High Seizure Frequency Research Articles

Clinical factors associated with suicide risk independent of depression in persons with epilepsy

PurposeWe determined whether factors related to epilepsy are associated with a risk of suicide independent of depression in persons with epilepsy. MethodThis cross-sectional study included adults with epilepsy. Suicidality and depression were assessed with the Mini International Neuropsychiatric Interview (MINI). Patients were divided into two age groups (≤ 40 vs. > 40 years). Presence of suicide risk was defined as a MINI suicidality score ≥ 1. A stepwise logistic regression analysis was conducted. ResultsA total of 212 participants were recruited (52.4 % men). Suicide risk and depression were noted in 31.6 % and 22.2 % of participants, respectively. An antiepileptic drug load ≥ 1 (odds ratio [OR], 4.093–4.152) was significantly associated with a risk of suicide, independent of depression (OR, 5.794), and a past or family history of psychiatric disorders (OR, 2.677). When stratified by age, pregabalin usage (OR, 13.403) in the younger group and high seizure frequency (≥ 1 per month) (OR, 5.748) in the older group were associated with a risk of suicide independent of current depression. ConclusionThe risk of suicide in persons with epilepsy may be associated with epilepsy-related factors such as a high antiepileptic drug load, frequent seizures, and use of pregabalin, independent of depression. Such risk factors may vary depending on the age of the patient.

Persons with onchocerciasis-associated epilepsy and nodding seizures have a more severe form of epilepsy with more cognitive impairment and higher levels of Onchocerca volvulus infection.

Following previous reports of very high epilepsy prevalence in the onchocerciasis-endemic villages in Maridi County, South Sudan, a study was conducted to investigate the association between the level of Onchocerca volvulus infection, epilepsy, and related outcomes. In December 2018, persons with epilepsy (PWE) were recruited from villages where an epilepsy prevalence of 4.4% (range: 3.5-11.9%) was documented. We enrolled 318 participants from whom two skin snips were taken for microscopic detection of O. volvulus microfilariae (mf). Seizure history was obtained for all PWE and their degree of disability assessed using the modified Rankin scale. Almost all (84.9%) PWE had detectable mf in their skin snips. Onchocerciasis-infected PWE experienced nodding seizures more often than uninfected PWE (p=0.034). Moreover, persons with nodding seizures had more frequent seizures (p<0.001) and higher disability scores (p<0.001), and were more often cognitively impaired and younger at the time of their first epileptic seizure (nine years vs 12 years, p<0.001) compared to PWE without nodding seizures. Based on multivariate models, nodding seizures were associated with higher mf densities (aOR: 1.022; 95%CI: 1.005-1.041). Epilepsy onset at a younger age was associated with a worse outcome. Higher frequency of seizures, longer duration of epilepsy and younger age were associated with increased disability. Regular antiepileptic drug use was associated with better cognitive and disability outcomes. PWE with nodding seizures have a more severe form of onchocerciasis-associated epilepsy, with earlier seizure onset and higher levels of O. volvulus infection. Younger PWE were prone to worse epilepsy outcomes, which would be prevented with regular antiepileptic treatment.

Factors associated with stigma and depressive symptoms in family members of patients with epilepsy

PurposeLiterature regarding family stigma related to epilepsy is scarce. This study investigated the prevalence of family stigma and depressive symptoms and the associated factors among the family members of patients with epilepsy. MethodsIn a cross-sectional study, Stigma Scale–Revised score ≥ 4 and Patient Health Questionnaire-9 score ≥ 10 were considered indicative of moderate-to-severe stigma and depressive symptoms, respectively. Stepwise logistic regression analyses were performed. ResultsOf the 482 family members, a mean age was 47.1 ± 9.4 years, and 73.4% were female. Of the patients, a mean age was 25.5 ± 16.7 years, and 45.0% were female. Idiopathic generalized epilepsy and focal epilepsy were noted in 22.4% and 65.6% of patients, respectively. Family stigma and depressive symptoms were noted in 10.0% and 11.2% of family members, respectively. Family stigma was significantly associated with high seizure frequency and being a sibling or offspring of a patient independent of their depressive symptoms. By contrast, depressive symptoms in family members were significantly associated with polytherapy, being parents of a patient, and neurological comorbidities independent of family stigma. In a subset of patients and their family, patients had higher proportion of stigma and depressive symptoms than their family. Depressive symptoms and stigma among patients were significantly correlated with those among parents, but not spouse. ConclusionFamily stigma is common in families with epilepsy and is closely related to depressive symptoms. Frequent seizures, polytherapy, neurological comorbidities, and the relationship to a patient may be factors that are independently associated with family stigma and depressive symptoms in family members.

