History Of Epilepsy Research Articles

Health Literacy and Attitudes Towards Childhood Epilepsy

ABSTRACT Purpose The purpose of this study was to investigate the public attitudes toward childhood epilepsy and the effects of health literacy and some sociodemographic variables on these attitudes. Design It is a descriptive and cross-sectional study. Methods The study was carried out with 311 individuals. Data were collected through face-to-face interviews with individuals using the Sociodemographic Characteristics Information Form, The Childhood Epilepsy Attitude Scale (CEAS), and the Health Literacy Scale (HLS). The data were evaluated using percentage and number, student t-test, One Way Anova, and hierarchical linear regression analysis. Findings The mean CEAS score of the participants was 43.61 ± 7.86 and the mean HLS score was 100.19 ± 17.90. According to the CEAS subscale/total score averages, no statistically significant difference was found between the variables of gender, family type, having children, family history of epilepsy, and history of epilepsy in one’s close circle (p > .05). Conclusions It was concluded that participants’ attitudes toward childhood epilepsy were positive, and that this attitude was affected by variables such as educational status, witnessing individuals having epileptic seizures, and health literacy. Clinical Evidence It is recommended that health professionals organize training programs to increase public understanding of childhood epilepsy and improve individual attitudes toward the condition. Community health nurses can play an important role in raising awareness about childhood epilepsy. Community healthcare centers may be advised to include the issue of childhood epilepsy in their awareness programs.

Exploring multimodal biomarker candidates of post-traumatic epilepsy following moderate to severe traumatic brain injury: A systematic review and meta-analysis.

This review systematically analyzes potential biomarker candidates for post-traumatic epilepsy (PTE) in humans who have experienced moderate to severe traumatic brain injury (TBI). Focusing on biomarkers across biofluid-based protein, genetic, neuroimaging, and neurophysiological categories, this review distinguishes between TBI patients who develop PTE and those who do not. The review adheres to established methodologies outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Data presentation follows the Meta-analyses of Observational Studies (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, Embase, and Web of Science were systematically searched and yielded 7538 records, of which 18 met inclusion criteria (moderate-severe TBI in humans, follow-up of at least 6 months, and no prior history of epilepsy). The review aggregates data from 15 cohort and 3 case-control studies (risk of bias was assessed using the Newcastle-Ottawa Scale). Statistically significant biomarkers were identified, with neurophysiological biomarkers showing the strongest effect size in a two-study meta-analysis. PTE, a severe long-term outcome of TBI affecting 2% to 53% of individuals with TBI, lacks validated biomarkers for forecasting development, crucial for designing preventive clinical trials. A multimodal approach, integrating biofluid-based protein, genetic, neuroimaging, and neurophysiological data, offers a promising strategy to enhance the predictability of PTE development and, potentially, its treatment. The study's protocol is registered in the International Prospective Register of Systematic Reviews PROSPERO (Registration ID: CRD42023470245).

Burden and impact of substance abuse among epileptic patients attending epilepsy outpatient clinic

BackgroundTo date, the burden and impact of substance use among epileptic patients were studied in a small number of studies and showed inconsistent findings, which may be attributed to the variation in age, test batteries, epilepsy subtypes, and substance use characteristics across research. The aim of the study was to determine the burden and impact of substance abuse among a sample of epileptic patients attending Alexandria University outpatient clinics. This study was conducted on 200 epileptic patients (100 male and 100 female patients). The diagnosis of epilepsy in those patients was confirmed by expert neurologists. Using the international league against epilepsy 2017 classification, they underwent a complete physical examination. EEG was done for all patients. Every patient was assessed using a semi-structured interview and a self-designed questionnaire to collect data concerning history of epilepsy, seizure type, EEG findings, as well as questions derived from the Addiction Severity Index (ASI). The Timeline between epilepsy and substance abuse, as well as the Effect of substance intake on epileptic seizures, were assessed.ResultsA total of 27 epileptic patients had a history of substance abuse; hence, the percentage of substance use among epileptic patients was 13.5%. Mean age in the male age group was (29.74 ± 11.52) years and (27.34 ± 9.35) years in females; mean seizure frequency per month was higher among males than females and this was statistically significant (P = 0.037*). More male (24%) than females (3%) had history of substance use and this was statistically significant (P < 0.001*). Regarding the Effect of substance intake on epileptic seizures, the male group (91.7%) had Seizure worsening, while in the female group, all three patients (100%) had seizures worsening with substance use. The mean Frequency of seizures was 4.48 ± 5.08 attacks per month for substance users and 2.49 ± 3.84 attacks per month for non-users; this was statistically significant. (t = 2.392) (P = 0.018*). Non-substance use patients had better compliance to treatment (79%) in comparison to 44.4%) of Substance use patients and this was statistically significant (P < 0.001*).ConclusionDrug abuse can have a negative impact on epilepsy in both sexes regarding seizure severity frequency, and even compliance with medication.

