High Seizure Frequency Research Articles

High frequency of post-stroke seizures among West Africans

High frequency of post-stroke seizures among West Africans

Epilepsy stigma in the Republic of Guinea and its socioeconomic and clinical associations: A cross-sectional analysis

ObjectiveWe aim to quantify the degree of epilepsy stigma perceived by people living with epilepsy (PLWE) in the Republic of Guinea (2019 gross national income per capita, 930 USD) and analyze the demographic, social, and clinical factors associated with epilepsy stigma in this setting. MethodsA prospective convenience cohort of PLWE was recruited at the Ignace Deen Hospital in Conakry and evaluated by U.S. and Guinean neurology-trained physicians. A survey instrument exploring demographic, social, and clinical variables was designed and administered. The primary outcome measure was the Stigma Scale of Epilepsy (SSE), a 24-item scale with scores ranging from 0 (least stigma)–100 (most). Regression models were fit to assess associations between SSE score and pre-selected demographic, social, and clinical variables of interest. Results249 PLWE (112 female; mean age 20.0 years; 22 % from rural locales; 14 % of participants >16 years old with no formal schooling; 11 % seizure-free for >=6 months) had an average SSE score of 46.1 (standard deviation = 14.5) points. Children had an average SSE score of 45.2, and adults had an average score of 47.0. There were no significant differences between self- and guardian-reported SSE scores (means = 45.8 and 46.5, respectively), p = .86.In univariate analyses, higher stigma scores were associated with more seizures (p = .005), more depressive symptoms (p = .01), and lower household wealth (p = .03). In a multivariable model including sex, educational level, household wealth, generalized tonic-clonic seizures, seizure frequency, and seizure-related burns, only higher seizure frequency (β = −2.34, p = .03) and lower household wealth (β = 4.05, p = .03) were significantly associated with higher SSE scores. ConclusionIn this Guinean cohort of people living with poorly-controlled epilepsy, there was a moderate degree of perceived stigma on average. Stigma was associated with higher seizure frequency and lower household wealth—both potentially modifiable factors.

Patient and Caregiver Health State Utilities in Tuberous Sclerosis Complex.

BackgroundTuberous sclerosis complex (TSC) is a rare multisystem disorder often associated with treatment-resistant epilepsy. Cost-effectiveness analysis for new antiseizure medications typically requires health state utilities (HSUs) that reflect the burden of a given condition.ObjectiveThis study aimed to estimate HSUs, with a focus on valuing the impact of seizure type and seizure frequency on health-related quality of life (HRQL) for patients with TSC and their caregivers.MethodsA targeted literature review and qualitative research with healthcare professionals and caregivers informed the development of health state vignettes describing the experience of living with TSC or caring for a child with TSC. Vignettes were evaluated in interviews with the UK general population using the time trade-off (TTO) method.ResultsSixteen vignettes were developed describing patient HRQL (n = 8) and caregiver HRQL (n = 8). Two hundred interviews were conducted via online video calls due to COVID-19 pandemic restrictions. Two hundred participants evaluated the patient (n = 100) and caregiver (n = 100) health state vignettes. Estimated utility scores varied consistently according to seizure type and seizure frequency. Patient TTO utility scores ranged between −0.234 (highest seizure frequency and multiple seizure types) and 0.725 (seizure-free state). Caregiver TTO utility scores ranged from 0.221 to 0.905.ConclusionsFindings highlight the substantial burden of living with TSC and caring for a child with TSC. Patient and caregiver burden was greater for generalised versus focal seizures. The burden was greatest for a combination of both seizure types and worsened with increasing seizure frequency.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00296-1.