Pathways to quality of life in adolescents with genetic generalized epilepsy: The role of seizure features and affective symptoms

Both clinical features of seizures and affective problems (i.e., depressive and/or anxious symptoms) affect quality of life perception in patients with epilepsy. Although genetic generalized epilepsies (GGEs) represent one-third of all epilepsies, very few studies focused on the association among seizures, affective problems, and perceived quality of life in pediatric patients with GGE. Here, we assessed the relative contributions of seizure characteristics and affective symptoms on quality of life in patients with adolescence-onset GGE. Forty pediatric outpatients completed self-report questionnaires on affective symptoms and quality of life. Sociodemographic and clinical variables were obtained from medical charts. Affective symptoms were present in 40% of patients. Higher scores emerged in patients who were seizure-free at the time of the survey for both the physical and mental components of quality of life. Higher seizure frequency was significantly associated with lower quality of life scores in the mental component, whereas the presence of depressive and/or anxious symptoms was significantly associated with lower scores in the physical component. These associations were confirmed after controlling for sociodemographic confounders. These findings suggest that adolescents with GGE are at increased risk for affective symptoms. Moreover, both GGE-related clinical features (i.e., seizure frequency) and the presence of affective symptoms (i.e., depression, anxiety) are relevant and independent contributors to quality of life. The investigation of affective problems is warranted to be included in routine assessments of GGE in pediatric populations.

Socioeconomic associations of poorly controlled epilepsy in the Republic of Guinea: cross-sectional study.

To explore the socioeconomic factors associated with epilepsy in the Republic of Guinea. People living with epilepsy (PLWE) were prospectively recruited at Ignace Deen Hospital, Conakry, in 2018. An instrument exploring household assets as a measure of wealth was designed and administered. Multivariate logistic regression models with fixed effects were fitted to assess the associations of sociodemographic and microeconomic factors with self-reported frequency of seizures in the prior month and regular intake of antiseizure medications (ASMs). Participants were stratified by age group: children (<13years), adolescents (13-21) and adults (>21). A total of 285 participants (mean age 19.5years; 129 females; 106 children, 72 adolescents, 107 adults, median household size 8) had an average of 4.2 seizures in the prior month. 64% were regularly taking ASMs. Direct costs of epilepsy were similar across income strata, averaging 60 USD/month in the lowest and 75 USD/month in the highest wealth quintiles (P=0.42). The poorest PLWE were more likely to spend their money on traditional treatments (average 35USD/month) than on medical consultations (average 11 USD/month) (P=0.01), whereas the wealthiest participants were not. Higher seizure frequency was associated with a lower household education level in adolescents and children (P=0.028; P=0.026) and with being male (P=0.009) in children. Adolescents in higher-educated households were more likely to take ASMs (P=0.004). Boys were more likely to regularly take ASMs than girls (P=0.047). Targeted programming for children and adolescents in the households with the lowest education and for girls would help improve epilepsy care in Guinea.

The use of the MSVT in children and adolescents with epilepsy

Pediatric neuropsychologists are increasingly recognizing the importance of performance validity testing during evaluations. The use of such measures to detect insufficient effort is of particular importance in pediatric epilepsy evaluations, where test results are often used to guide surgical decisions and failure to detect poor task engagement can result in postsurgical cognitive decline. The present investigation assesses the utility of the Medical Symptom Validity Test (MSVT) in 104 clinically referred children and adolescents with epilepsy. Though the overall failure rate was 15.4% of the total group, children with 2nd grade or higher reading skills (a requirement of the task) passed at a very high rate (96.6%). Of the three failures, two were unequivocally deemed true positives, while the third failed due to extreme somnolence during testing. Notably, for those with ≥2nd grade reading levels, MSVT validity indices were unrelated to patient age, intellectual functioning, or age of epilepsy onset, while modest relations were seen with specific memory measures, number of epilepsy medications, and seizure frequency. Despite these associations, however, this did not result in more failures in this population of children and adolescents with substantial neurologic involvement, as pass rates exceeded 92% for those with intellectual disability, high seizure frequency, high medication burden, and even prior surgical resection of critical memory structures.