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

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

Surgical treatment of long-term epilepsy-associated tumors guided by stereoelectroencephalography

PurposeAccurate detection and resection of the epileptogenic zone (EZ) in patients with long-term epilepsy-associated tumors (LEATs) are significantly correlated with favorable seizure prognosis. However, the relationship between tumors and the EZ remains unknown. This study aimed to evaluate the spatial relationship between LEATs and the EZ, as well as the electrophysiological features of LEATs.MethodsWe retrospectively studied five patients with LEATs who underwent deep electrode implantation and EZ resection in the hospital. The clinical characteristics, surgical outcomes, localizing features and intracranial SEEG results were reviewed.ResultsOne female and four males (mean age: 25.2 years; median age: 24 years; range: 13–45 years) were included in the study. Five-to-eleven electrodes (mean: 8.4) were implanted per patient. The EZ was located in the tumor and nearby cortex in three cases and in the tumor and distant areas in two cases. Pathological examination revealed ganglioglioma in four cases, two of which were associated with hippocampal sclerosis, and the other case showed a multinodular and vacuolating neuronal tumor with gliosis. All patients were seizure-free for at least 24 months postoperatively.ConclusionsSEEG provides valuable insights into the electrophysiological mechanisms of LEATs. The EZ often contains brain tissue around the tumor. However, only a few cases, particularly those with temporoparietal occipital (TPO) area involvement, a long history of epilepsy and other abnormalities on MRI, such as hippocampal sclerosis and focal cortical dysplasia, may include distant areas.

Clinical and Radiological Parameters Affecting the Yield of Routine Electroencephalography in Various Indications.

To highlight the significance of various clinical and radiological parameters in association with specific electroencephalographic (EEG) patterns in order to prioritize EEG referrals. This retrospective, cross-sectional study was conducted in the neurology department of King Fahad University Hospital, Alkhobar, and involved a review and analysis of EEG and medical records pertaining to 604 patients referred for routine EEG. The data were analyzed using SPSS version 22. An association between various parameters and EEG yield was established. Factors associated with the yield of abnormal EEG patterns were diverse, like generalized tonic-clonic seizures (GTCs) (P =.05), status epilepticus (SE) (P =.05), altered level of consciousness (ALC) (P =.00), abnormal movement (P =.00), cardiac arrest (P =.00), prior history of epilepsy (P =.04), chronic renal disease (CRD) (P =.03), abnormal neurological exam (P =.00), and cortical lesions on brain imaging (P =.00). Among the abnormal EEG patterns, epileptiform activity (EA) in EEG was associated with focal seizures (P =.03), GTCs (P =.00), falls (P =.05), cardiac arrest (P =.00), a history of epilepsy (P =.00), and hypoxic ischemic injury (P =.03). Encephalopathy in EEG was also associated with focal sz (P =.02), GTCs (P =.00), SE (P =.01), ALC (P =.00), cardiac arrest (P =.00), history of stroke (P =.01), and epilepsy (P =.00). Among the studied parameters, patient level of consciousness, neurological exam findings, and neuroimaging findings, with some discrepancies, were found to be the most consistent in predicting the EEG yield. The study demonstrated the value of a proper neurological exam and careful selection of patients to gain the optimum benefit from the routine EEG.