Clinical factors associated with work disability in epilepsy: A cross-sectional study at a tertiary referral hospital

ObjectiveThe impact of epilepsy on work disability remains unclear. The aim of this study was to determine the percentage of patients with epilepsy who are unemployed or on temporary or permanent disability leave and to analyze associated clinical factors. MethodsWe performed an observational cross-sectional study of consecutively recruited patients with epilepsy seen at a specialized epilepsy unit or admitted to the epilepsy monitoring unit of a tertiary referral hospital. We analyzed the percentage of patients who were actively employed, unemployed, and on temporary or permanent disability leave. The groups were compared for sociodemographic data (age, sex, marital status, and type of work), clinical data (type of epilepsy, disease duration, monthly seizure frequency, and presence of anxiety or depression), treatment-related factors, and quality of life. ResultsWe included 742 patients (53% male, mean age 44.3 ± 13.7 years old): 40.5% were employed, 29.2% were unemployed, 19% were on temporary disability leave, and 11.1% had a permanent work disability. Depressive symptoms and poorer quality of life were associated with unemployment (OR 2.3, p = 0.02 and OR 1.8, p = 0.01), temporary disability leave (OR 1.4, p = 0.05 and OR 1.7, p = 0.02), and permanent work disability (OR 1.9, p = 0.01 and OR 2.2, p = 0.01). Low-skilled work was also predictive of unemployment (OR 1.9, p = 0.04), temporary disability leave (OR 2.8, p = 0.03), and permanent work disability (OR 1.7, p = 0.04). A higher monthly seizure frequency was associated with permanent work disability (OR 2.01, p = 0.02). ConclusionLess than 50% of patients with epilepsy in our setting are working. Factors associated with unemployment and work disability are a higher frequency of seizures, low-skilled work, depressive symptoms, and poor quality of life.

Hippocampal atrophy and quantitative EEG markers in mild cognitive impairment in temporal lobe epilepsy versus extra-temporal lobe epilepsy.

Cognitive impairment in temporal lobe epilepsy is widely acknowledged as one of the most well-known comorbidities. This study aimed to explore cognitive impairment and to determine the potential clinical, radiological, and quantitative electroencephalography markers for cognitive impairment in temporal lobe epilepsy patients versus extra-temporal lobe epilepsy. Forty-five patients with temporal lobe epilepsy and forty-five patients with extra-temporal lobe epilepsy were recruited for an administered digit span test, verbal fluency test, mini-mental state examination, digital symbol test, and Montreal cognitive assessment. Also, they were subjected to magnetic resonance imaging assessment for hippocampal atrophy and a quantitative electroencephalography assessment for electroencephalography markers (median frequency, peak frequency, and the alpha-to-theta ratio). Patients with extra-temporal lobe epilepsy showed non-significant higher epilepsy durations and a higher frequency of seizures. Temporal lobe epilepsy patients showed a more statistically significant family history of epilepsy (37.7%), more history of febrile convulsions (13.3%), higher hippocampal atrophy (17.8%), and lower cognitive scales, especially mini-mental state examination and Montreal cognitive assessment; lower digital symbol test, verbal fluency test, and backward memory of digit span test. Also, temporal lobe epilepsy patients had a strong negative correlation with electroencephalography markers: median frequency, peak frequency, and the alpha-to-theta ratio (r = - 0.68, P < 0.005 and r = - 0.64, P < 0.005 and r = - 0.66, P < 0.005 respectively). Cognitive impairment in patients with temporal lobe epilepsy was correlated with hippocampal atrophy and quantitative electroencephalography abnormalities, especially peak frequency, median frequency, and alpha-to-theta ratio that could be used alone for the identification of early cognitive impairment. Clinicaltrials.gov: NCT04376671.

Improving the prediction of epilepsy surgery outcomes using basic scalp EEG findings.

