Incidence Of Epilepsy In Patients Research Articles

Antiepileptic Drugs Modulate Alzheimer-Related Tau Aggregation in a Neuronal Activity-Independent Manner

Introduction: A rapidly increasing number of patients with dementia present a serious social problem. Recently, the incidence of epilepsy in patients with Alzheimer’s disease (AD) is increasing, drawing attention to the pathological relationship between the two conditions. Clinical studies have suggested the protective action of antiepileptic agents on dementia; however, the underlying mechanism remains unknown. We evaluated the effects of multiple antiepileptic drugs using tau aggregation assay systems to determine the effects of antiepileptic agents on tau aggregation, a major neuropathological finding associated with AD. Methods: We evaluated the effects of seven antiepileptic agents on intracellular tau aggregation using a tau-biosensor cell-based high-throughput assay. Next, we tested these agents in a cell-free tau aggregation assay using thioflavin T (ThT). Results: The assay results revealed that phenobarbital inhibited tau aggregation, whereas sodium valproate, gabapentin, and piracetam promoted tau aggregation. In the cell-free tau aggregation assay using ThT, we confirmed that phenobarbital significantly inhibited tau aggregation. Conclusion: Antiepileptic drugs may modify the tau pathology in AD in a neural activity-independent manner. Our finding may provide an important insight into the optimization of antiepileptic drug therapy in older adults with dementia.

Association Between Angiotensin Receptor Blocker Therapy and Incidence of Epilepsy in Patients With Hypertension

Arterial hypertension is associated with an increased incidence of epilepsy. Results from animal studies suggest that angiotensin receptor blocker (ARB) therapy could inhibit epileptic seizures. However, there is a lack of clinical data to support the use of ARB therapy in humans. To assess whether ARB therapy is associated with a decreased incidence of epilepsy in patients with hypertension. This cohort study obtained data from the Disease Analyzer database (IQVIA) on patients aged 18 years or older who had hypertension and at least 1 antihypertensive drug prescription. Patients were treated at 1274 general practices between January 2010 and December 2020 in Germany. Data were available for 1 553 875 patients who had been prescribed at least 1 antihypertensive drug. Patients diagnosed with epilepsy before or up to 3 months after the index date were excluded. A total of 168 612 patients were included in propensity score matching. Patients treated with 1 of 4 antihypertensive drug classes (β-blockers, ARBs, angiotensin-converting enzyme inhibitors, and calcium channel blockers [CCBs]) were matched to each other using propensity scores. The main outcome of the study was the incidence of epilepsy associated with ARB therapy compared with other antihypertensive drug classes. Cox regression models were used to study the association between the incidence of epilepsy and ARBs compared with all other antihypertensive drug classes as a group. The study included a total of 168 612 patients, with 42 153 in each antihypertensive drug class. The mean [SD] age of patients was 62.3 [13.5] years, and 21 667 (51.4%) were women. The incidence of epilepsy within 5 years was lowest among patients treated with ARBs (0.27% at 1 year, 0.63% at 3 years, 0.99% at 5 years) and highest among patients receiving β-blockers and CCBs (0.38% for both β-blockers and CCBs at 1 year; 0.91% for β-blockers and 0.93% for CCBs at 3 years; β-blockers, 1.47%; and CCBs, 1.48% at 5 years). Angiotensin receptor blocker therapy was associated with a significantly decreased incidence of epilepsy (hazard ratio, 0.77; 95% CI, 0.65-0.90) compared with the other drug classes as a group. In this cohort study of patients with hypertension, ARB therapy was associated with a significantly decreased incidence of epilepsy. The findings suggest antihypertensive drugs could be used as a novel approach for preventing epilepsy in patients with arterial hypertension.