Alice in Wonderland Syndrome in Children With Severe Acute Respiratory Syndrome SARS-CoV-2 Infection: A Case Series of Two Patients in an Italian Hospital

BackgroundAlice in Wonderland syndrome (AIWS) is a disorienting neurological condition that affects human perception to the senses of vision, hearing, touch, and sensation and the phenomenon of time. Herein we report two pediatric cases of AIWS temporally related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case presentationAn eight-year-old-girl without history of migraine or epilepsy experienced some episodes of visual distortions (micropsia, macropsia, and teleopsia) and misperception of sound, sometimes associated with headache. The onset of symptoms began at the occurrence of fever (38°C), during SARS-CoV-2 infection. Another six-year-old girl, with no history of migraine or epilepsy, experienced short-term episodes of visual (metamorphopsia) and color disturbance (chromatopsia), during an otherwise asymptomatic SARS-CoV-2 infection. In both cases, clinical examination was unremarkable; surface electroencephalography showed normal findings, without any correlation between visual phenomena and cortical activity; and brain magnetic resonance was normal. The patients were given symptomatic treatment, consisting of anti-inflammatory drugs on demand. The frequency of episodes decreased progressively following a negative SARS-CoV-2 test, with full remission in a few weeks. At the moment of hospital admission, none of the patients had completed the two-dose vaccination schedule for SARS-CoV-2. ConclusionBased on our clinical experience, we believe SARS-CoV-2 may be responsible for AIWS, in addition to other neurological symptoms more frequently documented in the literature. Pathogenesis is multifactorial and arises from the activation of inflammatory pathways. We therefore suggest also searching for SARS-CoV-2, among other viruses linked with AIWS, in children presenting with visual and/or auditory hallucinations, even as isolated symptoms.

Independent Occurrence of Two Cases of Lennox — Gastaut Syndrome and Neurofibromatosis in the Family: A Clinical Observation

Developmental and epileptic encephalopathies (DEE) are the most difficult problem in epileptology. Lennox — Gastaut syndrome (LGS) is a developmental and epileptic encephalopathy with onset in childhood, manifested by: frequent polymorphic seizures, including tonic axial ones; severe cognitive impairment; slow activity (with a frequency of &lt;2.5–3.0 Hz) sharp-slow wave in the interictal period on the electroencephalogram, as well as runs of fast activity with a frequency of 10–20 Hz, often associated with tonic seizures; and resistance to therapy. Presumably genetic or forms with an unknown cause account for 20–30 % of cases of LGS, but a family history of epilepsy among patients with LGS is observed in only 2.5 %.The purpose of this work was to describe a familial case of LGS in two siblings.Materials and methods. A retrospective description of the medical history of 3 siblings born in a consanguineous marriage was performed.Results and discussion. There was a similarity in the course of the disease in the two brothers, absolute resistance to drug antiepileptic therapy and temporary effectiveness of hormonal therapy for LGS with a decrease in the duration of the effect from course to course. In addition, the rare parallel existence in this family of another autosomal dominant disease — neurofibromatosis type 1 — is shown.Conclusion. A detailed description of LGS within one family will not only expand doctors’ knowledge of this disease and the difficulties of its treatment, but also improve understanding of the genetic mechanisms of the development of DEE.

Cerebral Venous Thrombosis in a Young Adult: A Case Report Highlighting Thrombophilia and Epilepsy Management

Cerebral venous thrombosis (CVT) is a rare but serious condition that can lead to significant neurological complications if not promptly diagnosed and treated. This case report describes a 23-year-old male with a history of epilepsy, managed with sodium valproate, who presented with a sudden, severe headache and visual disturbances. Imaging revealed a linear filling defect in the straight sinus, consistent with CVT. Further investigation uncovered deficiencies in protein S and C, indicating an underlying thrombophilic condition. The patient was successfully treated with anticoagulation therapy, initially with enoxaparin followed by oral apixaban, resulting in the complete resolution of symptoms. This case shows the importance of considering thrombophilia in patients with CVT, especially those with a history of epilepsy, and demonstrates the effectiveness of early intervention with anticoagulants in achieving positive outcomes.

Racial/ethnic differences in the association of incident stroke with late onset epilepsy: The Northern Manhattan Study.