This study aims to evaluate the role of scalp electroencephalography (EEG; ictal and interictal patterns) in predicting resective epilepsy surgery outcomes. We use the data to further develop a nomogram to predict seizure freedom. We retrospectively reviewed the scalp EEG findings and clinical data of patients who underwent surgical resection at three epilepsy centers. Using both EEG and clinical variables categorized into 13 isolated candidate predictors and 6 interaction terms, we built a multivariable Cox proportional hazards model to predict seizure freedom 2years after surgery. Harrell's step-down procedure was used to sequentially eliminate the least-informative variables from the model until the change in the concordance index (c-index) with variable removal was less than 0.01. We created a separate model using only clinical variables. Discrimination of the two models was compared to evaluate the role of scalp EEG in seizure-freedom prediction. Four hundred seventy patient records were analyzed. Following internal validation, the full Clinical+EEG model achieved an optimism-corrected c-index of 0.65, whereas the c-index of the model without EEG data was 0.59. The presence of focal to bilateral tonic-clonic seizures (FBTCS), high preoperative seizure frequency, absence of hippocampal sclerosis, and presence of nonlocalizable seizures predicted worse outcome. The presence of FBTCS had the largest impact for predicting outcome. The analysis of the models' interactions showed that in patients with unilateral interictal epileptiform discharges (IEDs), temporal lobe surgery cases had a better outcome. In cases with bilateral IEDs, abnormal magnetic resonance imaging (MRI) predicted worse outcomes, and in cases without IEDs, patients with extratemporal epilepsy and abnormal MRI had better outcomes. This study highlights the value of scalp EEG, particularly the significance of IEDs, in predicting surgical outcome. The nomogram delivers an individualized prediction of postoperative outcome, and provides a unique assessment of the relationship between the outcome and preoperative findings.

Patients with epilepsy during the COVID-19 pandemic: Depressive symptoms and their association with healthcare access

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak impacted the lives of worldwide people with epilepsy (PWE) in various aspects, particularly in those countries most significantly affected by this pandemic, such as Brazil. We aimed to investigate the prevalence of depressive symptoms in PWE and their correlation with epilepsy features and access to treatment. MethodsPWE were invited to answer a cross-sectional online-based survey to assess and rate depressive symptoms using the NDDI-E during the first year of the COVID-19 pandemic and its relation to multiple lifestyles epilepsy clinical aspects. ResultsA total of 490 PWE were recruited. The prevalence of depressive symptoms during the COVID-19 pandemic was 35.3% (cutoff score > 15 on NDDI-E). The factors associated with higher NDDI-E scores were: female sex, increased seizure frequency, barriers to access to their treating physician and antiseizure medication, and unemployment. Regarding the pandemic impact on PWE healthcare, 29.2% reported restricted access to their medication, 46.1% barriers to access their physicians, 94.2% had their consultations canceled due to the pandemic, and 28.4% had seizure worsening in this period. ConclusionThe COVID-19 pandemic affected PWE access to the healthcare system. Depressive symptoms were more severe in patients with higher seizure frequency who had difficulties obtaining proper medical care. The COVID-19 pandemic may impact the healthcare and mental wellbeing of patients with chronic diseases such as epilepsy. Nevertheless, prospective studies on epilepsy and COVID-19 are still lacking.

Personality traits in patients with refractory versus non-refractory epilepsy

BackgroundEpilepsy has significant effects on the behavior of most people who suffer it. In some cases, the seizure activity itself is manifested as a brief change in behavior that might appear unusual to the casual observer. Evidence also suggests that epilepsy can affect behavior when seizures are not occurring. Descriptions of inter-ictal behavior in people with epilepsy have a long and controversial history. The study aims to assess the personality disorders among epileptic patients and impact of the severity of epilepsy on personality traits. Methods: This study is conducted upon 90 patients presented at outpatient clinic of epilepsy in Assiut University Hospital diagnosed as having epilepsy versus 40 cross-matched healthy controls. Patient group were classified into two groups (refractory versus controlled groups). All patients and control were subjected to (1) detailed medical interview. (2) Assessment of intelligence using The Arabic Version of Wechsler Adult Intelligence Scale. (3) Conventional EEG study. (4) The Arabic Version of The Structured interview for the five-factor model of personality.ResultsA relationship was found between personality traits and the severity of epilepsy. When patients have more severe epilepsy, they often have a high seizure frequency, they use more antiepileptic medications. It is likely that in those patients the need for control is usually high (because seizures mean a loss of control). Regarding the five-factor model of personality which we used to assess the personality traits of our selected studied samples, we found that the five main domains of the scale which are neuroticism, extraversion, openness to experience, agreeableness and conscientiousness differ markedly between the two groups of our patients. We found neuroticism was markedly increased at the refractory epileptic patients than the controlled epileptic ones, while extraversion, openness to experience, agreeableness, and conscientiousness increased at the controlled epileptic patients than the refractory epileptic ones.ConclusionPatients with epilepsy have raised scores for several personality traits also those personality traits are different in patients with refractory and controlled epilepsy. Also, those personality traits are different compared with a control group from the general population.