Prevalence of depression and associated factors among epileptic patients at Ilu Ababore zone hospitals, South West Ethiopia, 2017: a cross\u2011sectional study

BackgroundDepression is one of the most common and overwhelming mental disorder in patients with epilepsy. Despite its high prevalence, depression continues to be under-recognized and undertreated. This study aimed to assess the prevalence of depression and its associated factors among epileptic patients attending the outpatient department of Ilu Ababore zone hospitals, Southwest Ethiopia, 2017.MethodsInstitution-based cross-sectional study was carried out among 402 individual with epilepsy. The participants were selected using systematic random sampling technique. Depression was measured using Beck’s Depression Inventory II. Oslo 3 Social Support Scale was used to assess social support. Perceived Stress Scale was used to assess the stress level of epileptic patients. The data were entered into Epi Info version 7 and analyzed by the SPSS version 20 software. We computed bivariate and multivariate binary logistic regressions to assess factors associated with depression. Statistical significance was declared at p-value < 0.05.ResultsA total of 402 study participants were interviewed with a response rate of 96.2%. The prevalence of depression was found to be 48.1%. In the final multivariate analysis, educational status [unable to read and write (AOR = 4.01,95% CI = 3.82, 8.28), primary (AOR = 3.43, 95% CI = 3.12,9.29), secondary (AOR = 2.01, 95% CI = 1.89,7.24)], high perceived stress (AOR = 3.21, 95% CI = 2.70, 8.41), poor social support (AOR = 2.04, 95% CI = 1.42, 2.78), onset of illness < 6 year (AOR = 2.40, 95%CI = 2.10,7.91), seizure frequency of [1–11 per year (AOR = 2.34, 95% = 1.41, 4.36), ≥ 12/year (AOR = 3.49, 95% CI = 3.43, 6.40)], and polytherapy (AOR = 2.73, 95%CI = 2.52, 7.14) were independent predictors of depression among epileptic patients at p-value < 0.05.Conclusion and recommendationOverall, the prevalence of depression was found to be high. Having lower educational status, early onset of illness, poor social support, high perceived stress, high seizure frequency, and polytherapy were factors statistically associated with depression. Clinicians need to give emphasis to epileptic patients with high perceived stress, low educational status, and poor social support. An early depression-focused regular screening for epileptic patient should be carried out by trained health professionals. Linkage with mental health service providers also needs to be considered.

Evaluation of psychomotor functions in patients with drug-resistant epilepsy

PurposeThis study aimed to describe and analyze psychomotor functions in patients with drug-resistant epilepsy and identify factors associated with psychomotor deficits. MethodsWe performed a prospective case–control study comparing psychomotor skill performances in 40 adult patients and 80 healthy individuals between October 2017 and March 2018. Psychomotor functions were examined in both patients and controls using a full set of specific tests (Rey–Osterrieth complex figure test, Zazzo's cancelation task, Piaget-Head test, and paired images test). Potential risk factors for psychomotor deficit were assessed in the patient group using a multivariate analysis. ResultsThe two groups did not differ in age, sex, dominant hand, and level of education. Compared with the control group, patients with drug-resistant epilepsy showed worse performance on global psychomotor functions and, more selectively, in assessments exploring perceptual organization and visuospatial memory, laterality awareness, sustained attention, concentration, visual scanning, inhibition, and impulsivity. In the patient group, psychomotor deficits were associated with the severity of epilepsy (epileptic encephalopathy, high seizure frequency, heavy antiepileptic medication). ConclusionPsychomotor deficits could therefore be systematically detected in patients with drug-resistant epilepsy in order to provide psychomotor therapy and improve quality of life.