Epilepsy in Patients with Craniosynostosis: A Systematic Review

If left untreated, craniosynostosis can cause neuropsychological impairments, psychosocial problems, and craniofacial deformities. Its association with epileptic seizures is unknown. This review investigated the incidence of epilepsy in patients with craniosynostosis. The Cochrane Library, Science Direct, Web of Science, EBSCO, and PubMed were all searched. Rayyan QCRI was used to filter study article titles and abstracts before full-text evaluations were conducted. In total, 11 studies inv

Association between inflammatory central nervous system diseases and epilepsy: A retrospective cohort study of 4252 patients in Germany

GoalThe goal of this study was to analyze the association between inflammatory central nervous system (CNS) diseases and the incidence of epilepsy in patients followed up for up to 10 years in Germany. MethodsThis retrospective cohort study included adults aged ≥ 18 years who had an initial diagnosis of inflammatory CNS disease (i.e. encephalitis, meningitis or brain abscess) in one of 1229 general practices in Germany between 2005 and 2015 (index date). Patients without inflammatory CNS disease were matched (1:1) to those with inflammatory CNS disease by sex, age, follow-up time after index date, Charlson Comorbidity Index, and practice. The index date for patients without inflammatory CNS disease was a randomly selected visit date between 2005 and 2015. Kaplan–Meier curves and Cox regression analyses were used to assess the association between inflammatory CNS diseases and the incidence of epilepsy. ResultsThis study included 2126 individuals with and 2126 patients without inflammatory CNS disease (56.4% women; mean [SD] age 50.0 [12.3] years). Within ten years of the index date, 4.2% of patients with and 1.5% of patients without inflammatory CNS disease had been diagnosed with epilepsy (p < 0.001). This finding was corroborated in the Cox regression analysis, and there was a positive and significant association between inflammatory CNS diseases and epilepsy (HR: 3.82, 95% CI: 2.24–6.52). ConclusionsBased on these results, preventive interventions are urgently warranted to reduce the incidence of epilepsy in individuals with a history of inflammatory CNS disease.

Unravelling the Role of Glycogen Synthase Kinase-3 in Alzheimer's Disease-Related Epileptic Seizures.

Alzheimer’s disease (AD) is the most common form of dementia. An increasing body of evidence describes an elevated incidence of epilepsy in patients with AD, and many transgenic animal models of AD also exhibit seizures and susceptibility to epilepsy. However, the biological mechanisms that underlie the occurrence of seizure or increased susceptibility to seizures in AD is unknown. Glycogen synthase kinase-3 (GSK-3) is a serine/threonine kinase that regulates various cellular signaling pathways, and plays a crucial role in the pathogenesis of AD. It has been suggested that GSK-3 might be a key factor that drives epileptogenesis in AD by interacting with the pathological hallmarks of AD, amyloid precursor protein (APP) and tau. Furthermore, seizures may also contribute to the progression of AD through GSK-3. In this way, GSK-3 might be involved in initiating a vicious cycle between AD and seizures. This review aims to summarise the possible role of GSK-3 in the link between AD and seizures. Understanding the role of GSK-3 in AD-associated seizures and epilepsy may help researchers develop new therapeutic approach that can manage seizure and epilepsy in AD patients as well as decelerate the progression of AD.

Epilepsy combined with Wolf-Hirschhorn syndrome: a literature review and description of clinical cases

This article presents the anamnestic, clinical, electro-encephalographic and neuroimaging findings in 5 patients with epilepsy combined with Wolf-Hirschhorn syndrome (WHS). According to our data and the results of others, this combination has its specific characteristics. These include: a high incidence of epilepsy in patients with WHS (50-100% of cases), an early debut of seizures (mainly in the first year of life), fever-provoked seizures, and a variety of seizure types – focal paroxysms, bilateral tonic-clonic seizures, atypical febrile seizures, atypical absences and epileptic spasms. In addition, there may be frequent epileptic seizures tending toward status epilepticus, a slowing of the major EEG activity, a local EEG slowing (mainly in the posterior and bi-frontal areas), and regional / multiregional epileptiform activity. In more than 50% of cases, the diffuse peakwave activity is observed; the broad spectrum anti-epileptic drugs are highly efficient in 80% of cases. Based on this study, we propose recommendations for the management of patients with epilepsy combined with WHS.