PND59 Determining the Relationship of Seizures, Seizure-Free Days (SFDS) and Other Predictors of Health-Related Quality of Life (HRQOL) in Patients with Dravet Syndrome (DS) and Their Carers

DS is a rare, early onset, lifelong epileptic encephalopathy characterised by frequent and severe seizures. High seizure frequency is associated with behavioral and physical developmental comorbidities with a substantial burden to patients’ and carers’ HR-QoL. Reducing convulsive seizure frequency and increasing SFDs is a primary treatment goal for patients. This study explored the impact of increasing SFDs on patients’ and carers’ HR-QoL. In fenfluramine registration studies, patients (or proxies) completed the Pediatric Quality of Life Inventory. These patient HR-QoL data were mapped to EQ-5D-Y to provide patient utilities. Carer utilities were collected directly (EQ-5D) and mapped to EQ-5D-3L. A linear mixed effects regression model was developed to explore relationships between patient EQ-5D-Y, and clinically relevant variables: age group, frequency of SFDs per 28-days, motor impairment(s) and treatment dose. A linear panel regression model examined the relationship between SFDs and carer HR-QoL. Adjusting for age and underlying comorbidities, results from the patient regression model showed “frequency of SFDs per 28-days” was a significant predictor of HR-QoL (gain in EQ-5D utility of 0.005 per additional SFD, p<0.001). The carer linear panel model also showed “frequency of SFDs per 28-days” as a significant predictor of HR-QoL (gain in EQ-5D-3L utility of 0.014 per additional SFD, p<0.001). For example, a typical patient aged <6 years with 2 co-morbidities and 10 SFDs per 28-days would have an EQ-5D utility of 0.48. If on fenfluramine, SFDs increased to 20 or 28 (“seizure-free”) per 28 days, patient utility would rise 11.4% and 20.5%, and their carer’s utility by 27.7% and 49.8%, respectively. This regression framework provides a useful method in determining the HR-QoL impact that frequent seizures have on DS patients and their carers; highlighting that effective antiseizure treatments that durably increase SFDs, also improve patients’ and carers’ QoL in a directly quantifiable manner.

Effects of the COVID-19 pandemic on characteristics of functional (psychogenic) seizures

ObjectiveWe investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis). MethodsIn a retrospective study of a prospectively developed and maintained database, all patients diagnosed with FS before and during the COVID-19 pandemic were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2008 until February 2021. ResultsThree hundred and eighty-eight patients were studied. Three hundred and sixty-four patients (94%) were diagnosed before and 24 persons (6%) during the pandemic. Patients diagnosed during the COVID-19 pandemic less frequently had generalized motor seizures [odds ratio (OR): 0.30, 95% confidence interval (CI): 0.12–0.77; p = 0.012] and had higher seizure frequencies (OR: 1.00, 95% CI: 1.00–1.01; p = 0.044). Functional seizures were inversely associated with the education level as a trend during the COVID-19 pandemic (OR: 0.36, 95% CI: 0.13–1.01; p = 0.052). ConclusionThe COVID-19 pandemic has affected the characteristics of patients with FS (at the time of diagnosis). Larger and multi-center studies are needed to investigate the links and associations between the COVID-19 pandemic and characteristics of FS.