Little is known about the incidence of late onset epilepsy (LOE) across different racial/ethnic groups in the USA, particularly in the Hispanic population. Stroke, a strong predictor of LOE, is more common in non-Hispanic Blacks (NHBs) and Hispanics than in non-Hispanic Whites (NHWs). We assessed the incidence of LOE across racial/ethnic groups and examined whether the associations of stroke with LOE risk differ by race/ethnicity. The Northern Manhattan Study is a population-based longitudinal study of older adults enrolled between 1993 and 2001. Participants free of history of stroke or epilepsy at baseline (n = 3419) were followed prospectively for incidence of LOE. We estimated LOE incidence per 1000 person-years in each racial/ethnic group. We used Cox proportional hazards regression to assess the association of race/ethnicity with LOE and multiplicative interactions of race/ethnicity with incident stroke in relation to LOE, adjusting for demographics and comorbid diagnoses. During 51 176 person-years of follow-up, 183 individuals developed LOE. Incidence of LOE was significantly higher in NHBs (6.2 per 1000 person-years) than in NHWs (3.3 per 1000 person-years, p = .004). There was no significant difference in LOE incidence between NHWs (3.3 per 1000 person-years) and Hispanics (2.6 per 1000 person-years, p = .875). However, following incident stroke, the risk of LOE differed across racial/ethnic groups. Incident stroke was associated with 2.55 times the risk of LOE among NHWs (95% confidence interval [CI] = .88-7.35), 8.53 times the risk of LOE among Hispanics (95% CI = 5.36-13.57, p = .04 for stronger association than that in NHWs), and 6.46 times the risk of LOE among NHBs (95% CI = 3.79-11.01, p = .12 for stronger association than that in NHWs). We found a stronger association of incident stroke with LOE risk in Hispanics and NHBs than in NHWs, offering some insight into the racial/ethnic disparities of LOE incidence.

MNGA-01 ÉPILEPSIE LIÉE AU MÉNINGIOME: À PROPOS DE DEUX CAS

Abstract BACKGROUND Meningiomas are the most common intracranial primary neoplasms. Seizures are a common manifestation of these tumors (10% to 50%). PURPOSE To present 2 cases of meningioma-related epilepsy and discuss the predictive factors for preoperative and postoperative seizures, their physiopathology and their management. CASE REPORTS The first patient is a 36-years-old male with a 16 years history of epilepsy revealing an underlying left frontoparietal meningioma which benefited from a Simpson grade 1 surgical resection with a seizure free postoperative outcome. The second patient is a 46-years-old man with a 6 months history of seizures revealing a right parieto-occipital meningioma requiring surgical removal with persistence of seizures on postoperative follow-up. CONCLUSION Seizures are a common occurrence both prior to and after meningioma resection, and can have a significant negative impact on patient quality of life. Further efforts are required for better understanding and predicting seizures in meningioma as well as plan their medical treatment.

Characteristics of motor vehicle crashes and fatality risk among drivers with epilepsy.

Among motor vehicle crashes (MVCs), little is known about whether the characteristics and collision features involving drivers with epilepsy differ from those involving drivers without any history of epilepsy. We assessed MVC features and the effect of epilepsy diagnosis on the risk of severe crash-related injuries among drivers. A total of 33 174 MVC events among people with epilepsy (PWE) and 663 480 MVC events of age- and sex-matched non-PWE (1:20) were selected. Crash-related features that involved drivers with and without epilepsy were compared, including driver eligibility, medical history of comorbidities and medications, road and environmental conditions, and accident causes. Cox and logistic regression analyses were used to examine the risks of fatality and severe injury among drivers with and without epilepsy. PWE involved in MVCs were more likely to have lower socioeconomic status, comorbidities, scooter drivers without a qualified driver's license, driving under the influence of alcohol, and be involved in single-vehicle accidents than non-PWE. Drivers with epilepsy also had a higher risk of fatality within 30 days of MVC, with an adjusted hazard ratio (aHR) of 1.37 (95% confidence interval [CI], 1.20-1.57) and a higher risk of hospital admission within 3 days after MVC (aHR, 1.33; 95% CI, 1.29-1.38) compared to that of non-PWE. The characteristics of MVCs of drivers with epilepsy were distinct from those of non-affected drivers. And higher fatality and injury rates were observed among drivers with epilepsy, which should be considered in further policymaking regarding safe driving of PWE.