Incidence of Epilepsy after Neonatal Seizures: A Population-Based Study

Background: The incidence of childhood and adolescence epilepsy varies in different areas and over time. Published reports in the Italian pediatric population are few and there is no information on the incidence of epilepsy using the new clinical definition of the disease signed by the International League Against Epilepsy. An increased risk of epilepsy is reported in subjects who presented with neonatal seizures (NS), but few population-based studies are available that compare incidence and age at onset of epilepsy in children with and without NS. Objectives: Ascertain the incidence of epilepsy in children in the province of Parma by applying the new practical clinical definition of epilepsy, and compare incidence and age of epilepsy onset in children with and without previous NS. Methods: The study was carried out in the province of Parma, Emilia-Romagna Region, Northern Italy, using different data sources (clinical records and administrative data), and considered all the children born in the province of Parma between January 2002 and December 2014 and developing epilepsy by December 2016. We calculated the incidence of epilepsy in patients up to 14 years of age, incidence of epilepsy after NS and cumulative incidence of epilepsy at 1, 5, and 10 years’ follow-up. To evaluate age at onset of epilepsy, we divided patients into 3 groups (epilepsy onset within 1 month, between 1 and 12 months, and after 1 year of life) and we compared age at onset of epilepsy between patients who had had previous NS and those who had not. Results: The incidence of epilepsy was 78.6/100,000 persons-years (boys 88.1/100,000, girls 68.6/100,000). The incidence of epilepsy after NS was 15.2% (8.2% for male, 23.5% for female; 16.3% in born at term, 14.3% in pre-term). The incidence of epilepsy at 1, 5, and 10 years’ follow-up was higher in patients with previous NS than in others. The age at onset of epilepsy was significantly different in the 2 groups, and was younger in those with history of NS: mean age at onset was 10.5 months in those with NS and of 61.8 months in the others. Conclusions: The incidence rate of epilepsy in the Parma district was higher than that reported in other Italian areas studied, probably due to the different methodology used and the application of the most recent definition of epilepsy. Children with NS were at higher risk of epilepsy and develop the disease at a younger age.

Bidirectional association between autism spectrum disorder and epilepsy in child and adolescent patients: a population-based cohort study.

This study aimed to assess whether there is a bidirectional association between autism spectrum disorder (ASD) and epilepsy in child and adolescent patients. The National Health Insurance Research Database of Taiwan was used to conduct two cohort studies of patients who were under 18years of age during the period 1997-2008. Cohort 1 comprised patients with newly diagnosed ASD but excluded those diagnosed with epilepsy prior to ASD. A non-ASD comparison group was matched to each case in terms of age and sex. Cohort 2 comprised patients with newly diagnosed epilepsy but excluded those diagnosed with ASD prior to epilepsy. A non-epilepsy comparison group was matched to each case in terms of age and sex. We calculated the incidence of epilepsy in patients with ASD and hazard ratio (HR) to estimate the risk of epilepsy in association with ASD in cohort 1, and the reverse in cohort 2. In cohort 1, the incidence of epilepsy was 13.7 in the ASD group and 1.3 in the non-ASD group (per 1000 person-years). The adjusted HR for epilepsy was 8.4 (95% CI 5.5-12.7) in the ASD group when compared with the non-ASD group. In cohort 2, the incidence of ASD was 3.4 in the epilepsy group and 0.3 in the non-epilepsy group (per 1000 person-years). The adjusted HR for ASD was 8.4 (95% CI 6.2-11.4) in the epilepsy group when compared with the non-epilepsy group. A bidirectional association was, therefore, found to exist between ASD and epilepsy. These findings implicate that ASD and epilepsy probably share common risk factors. However, further studies are required to reveal more detail on the mechanism of this bidirectional association.

Incidental epileptiform discharges in patients of a tertiary centre

ObjectiveThis controlled study set out to assess the rate of incidental epileptiform discharges (ED) during routine EEG and the incidence of epilepsy within a 4-year follow-up period in patients without a history of epilepsy. MethodsWe retrospectively analyzed electroencephalography (EEG) recordings of 1750 consecutive patients referred to the Department of Neurology at the Vienna General Hospital between January 1 and December 31, 2009. The incidence of epilepsy in patients with ED and no prior history of epilepsy was compared with a disease control group matched for gender and neuroimaging findings. ResultsED were identified in 26 (4%) of 629 patients without a history of epilepsy. Sixteen (62%) of these patients developed epilepsy during follow-up compared with five (19%) of the disease controls (p=0.01), yielding an adjusted odds ratio of 8.8 (95% CI 2.1–37.7) for developing epilepsy in patients with ED and no prior history of epilepsy. ConclusionsIncidental ED during routine EEG significantly increase the likelihood of developing epilepsy. SignificancePatients with incidental ED should be specifically asked for any signs and symptoms suggestive of seizures, since they appear more prone to develop epilepsy.