Efficacy of phenobarbital in treating elderly epilepsy patients in rural northeast China: A community-based intervention trial

ObjectTo provide information on the characteristics of elderly epilepsy patients in rural Northeast China. MethodConsecutive patients (aged >60) who were diagnosed with convulsive epilepsy in seven counties in Jilin Province, Northeast China, between January 2010 and December 2019 were included in the program and were divided into the EOE (early-onset epilepsy) group and the LOE (late-onset epilepsy) group. The patients were followed up once a month, and demographics and clinical data were recorded. ResultThere were 471 patients enrolled in this study, with 329 patients classified into the EOE group and 142 patients recruited into the LOE group. At baseline, the EOE group was younger than the LOE group (t=-9.007, p < 0.001). The most common etiologies for the EOE and LOE groups were post-trauma (4.0%, n=13) and stroke (9.2%, n=13). Elderly epilepsy patients had a good response to PB monotherapy, and no significant difference was found between the two groups (p > 0.05). EOE patients complained of more serious adverse events (p < 0.05), and drowsiness (52%) and ataxia (28%) were the most common adverse events reported by the EOE and LOE groups, respectively; however, more LOE patients were prone to withdrawal due to side effects (p = 0.036). A total of 63 patients withdrew from the study, and nonadherence was the commonest cause for withdrawal (56% in EOE and 50% in LOE). In the entire follow-up period, 112 patients (63 in the EOE group and 49 in the LOE group) died; the most common causes of death were stroke (n=44, 39%) and heart disease (n=36, 32%). The LOE group had a shorter survival time than the EOE group (χ2=42.216, p < 0.001). The LOE group (HR=3.47, 95% CI: 2.36-5.09) and higher seizure frequency (HR=1.72, 95% CI: 1.17-2.52) were the risk factors for death. ConclusionElderly epilepsy patients had a good response to PB monotherapy. EOE patients complained of more serious adverse events, but more LOE patients were prone to withdrawal due to side effects. Nonadherence was the commonest cause of drug withdrawal, and it reflects the limited education regarding the impact of seizures and the differences in priorities of rural communities. EOE patients survive longer than LOE patients.

Autonomic Dysfunction Contributes to Impairment of Cerebral Autoregulation in Patients with Epilepsy.

Patients with epilepsy frequently experience autonomic dysfunction and impaired cerebral autoregulation. The present study investigates autonomic function and cerebral autoregulation in patients with epilepsy to determine whether these factors contribute to impaired autoregulation. A total of 81 patients with epilepsy and 45 healthy controls were evaluated, assessing their sudomotor, cardiovagal, and adrenergic functions using a battery of autonomic nervous system (ANS) function tests, including the deep breathing, Valsalva maneuver, head-up tilting, and Q-sweat tests. Cerebral autoregulation was measured by transcranial Doppler examination during the breath-holding test, the Valsalva maneuver, and the head-up tilting test. Autonomic functions were impaired during the interictal period in patients with epilepsy compared to healthy controls. The three indices of cerebral autoregulation—the breath-holding index (BHI), an autoregulation index calculated in phase II of the Valsalva maneuver (ASI), and cerebrovascular resistance measured in the second minute during the head-up tilting test (CVR2-min)—all decreased in patients with epilepsy. ANS dysfunction correlated significantly with impairment of cerebral autoregulation (measured by BHI, ASI, and CVR2-min), suggesting that the increased autonomic dysfunction in patients with epilepsy may augment the dysregulation of cerebral blood flow. Long-term epilepsy, a high frequency of seizures, and refractory epilepsy, particularly temporal lobe epilepsy, may contribute to advanced autonomic dysfunction and impaired cerebral autoregulation. These results have implications for therapeutic interventions that aim to correct central autonomic dysfunction and impairment of cerebral autoregulation, particularly in patients at high risk for sudden, unexplained death in epilepsy.

Association of preoperative seizures with tumor metabolites quantified by magnetic resonance spectroscopy in gliomas