Efficacy and safety of eslicarbazepine acetate as adjunctive therapy for refractory focal-onset seizures in children: A double-blind, randomized, placebo-controlled, parallel-group, multicenter, phase-III clinical trial

PurposeThis was a phase-III, randomized, double-blind, placebo-controlled study aimed to evaluate efficacy and tolerability of eslicarbazepine acetate (ESL) as adjunctive therapy in pediatric patients with refractory focal-onset seizures (FOS). MethodsChildren (2–18 years old) with FOS, receiving 1–2 antiepileptic drugs, were randomized to ESL or placebo. Treatment was started at 10 mg/kg/day, up-titrated up to 20–30 mg/kg/day, and maintained for 12 weeks, followed by one-year open-label follow-up. Primary efficacy endpoints were relative reduction in standardized seizure frequency (SSF) and proportion of responders (≥50% SSF reduction) from baseline. Safety was evaluated by the incidence of treatment-emergent adverse events (TEAEs). ResultsThe intention-to-treat (ITT) set included 134 patients randomized to ESL and 129 to placebo; 89.6% and 91.5%, respectively, completed the trial. An unbalanced number of seizures at baseline were observed between groups. Least square (LS) mean relative change in SSF from baseline was higher in the ESL group (−18.1%) than in placebo (−8.6%). Proportion of responders between ESL and placebo groups was not statistically different. A post hoc analysis showed greater relative reduction in SSF in patients above 6 years old treated with ESL 20 or 30 mg/kg/day compared with placebo; this was significant in patients above 6 years old treated with ESL 30 mg/kg/day (LS mean difference: 31.9%; p = 0.0478). The observed safety profile in children was consistent with that established in adult studies. ConclusionsAdjunctive ESL treatment was well-tolerated, but this trial failed to demonstrate that ESL was more effective than placebo in the predefined efficacy endpoints; factors that may have contributed to this outcome, affecting particularly the young age group, include etiological heterogeneity, difficulty in recognizing simple partial seizures, high seizure frequency with risk of imbalance, and underestimation of the efficacious dose range.

Assessment and treatment of childhood epilepsyin Haiti.

ObjectiveThe global burden of pediatric epilepsy is disproportionately concentrated in low‐ and middle‐income countries (LMICs). However, little is known about the effectiveness of current treatment programs in this setting. We present the outcomes of children who were assessed and treated at the Clinique D'Épilepsie de Port‐au‐Prince (CLIDEP), the only pediatric epilepsy referral center in Haiti.MethodsA 10‐year retrospective review of children consecutively assessed and treated at CLIDEP was performed. The primary outcome was seizure control following treatment for epilepsy. The secondary outcome was an accurate determination of the diagnosis of epilepsy. A data‐driven principle component regression (PCR) analysis was used to identify variables associated with outcomes of interest.ResultsOf the 812 children referred for evaluation, most children (82%) underwent electroencephalography to investigate a possible epilepsy diagnosis. Very few children (7%) underwent cranial imaging. Although many patients were lost to follow‐up (24%), most children who returned to clinic had less frequent seizures (51%) and compliance with medication was relatively high (79%). Using PCR, we identified a patient phenotype that was strongly associated with poor seizure control which had strong contributions from abnormal neurological examination, higher number of antiepileptic drugs, comorbid diagnoses, epileptic encephalopathy or epilepsy syndrome, and developmental delay. Head circumference also contributed to epilepsy outcomes in Haiti with smaller head sizes being associated with a poor seizure outcome. A dissociable phenotype of febrile seizures, suspected structural abnormality, epileptic encephalopathy or epilepsy syndrome, and higher seizure frequency was associated with a diagnosis of epilepsy.SignificanceWe describe the current landscape of childhood epilepsy in Haiti with an emphasis on diagnosis, treatment and outcomes. The findings provide evidence for the effectiveness of programs aimed at the diagnosis and management of epilepsy in LMICs and may inform the allocation of resources and create more effective referral structures.