Assessment Of Risk Factors For Recurrent Febrile Seizures Among Children Aged Below 5 Years

Background: Febrile seizures are seizures that occur between the ages of 6 and 60 months with a temperature of 100.4°F or higher, that are not result of CNS infection or any metabolic imbalance and that occur in the absence of a history of prior afebrile seizures. They occur in around 2% of 5% of children and recurrence is seen in about one-third of children. Very few studies till now reported the risk factors of recurrence of febrile seizure from India. Therefore, the present study was conducted to know the risk factors associated with recurrence of febrile seizures among South Indian children. Objectives: 1. To know the incidence of recurrence of febrile seizures among children. 2. To study the risk factors of recurrent febrile seizures among children aged below 5 years. Materials and Methods: 50 children with febrile seizures were included. The study was done in the Department of Pediatrics at ASRAM, Eluru, Andhra Pradesh, India. Male and females children aged 6 months to 5 years with clinical features suggesting febrile seizures were included. Results: Among 50 children included, 22 had recurrent febrile seizures and 28 had no recurrent febrile seizures. Overall 29 children were males. Family history of febrile seizures, young age, family history of epilepsy, temperature below 102°F, less duration of fever, complex febrile seizures are found to be risk factors for recurrence. Gender and duration of febrile seizures were not associated with the recurrence. Conclusion: The current study revealed that younger age at onset of 1 st episode of seizure, lower temperature during the episode, brief duration between onset of fever and seizure episode and family history of febrile seizures were associated with recurrence of febrile seizures.

Antiseizure Medications and Cardiovascular Events in Older People With Epilepsy

How epilepsy may promote cardiovascular disease remains poorly understood. To estimate the odds of new-onset cardiovascular events (CVEs) over 6 years in older people with vs without epilepsy, exploring how enzyme-inducing antiseizure medications (EIASMs) and traditional cardiovascular risk factors mediate these odds. This was a prospective cohort study using the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA), with 6 years of follow-up (2015-2021, analysis performed in December 2023). The CLSA is an ongoing, national study of 51 338 adults aged 45 to 85 years at baseline who are recruited in Canada. The comprehensive cohort includes 30 097 individuals living near 1 of 11 data collection centers. Participation in the CLSA was voluntary; participation rate was 45%. Among those in the comprehensive cohort, individuals reporting no previous history of CVEs (ie, stroke, transient ischemic attack [TIA], or myocardial infarction [MI]) at baseline were excluded. No other exclusion criteria were applied. A total of 86% of participants completed follow-up. Lifetime history of epilepsy. The primary outcome was new-onset CVEs over 6 years. Secondary outcomes were new-onset strokes, TIAs, and MIs. Logistic models were fitted for these outcomes as a function of epilepsy, age, sex, household income, and education level. Mediation analyses were conducted for strong EIASM use, weak EIASM use, Framingham score, Physical Activity Scale for the Elderly (PASE) score, and waist to hip ratio. Among the 30 097 individuals in the comprehensive cohort, a total of 27 230 individuals (mean [SD] age, 62.3 [10.1] years; 14 268 female [52.4%]) were included, 431 with a lifetime history of epilepsy. New-onset CVEs were more likely in epilepsy, with an adjusted odds ratio of 2.20 (95% CI, 1.48-3.27). The proportion of the effect of epilepsy on new-onset CVEs was mediated as follows by each of the following variables: strong EIASM use, 24.6% (95% CI, 6.5%-54.6%), weak EIASM use, 4.0% (95% CI, 0.8%-11.0%), Framingham score, 1.4% (95% CI, -1.6% to 4.5%), PASE score, 3.3% (95% CI, 1.4%-6.8%), and waist to hip ratio, 1.6% (95% CI, 0.4%-3.7%). Results of this cohort study reveal that epilepsy was associated with new-onset CVEs. Nearly one-third of this association can be explained by EIASMs. These findings should be considered when choosing an antiseizure medication for a person at risk for cardiovascular disease.