Seizures are common in patients with gliomas; however, the mechanisms of epileptogenesis in gliomas have not been fully understood. This study hypothesized that analyzing quantified metabolites using magnetic resonance spectroscopy (MRS) might provide novel insights to better understand the epileptogenesis in gliomas, and specific metabolites might be indicators of preoperative seizures in gliomas. We retrospectively investigated patient information (gender, age at diagnosis of tumor, their survival time) and tumor information (location, histology, genetic features, and metabolites according to MRS) in patients with gliomas. The data were correlated with the incidence of seizure and analyzed statistically. Of 146 adult supratentorial gliomas, isocitrate dehydrogenase (IDH) mutant tumors significantly indicated higher incidence of preoperative seizures than IDH wild-type gliomas. However, MRS study indicated that glutamate concentration in IDH wild-type gliomas was higher than that in IDH mutant gliomas. Glutamate was not associated with high frequency of preoperative seizures in patients with gliomas. Instead, increased total N-acetyl-l-aspartate (tNAA) was significantly associated with them. Moreover, multivariable analysis indicated that increased level of tNAA was an independent predictor of preoperative seizures. According to MRS analysis, tNAA, rather than glutamate, might be a useful to detect preoperative seizures in patient with supratentorial gliomas.

Vitamin D deficiency in a Portuguese epilepsy cohort: who is at risk and how to treat.

The epilepsy-related risk factors for vitamin D deficiency, particularly the use of enzyme-inducing antiepileptic drugs (EIAEDs), and how to treat vitamin D deficiency in patients with epilepsy remain unclear. Our aims were to explore risk factors and the influence of EAIEDs in vitamin D status and to determine the efficacy of a daily dose of oral cholecalciferol (vitamin D3) in epileptic patients with vitamin D deficiency. Clinical data were collected and 25-hydroxyvitamin D (25(OH)D) serum levels were measured. All patients with vitamin D deficiency (25(OH)D ≤20ng/mL) or insufficiency (25(OH)D from 21-29 ng/mL) were treated with 6,670IU/day cholecalciferol for eight weeks and 25(OH)D was then remeasured. Descriptive and inferential statistics were employed. A total of 92 patients (44.6% males), with mean age of 41.0±14.8 years, were included. Measurements of 25(OH)D revealed that 79.3% patients had abnormal levels: 56.5% were vitamin D deficient and 22.8% were vitamin D insufficient. The statistically significant risk factors for vitamin D deficiency identified were: number of AEDs, treatment with EIAEDs, low sun exposure, high body mass index (BMI) and a high frequency of epileptic seizures. After treatment, 25(OH)D mean level increased by 98.99% (regardless of EIAED use or being overweight). In our sample, more than half of the adults with epilepsy showed 25(OH)D deficiency. Patients on EIAEDs had lower 25(OH)D levels. A daily dose of 6,670IU cholecalciferol successfully led to the correction of 25(OH)D levels. A higher dose in obese patients or in patients taking EIAEDs may not be warranted and this should be considered in future guidelines for routine vitamin D deficiency treatment.

Altered peri-seizure EEG microstate dynamics in patients with absence epilepsy

ObjectiveTo investigate whether the parameters of EEG microstates changed before and after an absence seizure episode. MethodsAE patients with a current high frequency of seizures were included (n=21). Each included subject underwent a two-hour and 19-channel video EEG examination. Five epochs of 10-second EEG data in interictal, pre-seizure, and post-seizure states were collected from each AE patient. Five 10-second resting-state EEG epochs from sex- and age-matched HCs who reported no history of neurological or psychiatric disorders and visited the hospital for routine physical examinations were collected. Microstate analysis and source localization of microstates were performed using the LORETA KEY tool. ResultsCompared with the resting-state EEGs of HCs, the interictal EEGs of AE patients showed a higher relative transition rate from microstates B to D (p<0.05). From interictal to pre-seizure EEG, the total time ratio of microstate C and the occurrence of microstate B decreased significantly, while the duration of microstate B increased significantly (p<0.05). Compared with pre-seizure EEGs, microstate C in post-seizure EEGs showed a significantly downregulated total time percentage and occurrence (p<0.05). The source localization of each microstate in each condition also varied and showed spatial recovery tends from pre- to post-seizure states. ConclusionAltered EEG microstate dynamics exist between inter-ictal EEGs of AE patients and resting-state EEGs of HCs and between pre- and post-seizure EEGs in AE patients. The EEG microstates of epileptic patients before and after absence seizures are characterized by a “slowdown” in transitions between microstates. Microstates might be used as an index to evaluate the temporal and spatial recovery process of absence seizures in AE.