Abstract TP319: Risk Factors of Post-stroke Epilepsy

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, &lt;0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, &lt;0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p&lt;0.001) compared to controls (71.6%). CVR &lt; 10% was registered in 33.8% patients with seizures versus 13.4% controls (p&lt;0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p&lt;0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (&gt; 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, &lt;0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

Abstract TP412: Electroencephalographic Monitoring in Pediatric Arterial Ischemic Stroke

Introduction: Seizures occur at a high frequency in acute arterial ischemic stroke (AIS) in children however there is very limited knowledge regarding the frequency of electrographic only seizures. Early data suggests that seizures may independently be associated with a poorer outcome in acute brain injury. Without EEG monitoring electrographic seizures will go undetected resulting in a lost opportunity for neuroprotection. The aim of our study was to determine the incidence and risk factors of clinical and electrographic seizures in pediatric AIS. Methods: A pilot prospective single center study was performed between July 2018 and July 2019. Patients between 1 month and 18 years of age were eligible. Video EEG monitoring commenced &lt;10 days following stroke onset. A neurologist and a second independent blinded epileptologist reported the EEG’s. Assessments included the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) score and the modified Alberta Stroke Program Early Computed Tomography Score (modASPECTS). Clinical management was at the discretion of the treating neurologist. A standardized follow-up assessment was performed at 3 months. Results: Of 11 patients who had AIS during the study period, 10 were recruited. Median age was 3.7 years (range 6 weeks -12 years). Mean EEG duration was 26.8 hours. Electrographic seizures occurred in 4 (40%) patients. Of these 4 patients, 2 had clinical seizures prior to EEG onset. In addition, 1 patient had a clinical seizure prior to EEG with no subsequent electrographic seizures seen. Of the 5 patients with seizures, 3 were less than 2 years of age. Overall electrographic seizure burden was high. Only 2 of 10 patients had no cortical infarction however 1 of these patients had electrographic seizures. In comparing the group with electrographic seizures to those without, there was no statistically significant difference in the modASPECTS (median 4.5 (IQR 4) vs. 4 (9), p = 0.9239) and PedNIHSS scores (5 (9.5) vs. 14 (17), p = 0.3425). Conclusion: This prospective study demonstrated a high frequency and burden of electrographic seizures in young children with AIS. A larger multi-center study is warranted to define risk factors and outcome determinants with potential for recommendation regarding interventions.

Sexual functions in women with focal epilepsy: Relationship to demographic, clinical, hormonal and psychological variables

ObjectivesSexual dysfunctions [SDs] are common in women with epilepsy [WWE] but related studies were neglected in our locality. We aimed to determine the frequencies and severities of SDs and their clinical, hormonal and psychological determinants in WWE.Patients and methods: This study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status. Patients and methodsThis study included 120 adults [mean age: 36.35 ± 2.89yrs] with temporal [63.33 %] and frontal [36.67 %] lobe epilepsies and treated with carbamazepine [CBZ] [n = 60] or oxcarbazepine [OXC] [n = 60] for mean duration of 18.63 ± 4.33yrs. Patients were assessed using Female Sexual Function Index [FSFI] questionnaire, Beck Depression Inventory [BDI-II] and Hamilton Anxiety Rating Scale [HAM-A]. Total testosterone, sex hormone binding globulin [SHBG] and free androgen index [FAI] were measured to assess endocrinal status. ResultsThe majority had occasional/rare frequency of seizures [76.67 %] and well controlled on antiepileptic drugs [AEDs] [81.67 %]. Compared to healthy women, WWE had lower total testosterone and FAI and higher SHBG levels. Compared to women on CBZ, those on OXC had lower frequency and well controlled seizures on medication [P = 0.0001 for both], higher testosterone [P = 0.01] and FAI [P = 0.001] and lower SHBG [P = 0.001] levels. Compared to controls, WWE had significantly higher frequencies and severities of SDs [total sexual function, desire, arousal, lubrication, orgasm, satisfaction and pain] and depression and anxiety symptoms. OXC therapy was associated with lower SDs [FSFI: P = 0.033] and anxiety symptoms [P = 0.025] compared to CBZ therapy. In multiple logistic regression analyses, determinants of SDs were the higher seizures frequency, increasing severities of depression and anxiety but not lower androgen levels or type of epilepsy or AEDs. ConclusionsDifferent aspects of SD and depression and anxiety symptoms were frequent in WWE. Determinants of SDs were the higher frequency of seizures and increasing severities of depression and anxiety. OXC had better control on seizures and thus lower frequencies and severities of SDs and depression and anxiety symptoms. Thus optimizing seizure control is important for psychological state and healthy sexual function in WWE.