Development, assessment and validation of a novel nomogram model for predicting stroke mimics in stroke center：A single-center observational study

BackgroundEarly recognition and prediction of stroke mimics (SM) can avoid inappropriate recanalization therapy and delay in the management of SM etiology. The purpose of this study is to screen the predictors for SM and develop a novel predictive nomogram model for predicting SM. Meanwhile, the diagnostic performance of the nomogram model was evaluated and validated. The diagnostic efficacy of the nomogram model was also compared with four other SM structured scales. MethodsThe clinical data of eligible patients were retrospectively enrolled as training datasets from January 2020 to December 2021; and the clinical data of eligible patients were prospectively enrolled as validation datasets from February to December 2022 in stroke center, Shengjing hospital, respectively. Univariate analysis and Lasso regression were used to select the optimal predictors for the training set, and a nomogram model was constructed by multivariate logistics regression, predictive scoring based on nomogram model is performed for each subject suffering from suspected acute ischemic stroke. Area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test, Calibration curve, decision curve analysis (DCA), clinical impact curve (CIC) analysis and bootstrap sampling were performed to assess and validate the predictive performance and clinical utility of the nomogram model, and the DeLong test was used to compare the overall diagnostic performance of the nomogram model with the other four structured SM scales. The Delong test was also conducted to assess the external reliability of the SM nomogram model by comparing the predictive diagnostic performance of the validation set with the training set. Additionally, the Calibration curve was utilized to evaluate the diagnostic calibration capability of the SM nomogram model in the validation set. Results703 eligible patients (68 with SM, accounting for 9.7 %) were assigned to the training set, while 301 patients (26 with SM, accounting for 8.6 %) were assigned to the validation set. A nomogram model was then developed using these six parameters (SBP, history of epilepsy, isolated dizziness, isolated sensory impairment, headache, and absence of speech impairment symptoms), a dynamic web-based version of the nomogram was subsequently created. Comparing with four other scales, the nomogram model showed the highest overall diagnostic performance (AUC = 0.929, 95%CI = 0.908–0.947). The Hosmer-Lemeshow goodness-of-fit test was conducted to assess the agreement between the predicted SM values from the model and the observed SM values. The results of the test indicated a favorable consistency (χ2 = 9.299, P = 0.3177) between the predicted and observed SM. The results obtained from the analysis of the Calibration curve, DCA curve, and CIC analysis suggested that the nomogram possesses a favorable predictive capacity and superior clinical usefulness. Furthermore, the external validation demonstrated that there is no significant difference in the overall predictive diagnostic performance between the validation set and training set (0.929 vs 0.910, P > 0.05), thereby confirming the favorable stability of the nomogram model. ConclusionOur study firstly proposed a nomogram prediction approach based on the clinical features of SM, which could effectively predict the occurrence of SM. The utilization of the nomogram in stroke center proves advantageous for the identification and evaluation of SM, thereby enhancing diagnostic decision-making and strategies employed for suspected acute stroke patients.

Clinical efficacy and safety of perampanel monotherapy as primary anti-seizure medication in the treatment of pediatric epilepsy: A single-center, prospective, observational study.