Predictive Factors for Epilepsy in Moyamoya Disease

Epilepsy cannot always be recognized in patients with moyamoya disease. In this report, the clinical features of patients with epilepsy were evaluated for assessing the predictive factors of epilepsy in moyamoya disease. A total of 64 consecutive patients with moyamoya disease were included in this study. During their follow-up periods, 7 patients were diagnosed with epilepsy. Then, the patients with epilepsy were compared with the patients without epilepsy regarding their clinical features. Analysis of patient background characteristics revealed a significantly higher incidence of epilepsy in patients with high modified Rankin Scale (mRS) scores, high cerebrovascular attack scores, onset age of 3 years or less, early seizures, cortical involvement, stroke subtype, and diffuse brain atrophy. A logistic analysis of epilepsy data revealed significant differences between the 2 groups in mRS score, cerebrovascular attack score, onset age 3 years or less, early seizure, cortical involvement, stroke subtype, and diffuse brain atrophy. Of these, significant differences were noted in 3 items (mRS score, early seizure, and diffuse brain atrophy) on multivariate analysis. These 3 items were selected as the basis of our new moyamoya disease epilepsy risk scale (MDERS), which we then evaluated. The cutoff value estimated by the receiver operating characteristic curve was set at 1 (sensitivity, .857; specificity, .825) or 2 (sensitivity, .571; specificity, 1.000). Epilepsy in moyamoya disease is associated with clinical factors and is not an independent category. For prediction of epilepsy in moyamoya disease, MDERS is a simple and convenient assessment scale.

Epilepsy in ring 14 syndrome: A clinical and EEG study of 22 patients

To characterize epileptic phenotype, electroencephalography (EEG) features, and epileptic evolution in patients with ring 14 r(14) syndrome. Twenty-two patients with ring chromosome 14 were enrolled in the study. We examined age at onset, seizure semiology and frequency at onset and at follow-up, drug responsiveness/resistance, and interictal/ictal EEG data. The degree of severity of the epileptic phenotype negatively influences child cognitive development. The incidence of epilepsy in patients with r(14) syndrome is virtually 100%, characterized by early onset, polymorphic seizures, and drug-resistant seizures. In addition, we ascertained focal secondarily generalized epilepsy, seizure cluster tendency, frequent status epilepticus, and a rather typical epilepsy evolution. EEG abnormalities consisted of slow background activity with pseudoperiodic bursts of generalized slow waves in the early stage, focal frontotemporal or temporoposterior slow waves with multifocal spikes interposed, and unusual rhythmic fast recruiting posterior spikes followed by secondary generalization. The degree of severity of the epileptic phenotype negatively influences child cognitive development. This study provides a more precise definition of seizure types, natural history, and drug responsiveness of r(14) syndrome, a highly epileptogenic chromosomal condition.

Epilepsy and electroencephalographic features in trisomy 13: A case report and review of literature

Epilepsy and electroencephalographic features in trisomy 13: A case report and review of literature

A forensic autopsy case of death in a patient with pseudoxanthoma elasticum – Dermatopathologic findings as a clue of the cause of death

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disorder, characterized by papular skin lesions and cutaneous laxity caused by fragmentation and mineralization of elastic fibers. Although vascular and retinal aspects of this disease and their associated complications are well characterized, few authors have focused on the increased incidence of epilepsy in patients with PXE. A 28-year-old Korean male was found dead in his work place with bloody-foamy discharge from his mouth and nostrils. He reportedly had a convulsive episode 5 days prior to his death in the work place. The skin showed generalized laxity and many creases with maculopapular pigmentations. A histopathologic examination of the skin revealed Pseudoxanthoma elasticum. Based on the histopathological findings and medical history, death was postulated to be due to ‘an internal cause, possibly related to a seizure attack’. Our findings suggest that histopathologic examinations of any lesions found during the forensic autopsy should be encouraged.