Seizure-related injury and postictal aggression in refractory epilepsy patients

ObjectiveIn the general population, injury related to seizures often involves falls, head trauma, soft tissue injuries, burns and fractures. Additionally, postictal deleterious behavior changes can by experienced by patients. We seek to identify the risk for seizure-related injury (SRI) and postictal aggression (PIA) in patients with refractory epilepsy. MethodsSelf-reported SRI and PIA were gathered through a seizure questionnaire as part of the epilepsy center’s seizure safety protocol. Retrospective review of questionnaire, clinical course, and demographic data was completed. Statistical analysis of variables of interest was done using nonparametric methods. Results126 patient questionnaires were completed over a one-year duration. Most patients reported seizure related injury (56.3 %) and postictal aggression (52.4 %). Increased disease duration was associated with seizure related injury and its severity (Kwallis p = 0.025), with number of antiepileptic drugs (AEDs) as significant factors (p = 0.012). Postictal aggression was also associated with a longer duration of epilepsy (Ranksum p = 0.037, t-test p = 0.04) and higher seizure frequency (p = 0.017). Patients who reported seizure related injury and postictal aggression were on more AEDs (p = 0.0003, p = 0.01, respectively), with first-generation AEDs being most contributory. ConclusionThe majority of patients with seizures report seizure-related injuries and postictal aggression. Duration and AED regimen are significant risk factors and screening practices can potentially guide safety measures and recommendations.

The economic burden of caregiving in epilepsy: An estimate based on a survey of US caregivers.

The burden of caregiving for persons with epilepsy (PWEs) has not been examined previously in the United States. We assessed the clinical impact and direct and indirect economic costs for caregivers of PWEs. An internet survey of 500 caregivers of PWEs was conducted from May to July 2015 using a combination of validated instruments and questions designed specifically for this survey. Caregivers were stratified by PWE age (adult/child) and disease severity (low: 0 vs high: 1+seizures in the prior month). Annual self-reported direct and indirect costs were reported per caregiver and extrapolated to all US caregivers. The economic burden of caregiving for PWEs was defined as the difference between costs for caregivers and the general population. Caregivers reported that PWEs averaged 11.4 seizures in the prior month. Eighty percent of respondents were female and the average age was 44.3. Since becoming a caregiver, many reported anxiety (52.8%), depression (41.0%), and insomnia (30.8%). Annual mean direct medical costs for caregivers of children with low vs high seizure frequency were $4344 and $10162, respectively. Costs for caregivers of adult PWEs were $4936 and $8518. Mean indirect costs associated with caregiving for a child with low vs high seizure frequency were $20529 and $40137; those for caregivers of an adult were $13981 and $28410. The cost estimates are higher vs the general US population; annual per-person healthcare utilization costs were $2740 and productivity loss costs were $5015. When extrapolating to the US population of PWE caregivers, annual costs exceeded $62 billion vs $14 billion for the general population, resulting in a caregiver burden of nearly $48 billion. The clinical and economic burden of caregivers for PWE were substantial, and greatest for those caring for children with frequent seizures. The impact on caregivers should be considered when estimating the value of interventions that control epilepsy.

Mitochondrial epilepsy: a cross-sectional nationwide Italian survey

Many aspects of epilepsy in mitochondrial disorders (MDs) need to be further clarified. To this aim, we explored retrospectively a cohort of individuals with MDs querying the "Nationwide Italian Collaborative Network of Mitochondrial Diseases" (NICNMD) database (1467 patients included since 2010 to December 2016). We collected information on age at epilepsy onset, seizure type and frequency, genetic findings, and antiepileptic drugs (AEDs). At the time of our survey, 147/1467 (10%) patients in the NICNMD database had epilepsy. Complete information was available only for 98 patients, 52 males and 46 females, aged 5-92years (mean age 40.4 ± 18.4; 14/98 children/teenagers and 84 adults). Epilepsy was the presenting feature of MD in 46/98 (47%) individuals, with onset at a median age of 19years (range, 0.2-68; < 3years in 14/97 (14%), 3-19years in 36/97 (37%), > 19years in 47/97 (49%)). Moreover, 91/98 patients (93%) displayed multiple seizures, with daily or weekly frequency in 25/91 (28%). Interictal EEG was abnormal in 70/78 (90%) patients, displaying abnormal background (47/70; 67%) and/or interictal paroxysms (53/70; 76%). Eighty of 90 patients (89%) displayed a 50-100% reduction of seizures on AEDs; levetiracetam was the most commonly used. Forty-one patients (42%) carried the m.3243A>G mutation, 16 (16%) the m.8344A>G, and 9 (9%) nuclear DNA (nDNA) mutations. Individuals with early-onset seizures mainly carried nDNA mutations and had a more severe epilepsy phenotype, higher seizure frequency, and disorganized background EEG activity. A better definition of epilepsy in MDs may foster the diagnostic workup, management, and treatment of affected patients, and allow more homogeneous patient stratification.