To assess the efficacy and safety of perampanel (PER) as primary monotherapy in patients aged 4-18 years old with epilepsy. A single-center, prospective, observational study was conducted from October 2021 to October 2023, to evaluate PER monotherapy's efficacy and safety as initial therapy for pediatric epilepsy. Changes in seizure frequency, safety, and retention rate were observed at 3, 6, 9, and 12 months after initiating PER primary monotherapy. A total of 124 children aged 4-15 years (mean age = 8.25 ± 2.50 years) were included in the Analysis Sets. The retention rates at 3, 6, 9, and 12 months were 88.71% (110/124), 84.68% (105/124), 78.26% (90/115), and 71.58% (68/95), respectively. Seizure freedom rates at 3, 6, 9, and 12 months were 85.45%, 79.09%, 76.24%, and 75.31%, respectively. The responder rates (≥50% but <100%) at the same endpoints were 9.09%, 14.55%, 12.87%, and 7.41%, respectively. Seizure freedom rate of PER was independent of age at PER initiation, seizure onset age, gender, baseline frequency, seizure types, and family history of epilepsy (p > 0.05) but associated with duration of treatment (p = 0.001) and maintenance dose (p = 0.022). Additionally, 124 patients were included in the safety analysis set. The overall adverse event rate was 38.71% (48/124), with irritability (19 cases, 15.32%) and dizziness (18 cases, 14.52%) being the most common adverse effects. One patient discontinued PER monotherapy within 1 month due to unbearable itching of the skin. PER monotherapy as the primary anti-seizure medication (ASM) for pediatric epilepsy demonstrates high efficacy and safety in real-world clinical treatment. Patients who respond well to this drug and adhere to long-term treatment can achieve favorable seizure control. Furthermore, patients achieving seizure freedom with a relatively lower dose can opt for the same dose as the maintenance dose. This study provided the efficacy and safety of PER monotherapy as the primary ASM for Chinese pediatric epilepsy. In total, 124 patients took part. The seizure freedom rates were over 70% at different observation points (OPs), along with a retention rate of 71.58% at the 12-month OP. Most of adverse effects observed were mild to moderate.

Neuropsychiatric comorbidities in adult patients with new-onset epilepsy

BackgroundNeuropsychiatric comorbidities in adult patients with new-onset epilepsy in our university hospitals has not been assessed, so the purpose of this study was to identify the neuropsychiatric comorbidities in adult patients with new onset epilepsy in our university hospitals. We recruited one hundred patients, assessed them clinically, radiologically, electrophysiologically, and we performed Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV), Liverpool Seizure Severity Scale (LSSS), Generalized Anxiety Disorder 7-item (GAD-7) scale, Beck’s Depression Inventory II (BDI II) and Quality of Life In Epilepsy-10 Questionnaire (QOLIE-10) to assess cognitive function, seizure severity, anxiety, depression, and quality of life of the patients, respectively.ResultsOlder adult age group had higher LSSS than other groups. Middle-aged adults’ group had higher WAIS-IV full scale Intelligence Quotient (IQ) score and lower GAD-7 scale scores than other age groups. Patients regularly on more than one anti-seizure medication had lower IQ results, more seizure severity, depression, anxiety and worse quality of life than those on monotherapy. Males had slightly higher IQ scores. Patients with moderate and severe BDI-II score had significantly higher rate of uncontrolled seizures, higher seizures’ frequency, more abnormal EEG and were regularly on valproate at significantly higher rates as compared to those with minimal BDI-II score. Patients with moderate anxiety were significantly older than those with normal and severe anxiety. Patients with severe anxiety had higher rate of family history of epilepsy, higher rates of uncontrolled seizures and higher seizures’ frequency as compared to those with mild and moderate anxiety. Patients with mild, moderate, and severe score on GAD-7 had more abnormal EEG as compared to those with normal GAD-7 score. Patients with severe and very severe seizures had significantly higher levels of anxiety, depression and impaired quality of life than those with mild and moderate seizure severity.ConclusionsMost patients with epilepsy had psychiatric comorbidities such as depression and anxiety which strongly reduce their quality of life and interfere with their compliance to anti-seizure medication. Males had slightly higher Intelligence Quotient (IQ) scores on WAIS-IV. Moreover, patients regularly taking more than one anti-seizure medication had a statistically significantly lower IQ score, more seizure severity, higher Beckʼs depression inventory II score, higher generalized anxiety disorder 7-item scale score, and worse quality of life than those on monotherapy.

Intravenous lacosamide for acute repetitive seizures and convulsive status epilepticus in critically ill children.

Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in critically ill children. The aim of the study was to evaluate the effectiveness and safety of intravenous lacosamide in critically ill children with acute repetitive seizures and convulsive status epilepticus. This retrospective study included children who received intravenous lacosamide for acute repetitive seizures or convulsive status epilepticus from October 2017 to September 2022 and were admitted to the pediatric intensive care unit at a tertiary medical center. Children who were newly started on intravenous lacosamide were included and divided into two groups: (a) previously healthy, and (b) history of epilepsy and receiving antiseizure medications. Efficacy was defined as the cessation of seizures within 72 h of administering lacosamide. Adverse effects were defined using predefined criteria, and most were evaluated during the first 7 days. Sixty-seven children were enrolled, including 25 (37.3%) girls and 42 (62.7%) boys with a mean age of 7.20 ± 5.66 years. Among them, 30 (44.8%) had acute repetitive seizures, and 37 (55.2%) had convulsive status epilepticus. The seizure types were focal onset (n = 34, 50.7%), generalized onset (n = 27, 40.3%), and mixed type (n = 6, 9.0%). In the previously healthy group, 9 patients had acute repetitive seizures and 23 had convulsive status epilepticus, and the rates of seizure cessation when lacosamide was used as the first to fourth choice of antiseizure medication were 100.0%, 85.7%, 40.0%, and 50.0%, respectively, compared to 73.7%, 54.5%, 100.0%, and 0.0% in the patients with epilepsy (21 had acute repetitive seizures and 14 had convulsive status epilepticus). Sixteen (23.9%) patients developed bradycardia and 1 (1.5%) patient developed a rash. The early use of intravenous lacosamide was effective with acceptable side effects in treating acute repetitive seizures and convulsive status epilepticus in critically ill children, including young infants and children less than 4 years old and those with different etiologies. Acute repetitive seizures and convulsive status epilepticus are common neurological emergencies in pediatric intensive care units (PICUs), traditional intravenous antiseizure medications (ASMs) include phenytoin, valproic acid, levetiracetam, and phenobarbital. In this study, we categorized patients based on their epilepsy history and different etiologies. We observed that early use of lacosamide, even in young infants, demonstrated good efficacy and safety.

The incidence of sudden unexpected death in epilepsy (SUDEP) in the Republic of Ireland

BackgroundThe incidence of sudden unexpected death in epilepsy (SUDEP) in Ireland has previously been studied in only a small geographical area. Our aim was to calculate an incidence rate for the whole of the Republic of Ireland in 2019. MethodsAll deaths referred to the coroner in 2019 were examined. Those with a history of possible epilepsy were noted and subjected to a more detailed assessment. Cases fulfilling the definition of definite SUDEP were identified. The incidence of SUDEP was calculated using the population of the Republic of Ireland in 2019 and the known prevalence of epilepsy in Ireland. ResultsThirty-three cases of definite SUDEP were identified in the Republic of Ireland in 2019. The estimated incidence of SUDEP in the epilepsy population as a whole was 0.7/1000(0.46 – 0.94) person years. This may be a conservative estimate. More men than women were identified, and most individuals were found dead at home. SUDEP was mentioned on the death certificate in only 52 % of cases. ConclusionThis is the first nationwide study of SUDEP incidence in Ireland and provides an incidence rate in keeping with other populations. This work demonstrates that the interrogation of coronial records is a useful way to monitor epilepsy mortality albeit with certain limitations.

Discovery of a TRMT10A mutation in a case of atypical diabetes: Case report

It is notable that monogenic forms of diabetes are exceedingly uncommon, with only 28 genes thus far identified. Such conditions frequently result in the dysfunction of pancreatic cells responsible for insulin production. Mutation in the TRMT10A gene leads to a rare genetic disease that is associated with endocrine and metabolic disorders, including diabetes and short stature. This article presents a review of the existing literature on the subject, describing the association between TRMT10A gene mutation and diabetes. It also presents the clinical case of a young girl with type 1 diabetes and facial dysmorphia. TRMT10A gene mutation has been linked to syndromic juvenile diabetes in a manner analogous to Wolfram's syndrome. This form of diabetes, which manifests in early childhood and is associated with microcephaly, epilepsy and intellectual disability, is caused by mutations in the gene for homolog A of tRNA methyltransferase 10 (TRMT10A). This emphasizes the importance of using a targeted panel to recognize previously unidentified monogenic diabetes among early-onset non-insulin-dependent diabetes in the absence of obesity and autoimmunity. In view of the aforementioned data, it is recommended that TRMT10A sequencing be considered in children or adults with early-onset diabetes and a history of intellectual disability, microcephaly and epilepsy.