Altered distribution of inhibitory interneurons in polymicrogyria

There is a high incidence of epilepsy in patients with polymicrogyria; however, the epileptogenic mechanisms are largely unknown. The density of parvalbumin-immunoreactive interneurons was evaluated in an experimental model of polymicrogyria, in order to assess the potential changes in the development of one population of inhibitory interneurons. Newborn hamsters received an intracerebral injection of ibotenate, and all injected animals showed abnormal cortical layers characterized by one or two microgyrus in the fronto-parietal cortex. A quantitative analysis revealed that the ratios of parvalbumin-immunoreactive neurons in total neurons were significantly reduced in the medial paramicrogyral area, and in the medial and central parts of microgyrus in comparison to that in the lateral part of microgyrus (P<0.01). The lateral paramicrogyral area had the greatest number of parvalbumin-immunoreactive neurons, which was increased significantly in comparison to that in the control cortex (P<0.01). We suggest that the callosal, thalamic and intracortical afferents to the microgyrus and paramicrogyral area may induce a remarkable imbalance between the excitatory and inhibitory activities of the cortical structures, associated with the epileptogenic mechanism in polymicrogyria.

Outcome of Treatment of Epilepsy in Adult Patients with Cerebral Palsy (P01.068)

Objective: To study the treatment outcome, defined as degree of seizure control, in adult patients with Cerebral Palsy who have Epilepsy. Background Cerebral Palsy is the most common cause of motor disability in early childhood. Cerebral palsy is associated with a high incidence of epilepsy. The incidence of epilepsy in patients with cerebral palsy ranges from 15-90%. There is a paucity of data on outcomes of epilepsy in adult patients with cerebral palsy. Design/Methods: This is a retrospective study reviewing the database of Cerebral Palsy patients with Epilepsy seen at Creighton Epilepsy Center. 49 Cerebral Palsy patients with were identified who had epilepsy and were treated with antiepileptic medications. The seizure outcome was classified as follows:Class 1- Seizure free for the last 1 yearClass 2- One seizure per year to 1 seizure per monthClass 3- One seizure per month to one seizure per weekClass 4- One seizure per week to daily seizures. Results: 29(59.1%) out of 49 patients were free of epileptic seizures for at least the last one year. 12 patients(24.5%) had a Class 2 outcome. 3 patients(6.1%) had a class 3 outcome. 5 patients(10.2%) had a Class 4 outcome. 83.6% of patients with cerebral palsy and epilepsy had less than 1 seizure a month. 5 patients had a VNS implanted. 2 patients were seizure free and were off all anti-epileptics. 26.5% were on one antiepileptic medication(AED), 24.4% on two AED9s,18.3% on three AED9s and 26.5% patients were on 4 anti-epileptic medications. Conclusions: This study shows that around 59.1% of Cerebral Palsy patients with Epilepsy were seizure free when treated with antiepileptic medications. And the majority of the rest had less than one seizure per month. This study shows that majority of patients with cerebral palsy who have epilepsy can achieve adequate seizure control with appropriate treatment. Disclosure: Dr. Alareddy has nothing to disclose. Dr. Sankaraneni has nothing to disclose. Dr. Singh has nothing to disclose.

Epilepsy related to traumatic extradural haematomas.

?Ai71991;302:448 Intracranial haematoma is a well recognised risk factor for post traumatic epilepsy, whether early or late.1 Epilepsy occurs more commonly after an intradural rather than extradural haematoma.1 Studies published before computed tomography became available report incidences of epilepsy after traumatic extradural haematoma of 22% and 0-29%.12 Concomitant intra? dural damage, which probably influences the develop? ment of epilepsy, could not then have been assessed. We studied the incidence of epilepsy in patients who required surgery for traumatic extradural haematoma with reference to the results of preoperative computed tomography.