Clinical features associated with convulsive status epilepticus in patients with epilepsy

Aim: Status epilepticus (SE) is an important and distinct problem with its high morbidity and mortality. The need for early identification of SE to predict the course and prognosis of epilepsy have led us to investigate the clinical features associated with SE in patients with epilepsy in this study.Material and Methods: The information of the patients with epilepsy recorded comprised demographic features, type and etiology of seizures, age of onset of epilepsy, frequency of seizures, mono- or polytherapy treatment, history of convulsive SE, triggering factors for SE and brain magnetic resonance imaging findings. The data also included patients’ family history of epilepsy and history of febrile seizures, mental retardation.Results: A total of 610 patients with epilepsy (291 men, 319 women) were included in the study. It was found that 49 (8%) of the patients had at least one convulsive SE. Univariate logistic regression analysis showed that earlier onset of epilepsy, symptomatic/cryptogenic etiology, mental retardation, frequency of seizures ≥1/month, treatment with polytherapy, and abnormalities in neuroimaging are associated with SE (p=0.001, p0.001, p0.001, p0.001, p0.001 and p0.001, respectively). In multivariate logistic regression analysis; mental retardation (SE 0.380; 95% CI 0.186-0.825; p=0.014) and polytherapy (SE 0.392; 95% CI 0.158-0.735; p=0.006) were found to be independent factors related with SE. It was determined that 69% of patients had a triggering factor for SE and infection (65%) was the most common among these.Conclusion: The results of this study showed that there is a clear relationship between the occurrence of SE and mental retardation and treatment with polytherapy in patients with epilepsy. Symptomatic/cryptogenic etiology, early onset of epilepsy, high frequency of seizures and presence of abnormalities in neuroimaging are also associated with SE. Identification of these risk factors of SE will be helpful to initiate the appropriate treatment within a short time after diagnosis.

Social Cognition in Neuropsychiatric Disorders in Pediatric Age

Objective: The purpose of our study was to assess social cognition in adolescents and children with epilepsy or Specific Learning Disorder (SLD) compared to typical individuals. It was verified whether the age of onset, duration and drug therapy of epileptics can influence this ability and if there is a correlation between Social Cognition, intelligence and executive functions. Methods: This is an observational cross-sectional study that included a total of 125 subjects between 7 and 16 years (62 with focal epilepsy and 63 with SLD). The control group included 32 healthy subjects. Study subjects were evaluated with neuropsychological tools to evaluate executive functions (EpiTrack Junior), Social Cognition (NEPSY-II), and intelligence; a nonverbal cognitive test (Raven's Matrices) was used in subjects with Epilepsy, while WISC-IV was administered to SLDs. Results: the groups of subjects scored significantly lower than the controls in Social Cognition. The results showed a positive correlation between affect recognition scores and executive function in both groups. In patients with epilepsy the deficit in Affect Recognition appeared to be linked with early age of onset of epilepsy, long term of disease and lack of non-verbal intelligence; a high frequency of seizures, on the other hand, was related to poor performance in the Theory of Mind (ToM). In the SLD group there was no correlation between social cognition and intellectual level. Conclusions: The results of our study suggest that individuals with focal epilepsy or SLD have deficits in the recognition of facial emotions and ToM compared to their peers. In epilepsy group, the Social Cognition deficit seems to be linked to characteristics of epilepsy, particularly the deficits in the recognition of facial emotions seems linked to problems in nonverbal intelligence and in executive function. In the SLD group, however, the ability to recognize emotions was correlated only with executive functions.

COGNITIVE ASSESSMENT IN A SAMPLE OF EGYPTIAN PATIENTS WITH GENERALIZED ONSET EPILEPSY

Background: Cognitive brain functions constitute the ability to work with information in a meaningful way, apply gained information, perform preferential changes, and someone ability to change opinions about that information. Individuals with epilepsy have a higher prevalence of impaired cognitive performance compared to healthy individuals who are matched for age and education. Numerous factors can have a deleterious impact on cognition in patients, including age at onset of epilepsy, seizure frequency, duration of seizures, structural cerebral damage as a consequence of repetitive or prolonged seizures and medications used for treating seizures. Objective: Assessing the cognitive functions in patients with generalized onset epilepsy. Patients and Methods: Our study was conducted, in the neurology department of Sohag general hospital upon 75 individuals divided into 3 equal groups presented with epilepsy selected from the inpatient and outpatient clinics. Patients were divided into three groups: I. Group A: patients diagnosed with generalized onset epilepsy with medication (anti-epileptic drugs). II. Group B: patients diagnosed with generalized onset epilepsy without medication (anti-epileptic drugs). III. Group C: healthy subjects will be included in the study as the control group. All of the participants were be subjected to the following: *Full history (demographic data and personal history, detailed history of general health condition and chronic or current diseases) and general and neurological examination *Special tests including: PEBL Wisconsin (Berg) Card Sort test, PEBL The Conners’ continuous performance test, Montreal cognitive assessment (MoCa) *Brain imaging: MRI brain (to exclude organic cause). *EEG. Results: The mean Correct Responses Wisconison card sorting test of study groups was around 76.7±5.65 in group 1, around 78±2.88 in group 2 and 81.8±2.38 in group 3; with significant difference between group 1 and group 3 and significant difference between group 2 and group 3. The mean Target Acc Rate continuous performance test was around 0.956±0.03 in group 1, around 0.970±0.015 in group 2 and 0.974±0.015 in group 3; with significant difference between group 1 and group 2 and significant difference between group 1 and group 3. The mean MoCa of study groups was around 24.1 in epileptic with medication group, 23.96 in epileptic without medication group and 25 in control group with no significant difference between all groups. With high significant difference between Group 1 versus Group 3, and Group 2 versus Group 3. The normal MoCa was around 3 in epileptic with medication group, 2 in epileptic without medication group and 22 in control group with high significant difference between all groups. Conclusion: All patients with epilepsy reported significant impairment in all cognitive measures such as working memory, inhibitory control, goal maintenance, and mental flexibility. We observed attentional deficits in processes such as alertness and attention span and those requiring sustained and divided attention compared with controls. Attentional and executive impairment was correlated with higher frequency of seizures.

Does Stress Trigger Seizures? Evidence from Experimental Models.

This chapter describes the experimental evidence of stress modulation of epileptic seizures and the potential role of corticosteroids and neurosteroids in regulating stress-linked seizure vulnerability. Epilepsy is a chronic neurological disorder that is characterized by repeated seizures. There are many potential causes for epilepsy, including genetic predispositions, infections, brain injury, and neurotoxicity. Stress is a known precipitating factor for seizures in individuals suffering from epilepsy. Severe acute stress and persistent exposure to stress may increase susceptibility to seizures, thereby resulting in a higher frequency of seizures. This occurs through the stress-mediated release of cortisol, which has both excitatory and proconvulsant properties. Stress also causes the release of endogenous neurosteroids from central and adrenal sources. Neurosteroids such as allopregnanolone and THDOC, which are allosteric modulators of GABA-A receptors, are powerful anticonvulsants and neuroprotectants. Acute stress increases the release of neurosteroids, while chronic stress is associated with severe neurosteroid depletion and reduced inhibition in the brain. This diminished inhibition occurs largely as a result of neurosteroid deficiencies. Thus, exogenous administration of neurosteroids (neurosteroid replacement therapy) may offer neuroprotection in epilepsy. Synthetic neurosteroid could offer a rational approach to control neurosteroid-sensitive, stress-related epileptic seizures.