Epileptic hypothalamic hamartomas impact of topography on clinical presentation and radiosurgical outcome

IntroductionEvidence exists for the role of the hypothalamic hamartoma’s topography as a determinant for the clinical presentation. How the hamartoma relation to the hypothalamic structures can make clinical presentations, severity and surgery outcomes different from patient to patient is largely unknown. Our aim was to analyze the effect of fine anatomical topography on clinical spectrum and radiosurgery outcome. MethodsForty-eight epileptic patients with hypothalamic hamartoma were treated by Gamma Knife Surgery and were reviewed for fine topography and morphology using magnetic resonance neuroimaging. We evaluated different topographic patterns; contact to prominent structures (the mammillary body, tuber cinereum and pituitary stalk), the degree of involvement within sagittally-oriented regions, (mammillary, tuberal, and supra optic) coronally-oriented zones (periventricular, medial, and lateral), lesion dimensions (length, width, and height),and volumes (total, intra-hypothalamic, and extra-hypothalamic volumes). This data were statistically analysed for correlation with all clinical variables and epilepsy surgery outcome. We reviewed all the classification protocols in the literature. ResultsFocal onset impaired awareness seizures started at an earlier age of onset with larger hypothalamic hamartoma volume and dimensions. Lateral extension within the hypothalamus was associated with more severe epilepsy, higher seizure frequency, more severe psychiatric comorbidity, hetero-aggression, hyperkinesia, and school difficulties. Presence of precocious puberty was positively correlated to anterior-posterior extension; tuberal region involvement, hypothalamic hamartoma volume, and type III-VI. Larger hypothalamic hamartoma presented precocious puberty at an earlier age of onset. After Gamma Knife Surgery, epilepsy outcome was better and rapid when lesion is smaller. Post-radiosurgical transient increased seizures were present when the mammillary region was more involved. ConclusionClinical presentation of epileptic hypothalamic hamartoma is significantly affected by fine topography patterns and invaded hypothalamic areas. Gamma Knife Radiosurgery effect is better and rapid in smaller hamartoma (Type I-III) and seizure outcome was not affected by the invaded hypothalamic areas.

Socio-economic impact on epilepsy outside of the nation-wide COVID-19 pandemic area

ObjectiveTo identify people with epilepsy (PWE) who required extensive care before the novel coronavirus disease 2019 (COVID-19) pandemic that had world-wide impacts on medical care and on socio-economic conditions. MethodsConsecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital, which was located in the COVID-19 non-pandemic area, between March 2019 and August 2020 were enrolled. We evaluated clinical and socioeconomic factors that were associated with seizure exacerbation (an increase in seizure frequency) during the first 6 months after the COVID-19 pandemic started compared with the previous 6 months. ResultsAmong the 196 PWE who were evaluated (mean age was 37.8 ± 16.2 years), there were 33 PWE (16.8%) whose seizure frequency had increased after the pandemic began. People with epilepsy with a seizure increase showed a significant association with living alone (p < 0.001), a higher seizure frequency (p < 0.001), negative findings on MRI (p = 0.020), history of dissociative seizure (p < 0.001), mood disorders (p < 0.001), insomnia (p < 0.001), and high psychological stress levels (p = 0.024) at baseline compared with PWE without seizure exacerbation. Multivariate logistic regression analysis revealed that “living alone” (odds ratio (OR) 3.69; 95%CI 1.29–10.52), “high seizure frequency at baseline” (OR 4.53; 95%CI 1.63–12.57), and “comorbidity of insomnia” (OR 9.55; 95%CI 3.71–24.55) were independently associated with seizure exacerbation. ConclusionsEven in the non-pandemic area, PWE had seizure exacerbation, suggesting that clinicians should screen patients’ mental health before the outbreak to provide care, reduce the burden, and prevent social isolation in PWE. This should be addressed particularly in patients with medically refractory seizures with insomnia who live alone.

