patient charts and through (telephone) interviews. RESULTS The cohort included 160 (30.6%) meningiomas, 135 (25.6%) glioblastomas, 111 (21.2%) metastases and 56 (10.7%) other gliomas. 135/523 (25.8%) presented with seizure(s). At 3 months (excluding early post operative seizures) overall 57 (10.9%; prospective vs. retrospective cohort: 13.2 vs. 8.1%) patients reported seizure(s). The seizure incidence at 1 year was 18.4% (prospective vs. retrospective cohort: 18.7 vs. 18.2%). 22/173 (12.7%) patients reported de-novo seizures at 1 year. Significant predictors of seizures at 1 year included preoperative seizures (p&amp;lt;0.001), an adverse preoperative and postoperative KPI (p=0.038 and p=0.001) as well as postoperative NANO (p&amp;lt;0.001) score and histology (e.g. meningiomas: 7.5%, metastases: 22.0%, glioblastomas: 38.5%, other gliomas: 18.8%; p&amp;lt;0.001). 219/318 (69.9%) assessable patients were not driving in 3 months. Reasons included no driver’s license (6.3%), death (7.9%), neurological deficits (38.4%), epilepsy (9.0%), and personal choice (12.9%). 91.3% of glioblastoma patients did not drive in 3 months (cf. metastases: 77.8%, other gliomas. 72.4%, meningiomas: 43.8%; p&amp;lt;0.001). CONCLUSION We documented a high incidence of postoperative seizures and potential risk factors in patients following brain tumor surgery. Our figures support postoperative restriction of driving privileges even in seizure-naive patients (12.7% de-novo seizures at 1 year). Of note, epilepsy was the reason for not driving after surgery for a brain tumor only in 9.0%.

Efficacy evaluation of a commercially available MCT enriched therapeutic diet on dogs with idiopathic epilepsy treated with zonisamide: a prospective, randomized, double-blinded, placebo-controlled, crossover dietary preliminary study

BackgroundIdiopathic epilepsy (IE) is a common, chronic brain dysfunction in dogs. Recently, the effect of feeding a diet enriched with medium-chain triglycerides (MCTs) on seizure frequency has been evaluated in several studies in dogs with IE. However, most dogs with IE in previous studies were treated with phenobarbital as the main antiseizure medication (ASM). In Japan, zonisamide (ZNS) is the most prescribed ASM for dogs with IE. The interaction between ZNS and various nutrients including MCTs and the potential effects on treatment efficacy resulting from combining these therapies have not been previously studied. A prospective, randomized, double-blinded, placebo-controlled, crossover dietary study was conducted. Dogs (n = 7) treated with ZNS were fed either a placebo diet (PL) or Purina ProPlan Veterinary Diet NeuroCare (NC) for 3 months, after which treatments were crossed over and continued for another 3 months. Seizure frequency (seizures/month; sz/m), blood tests including concentrations of ZNS and β-hydroxybutyric acid, and owner’s visual analogue scale score were collected from all dogs for both treatment periods.ResultsThere was no significant difference in the seizure frequency between PL (2.95 ± 0.80 sz/m) and NC (1.90 ± 0.57 sz/m) during the 6 months of trial. Three of 7 dogs showed ≥ 50% seizure reduction, and 1 of those 3 dogs achieved seizure freedom in NC period. However, 2 of 7 dogs had no changes in epileptic seizure frequency, 2 of 7 dogs had a deterioration in seizure frequency in the NC period. Feeding the MCT diet concurrent with ZNS showed no apparent adverse effects and did not affect ZNS concentration.ConclusionsThis study indicated that the commercially available MCT-enriched diet (NC) can be safely used concurrently with ZNS for dogs with IE.

CLINICAL AND PSYCHIATRIC CHANGES IN EPILEPTIC PATIENTS WITH COVID-19 INFECTION

The article provides information about clinical and mental changes in epileptic patients who have experienced COVID-19 infection. The frequency of these symptoms, their clinical characteristics and the dependence of their manifestation on the infection of COVID-19 were investigated. Various scales or questionnaires were used in the research. Observations have shown that epileptic seizures on the NHS-3 scale occur more frequently and tend to increase in severity in epileptic patients who have had an infection with COVID-19. When assessing the mental sphere of their patients (with the MMSE and HADS scales), it was found that cases of mental spectrum disorders prevail in epileptic patients who have experienced COVID-19. The presence of mild depression (BDI scale) and severe asthenia (MFI scale) were also more marked in this group. Analysis of the results showed that epileptic patients who had experienced a COVID-19 infection were more likely to have impaired cognitive function. Sleep disturbances were assessed using the MOS-SS scale, and it was found that epileptic patients with coronovirus infection were more likely to have moderate sleep disturbances than those without COVID-19. During the correlation analysis, it was determined that there is a direct positive relationship between the severity and frequency of epileptic seizures with the infection of COVID-19. All this shows the negative effect of the infection of COVID-19 on the course of epilepsy.