Factors associated with delay to video-EEG in dissociative seizures

PurposeWhile certain clinical factors suggest a diagnosis of dissociative seizures (DS), otherwise known as functional or psychogenic nonepileptic seizures (PNES), ictal video-electroencephalography monitoring (VEM) is the gold standard for diagnosis. Diagnostic delays were associated with worse quality of life and more seizures, even after treatment. To understand why diagnoses were delayed, we evaluated which factors were associated with delay to VEM. MethodsUsing data from 341 consecutive patients with VEM-documented dissociative seizures, we used multivariate log-normal regression with recursive feature elimination (RFE) and multiple imputation of some missing data to evaluate which of 76 clinical factors were associated with time from first dissociative seizure to VEM. ResultsThe mean delay to VEM was 8.4 years (median 3 years, IQR 1–10 years). In the RFE multivariate model, the factors associated with longer delay to VEM included more past antiseizure medications (0.19 log-years/medication, standard error (SE) 0.05), more medications for other medical conditions (0.06 log-years/medication, SE 0.03), history of physical abuse (0.75 log-years, SE 0.27), and more seizure types (0.36 log-years/type, SE 0.11). Factors associated with shorter delay included active employment or student status (-1.05 log-years, SE 0.21) and higher seizure frequency (0.14 log-years/log[seizure/month], SE 0.06). ConclusionsPatients with greater medical and seizure complexity had longer delays. Delays in multiple domains of healthcare can be common for victims of physical abuse. Unemployed and non-student patients may have had more barriers to access VEM. These results support earlier referral of complex cases to a comprehensive epilepsy center.

Sex differences in anxiety in patients with epilepsy: Status and risk factors analysis

ObjectivesEvidence has indicated that there may be sex differences in the prevalence of and risk factors for anxiety in patients with epilepsy (PWE). The prevalence and risk factors for anxiety in male and female PWE in Northeast China were investigated. MethodsA consecutive cohort of patients with epilepsy (PWE) from the First Hospital of Jilin University was recruited. Anxiety symptoms were assessed using the 7-item Generalized Anxiety Disorder-7 questionnaire (GAD-7; Chinese version). Multivariate logistic regression analyses were used to confirm independent risk factors for anxiety in male and female patients. ResultsAnxiety was prevalent in 28.2% (n = 162) of the total sample of patients, in 23.2% (n = 79) of males, and in 35.5% (n = 83) of females. Younger age (P = 0.033), higher seizure frequency over the last year (P = 0.003), and higher C-NDDI-E scores (P = 0.001) were risk factors for anxiety in males with epilepsy. Only higher C-NDDI-E scores (P = 0.001) had an independent effect on the risk of anxiety in females with epilepsy. ConclusionAnxiety is a common psychiatric comorbidity among PWE. There were sex differences in the prevalence and risk factors for anxiety in patients.

Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia.

Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. However, evidence from low-income countries is lacking. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy. A facility-based, community ascertained cross-sectional survey was carried out in selected districts of the Gurage Zone, Southern Ethiopia. Participants were identified in the community and referred to primary health care (PHC) clinics. Those diagnosed by PHC workers were recruited. Co-morbid mental disorders were measured using a standardised, semi-structured clinical interview administered by mental health professionals. The main outcome, quality of life, was measured using the Quality of Life in Epilepsy questionnaire (QOLIE-10p). The secondary outcome, functional disability, was assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-2). The prevalence of comorbid mental disorders was 13.9%. Comorbid mental disorders were associated with poorer quality of life (Adjusted (Adj.) β -13.27; 95% CI -23.28 to-3.26) and greater disability (multiplier of WHODAS-2 score 1.62; 95% CI 1.05, 2.50) after adjusting for hypothesised confounding factors. Low or very low relative wealth (Adj. β = -12.57, 95% CI -19.94 to-5.20), higher seizure frequency (Adj.β coef. = -1.92, 95% CI -2.83 to -1.02), and poor to intermediate social support (Adj. β coef. = -9.66, 95% CI -16.51 to -2.81) were associated independently with decreased quality of life. Higher seizure frequency (multiplier of WHODAS-2 score 1.11; 95% CI 1.04, 1.19) was associated independently with functional disability. Co-morbid mental disorders were associated with poorer quality of life and impairment, independent of level of seizure control. Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy.