Low Seizure Frequency Research Articles

Stigma and functional disability in relation to marriage and employment in young people with epilepsy in rural Tanzania

PurposeTo assess the impact of childhood epilepsy on social transitioning outcomes for young people with epilepsy (YPWE) living in Tanzania, and to explore influences on these outcomes. MethodsAt six years from baseline, we followed up 84 YPWE and 79 age- sex- and village- matched controls recruited into a case-control study of childhood epilepsy in rural northern Tanzania. Data were collected from interviews with young people and their carers using a structured questionnaire. Perceived stigma was evaluated using the Kilifi Stigma Score and functional disability using the Barthel Index (BI). The effects of age, gender, functional disability and stigma on selected markers of social transitioning (education, employment and relationships) were estimated using multivariable modelling. ResultsFewer YPWE than controls were in an intimate relationship (42.3% vs. 76.9%) or in education or paid employment (33.3% vs. 91.1%) and they reported elevated perceived stigma scores (27.4% vs. 3.8%). Among YPWE, a positive education or employment outcome was predicted by a lower seizure frequency (adjusted OR 3.79) and a higher BI score (adj. OR 12.12); a positive relationship outcome was predicted by a higher BI score (adj. OR 45.86) and being male (adj. OR 8.55). ConclusionYPWE were more likely to experience adverse employment, educational and relationship outcomes in the transition to adult life than controls, with the greatest disadvantage experienced by females, those with greater functional disability and those with poorer seizure control. Markers of social transitioning should be included in any prospective evaluation of interventions designed to support these groups.

The use of single bipolar scalp derivation for the detection of ictal events during long-term EEG monitoring.

Epilepsy is difficult to diagnose using routine EEG recordings of short duration in patients who have low seizure frequency. Long-term EEG may be useful but is impractical in an out-of-hospital setting. We investigated whether single-channel scalp EEG placed behind the earlobe is suitable for seizure identification during prolonged EEG monitoring. Scalp EEG samples were selected from subjects over 15 years of age, and comprised two segments of either background followed by seizure or background followed by background. Bipolar EEG derivations in three directions (F8-T8, C4-T8 and T8-P8) were evaluated for the presence of a seizure by two experienced reviewers. For each EEG segment containing a seizure, one pair of electrodes was oriented towards the suspected region of seizure onset, while two pairs of electrodes were oriented elsewhere. The EEG data contained five frontally localized seizures, five parietal, five temporal, two occipital, and four primary or secondary generalized seizures. The sensitivity and specificity for recognition of seizures was 86% and 95% for Reviewer 1, and 79% and 99% for Reviewer 2, respectively. When identifying a seizure with the lead orientation towards the region of seizure onset, both reviewers identified 20 out of 21 seizures (95%). When the lead was not oriented towards the region of seizure onset, the reviewers identified 34 and 30 out of 42 ictal records correctly, respectively. These results suggest that it is possible to identify epileptic seizures by bipolar EEG derivation using only two scalp electrodes. Lead orientation towards the suspected region of seizure onset is important for optimal detection sensitivity.

Diagnosing psychogenic nonepileptic seizures: Video-EEG monitoring, suggestive seizure induction and diagnostic certainty.

Psychogenic nonepileptic seizures (PNES) can remain undiagnosed for many years, leading to unnecessary medication and delayed treatment. A recent report by the International League Against Epilepsy Nonepileptic Seizures Task Force recommends a staged approach to the diagnosis of PNES (LaFrance, et al., 2013). We aimed to investigate its practical utility, and to apply the proposed classification to evaluate the role of long-term video-EEG monitoring (VEEG) and suggestive seizure induction (SSI) in PNES workup. Using electronic medical records, 122 inpatients (mean age 36.0±12.9years; 68% women) who received the diagnosis of PNES at our epilepsy center during a 4.3-year time period were included. There was an 82.8% agreement between diagnostic certainty documented at discharge and that assigned retroactively using the Task Force recommendations. In a minority of cases, having used the Task Force criteria could have encouraged the clinicians to give more certain diagnoses, exemplifying the Task Force report's utility. Both VEEG and SSI were effective at supporting high level diagnostic certainty. Interestingly, about one in four patients (26.2%) had a non-diagnostic ("negative") VEEG but a positive SSI. On average, this subgroup did not have significantly shorter mean VEEG recording times than VEEG-positive patients. However, VEEG-negative/SSI-positive patients had a significantly lower habitual seizure frequency than their counterparts. This finding emphasizes the utility of SSI in ascertaining the diagnosis of PNES in patients who do not have a spontaneous habitual event during VEEG due to, for example, low seizure frequency.

SCN1A Gene Mutation and Adaptive Functioning in 18 Vietnamese Children with Dravet Syndrome.

Background and PurposeDravet syndrome is a rare and severe type of epilepsy in infants. The heterogeneity in the overall intellectual disability that these patients suffer from has been attributed to differences in genetic background and epilepsy severity.MethodsEighteen Vietnamese children diagnosed with Dravet syndrome were included in this study. SCN1A variants were screened by direct sequencing and multiplex ligation-dependent probe amplification. Adaptive functioning was assessed in all patients using the Vietnamese version of the Vineland Adaptive Behavior Scales, and the results were analyzed relative to the SCN1A variants and epilepsy severity.ResultsWe identified 13 pathogenic or likely pathogenic variants, including 6 that have not been reported previously. We found no correlations between the presence or type of SCN1A variants and the level of adaptive functioning impairment or severity of epilepsy. Only two of nine patients aged at least 5 years had an adaptive functioning score higher than 50. Both of these patients had a low frequency of convulsive seizures and no history of status epilepticus or prolonged seizures. The remaining seven had very low adaptive functioning scores (39 or less) despite the variability in the severity of their epilepsy confirming the involvement of factors other than the severity of epilepsy in determining the developmental outcome.ConclusionsOur study expands the spectrum of known SCN1A variants and confirms the current understanding of the role of the genetic background and epilepsy severity in determining the developmental outcome of Dravet syndrome patients.

Clinical analysis on benign temporal lobe epilepsy with hippocampal sclerosis

Objective To observe the drug response of patients with benign temporal lobe epilepsy with hippocampal sclerosis (TLE-HS), and to summarize the clinical characteristics of patients with good drug response. Methods A total of 46 benign TLE-HS patients who were treated by anti-epileptic drugs (AEDs) and followed-up for at least 2 years with seizure-free periods longer than 12 months were enrolled in benign TLE-HS group and 51 AEDs-resistant patients were enrolled in control group. Demographic data, early sudden damage factor, family history of epilepsy, clinical symptoms, interictal EEG abnormality, side of hippocamal sclerosis and drug strategy were noted and compared between 2 groups. Multivariate forward Logistic regression was used to analyze the influencing factors of good drug response to TLE-HS. Results Age of onset ( P = 0.041), duration ( P = 0.001), history of febrile seizure ( P = 0.019), initial seizure frequency ( P = 0.001) and drug strategy ( P = 0.000) were statistically different between 2 groups. Age, sex, perinatal injury, encephalitis, traumatic brain injury (TBI), family history of epilepsy, status epilepticus (SE), cognitive impairment, mental disturbance, seizure type, aura, interictal EEG abnormality and side of hippocamal sclerosis were not statistically different between 2 groups ( P > 0.05, for all). History of febrile seizure was risk factor for benign TLE-HS ( OR = 3.405, 95%CI: 1.080-10.737; P = 0.037), while low initial seizure frequency ( OR = 0.275, 95% CI: 0.100-0.758; P = 0.013) and monotherapy ( OR = 0.135, 95% CI: 0.049-0.373; P = 0.000) were protective factors for good drug response. Conclusions Benign TLE - HS often occurs in late adolescence. In the early stage, seizure frequency is low and the occurrence of febrile seizure is rare. Monotherapy of carbamazepine or oxcarbazepine may achieve good therapeutic effect. DOI: 10.3969/j.issn.1672-6731.2016.10.012

Correlation of seizure frequency and medication down-titration rate during video-EEG monitoring.

The three important questions in video-EEG monitoring are (1) whether it is productive to monitor patients with low outpatient seizure frequency, (2) whether rapid down-titration of antiepileptic drugs (AEDs) during EMU admission helps generate more recorded seizures, and (3) how long a patient who has not yet had a seizure should be monitored in the EMU. This study aimed to answer these three questions. Preadmission seizure frequency, times of AED administration, and times of seizure occurrence were collected on all adult patients admitted to the EMU at the Medical University of South Carolina (MUSC) between 2012 and 2014 - a total of 439 patients. The correlations between EMU seizure frequency and both (1) preadmission seizure frequency and (2) rate of antiepileptic drug (AED) down-titration were evaluated. The time of occurrence of seizures was evaluated. There was no correlation between patient-reported outpatient seizure frequency and EMU seizure frequency. In patients who were tapered off AEDs during monitoring, the rate of AED taper correlated with the EMU seizure frequency. Patients whose AEDs were more quickly tapered had higher EMU seizure frequencies. In order to record a first event in patients of unknown seizure type, approximately 3.5days of EMU monitoring was required. Clinicians should not hesitate to admit patients with low preadmission seizure frequency to the EMU since many of these patients will have a seizure during monitoring. Faster AED down-titration in the EMU increases EMU seizure frequency. In patients who have not yet had a seizure in the EMU, monitoring should continue for at least four days.

Cortical gene expression correlates of temporal lobe epileptogenicity

IntroductionDespite being one of the most common neurological diseases, it is unknown whether there may be a genetic basis to temporal lobe epilepsy (TLE). Whole genome analyses were performed to test the hypothesis that temporal cortical gene expression differs between TLE patients with high vs. low baseline seizure frequency. MethodsBaseline seizure frequency was used as a clinical measure of epileptogenicity. Twenty-four patients in high or low seizure frequency groups (median seizures/month) underwent anterior temporal lobectomy with amygdalohippocampectomy for intractable TLE. RNA was isolated from the lateral temporal cortex and submitted for expression analysis. Genes significantly associated with baseline seizure frequency on likelihood ratio test were identified based on >0.90 area under the ROC curve, P value of <0.05. ResultsExpression levels of forty genes were significantly associated with baseline seizure frequency. Of the seven most significant, four have been linked to other neurologic diseases. Expression levels associated with high seizure frequency included low expression of Homeobox A10, Forkhead box A2, Lymphoblastic leukemia derived sequence 1, HGF activator, Kelch repeat and BTB (POZ) domain containing 11, Thanatos-associated protein domain containing 8 and Heparin sulfate (glucosamine) 3-O-sulfotransferase 3A1. ConclusionsThis study describes novel associations between forty known genes and a clinical marker of epileptogenicity, baseline seizure frequency. Four of the seven discussed have been previously related to other neurologic diseases. Future investigation of these genes could establish new biomarkers for predicting epileptogenicity, and could have significant implications for diagnosis and management of temporal lobe epilepsy, as well as epilepsy pathogenesis.

Occurrence predictors of the temporal interictal epileptic discharges in epilepsy patients with extratemporal lesions: A prospective cohort study

ObjectiveElectrical kindling models of epilepsy suggest that medial temporal structures are more prone to be irritated. The aim of this study is to investigate the occurrence rate of temporal interictal epileptic discharges (TIEDs) in the epilepsy patients with extratemporal lesions (ETLs), and to determine the predictive factors for TIEDs in this cohort. MethodsTotally 221 patients were admitted for presurgical evaluation, and focal ETL were found in all of them by MRI examination. The occurrence rates of TIEDs in several groups with different brain lobe locations, durations; of epilepsy, seizure frequencies, and onset ages stages were assessed. We also evaluated the surgical outcome of; resection in this cohort. ResultsThe total occurrence rate of TIEDs in this cohort was 29.9%. The occurrence rate of TIEDs in the patients with longer durations (>5 or 10 years) was significantly higher than those with shorter duration (<1 year). These; patients with lower seizure frequency (<1 seizure/month) had a significantly decreased incidence of TIEDs; compared with those with higher frequency (>1 seizure/month or week). In the terms of the brain lobe locations; and age at onset, there were no differences between the groups. Furthermore, there were no differences in terms of the surgical outcomes between the patients with TIEDs and other patients in this series. ConclusionsTIEDs were frequently recorded in these patients with ETLs, and the predictive factors for TIEDs included the epilepsy duration and seizure frequency. SignificanceThis study is instrumental for the presurgical EEG interpretationand the counseling of these ETLs patients considered for epilepsy surgery.

Resective focal epilepsy surgery – Has selection of candidates changed? A systematic review

ObjectiveNo standard, widely accepted criteria exist to determine who should be referred for an epilepsy surgical evaluation. As a result, indications for epilepsy surgery evaluation vary significantly between centers. We review the literature to assess what criteria have been used to select patients for resective epilepsy surgery and examine whether these have changed since the publication of the first epilepsy surgery randomized controlled trial in 2001. MethodsA systematic review was conducted using PubMed and EMBASE, bibliographies of reviews and book chapters identifying focal epilepsy resective series. Abstract, full text review and data abstraction (i.e. indications for surgery) were performed independently by two reviewers. Descriptive historical analysis was done to examine indications over time. ResultsOut of 5061 articles related to epilepsy surgery, 384 articles met all eligibility criteria. Most common criteria for selecting patients for evaluation for resective surgery were: AED resistance (n=303, most commonly >2 AEDs=46), epilepsy duration (n=53, most commonly >1 year=42) and seizure frequency (most commonly at least one seizure/month, n=29). Out of the prospective studies the most notable change over time (pre-2000 vs. post-2000) was failure of ≥2 AEDs (8% vs. 43% respectively, p<0.001). ConclusionsImportant variations between studies make it difficult to identify consistent criteria to guide surgical candidacy or changes in indications over time. With increasing evidence that earlier surgery is associated with better outcomes, it is recommended that patients be evaluated as soon as they have failed two AEDs, consistent with the new definition of drug resistant epilepsy. Furthermore, low seizure frequency should not be a barrier to epilepsy surgery. Anyone with drug resistant epilepsy should be promptly evaluated for possible surgery, regardless of seizure frequency.

Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II

SummaryIntroduction. Population-based data on the prognosis of childhood-onset epilepsy were almost nonexistent in the 1960s. This prompted me to start an epidemiological prospective study on children with epilepsy.Aim. To study the medical and social outcome of children with epilepsy.Methods. The most important personal data on the natural course and outcome were reviewed and compared with the relevant data of other investigators.Results and discussion. The natural course of treated epilepsy is remitting, uninterrupted by relapse (in 48%); a remitting-relapsing course (interrupted by relapses, in terminal remission) (19%); worsening course (early or late remission followed by drug-resistant epilepsy) (14%); and never in ≥5-year remission (drug resistance) (19%) The medical and social outcomes based on my unique, five decades followed cohort show that most subjects are in 10-year remission without medications, which is the definition of resolved epilepsy. Normal or subnormal IQ, non-symptomatic etiology, and low seizure frequency both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy. Subjects with 1-year remission during the first five years form onset of treatment have more than 10-fold chance for entering 5-year terminal remission vs those who have no 1-year remission during the first five years. Even about one fourth of difficult-to-treat subjects become seizure free on medication and more than half of them enter one or more 5-year remissions. Epilepsy has a substantial impact on quality of life even in those who are seizure free off medication for many years and particularly those not in remission or in remission but still on medication.Conclusions. The prognosis is excellent for medical and social outcome. The successful outcome is confirmed by several longitudinal studies from recent decades. Good response to early drug therapy does not necessarily guarantee a favorable seizure outcome, and even a late good response may still predict a successful prognosis. Our life-cycle study is being continued and targets to answer the question whether or not childhood-onset epilepsy is a risk factor for premature and/or increased incidence of mental impairment and dementia.

Utility of Home-Made Videos in an Adult Epilepsy Clinic

Introduction: According to the ILAE, the definition of epilepsy requires the occurrence at least one epileptic seizure. Up to 20% of patients diagnosed of epilepsy are not actually epileptic. An accurate diagnosis is necessary for a satisfactory management of patients with Epilepsy. New broad access image technologies allow patients and families to record homemade videos helping neurologists in diagnosis. Method: During a two-year period in an epilepsy clinic, consecutive patients were encouraged to record their events with any available device. Instructions for good quality videos were given. Three neurologists/epileptologists watched the videos in clinical session, rated the quality of the recordings following some parameters and made a clinical diagnosis. In a second phase, previous diagnosis was revised. Results: 314 consecutive patients (relatives) were encouraged to record events. 52% male. Average age: 46 years. 267 patients had video recording devices available (87%) (Photo camera: 100%, cell-phone: 100%, webcam: 10%, video camera: 30%). From this group, 135 (50%) felt unable to record events. Reasons given: Low seizure frequency: 60%, seizures short duration: 80%. 50 events from 22 patients recorded. Mean age: 35 years. Seizure frequency three months prior to video deposit was 3, 5 seizures/patient/month. Previous epileptic syndrome diagnosed (based on description/neuroimaging/EEG): 15 focal temporal lobe epilepsy, 4 focal frontal probably symptomatic epilepsy, 3 epileptic encephalopathy. Type of seizures recorded: Focal motor with typical automatisms: 14 seizures/11 patients. Focal motor with hyperkinetic automatisms: 9 seizures/2 patients. Asymmetrical tonic motor seizures: 4 seizures/1 patient. Focal clonic seizure: 5 seizures/1 patients. Atypical absence seizure: 6 seizures/3 patients. Non-epileptic Seizure (NES): 13 seizures/3 patients. Postural tremor: 1 patient. There was agreement in diagnosis but in one. 18 patients were confirmed in their Diagnosis: Epilepsy misdiagnosis: 4. Three NES and one undetermined tremor. Conclusion: Homemade videos may be of diagnostic value in epilepsy management. Training in performing good-quality videos is necessary. Webcam long term recordings should be recommended as the best recording option.

Clinical, serologic, and immunogenetic characterization (HLA-DRB1) of late-onset lupus erythematosus in a Colombian population.

Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup that is defined as onset after 50 years of age. Late-onset lupus may have a different clinical course and serological findings, which may delay diagnosis and timely treatment. The objective of this paper is to determine the clinical, serologic, and immunogenetic differences among Colombian patients with late-onset SLE versus conventional SLE patients. This was a cross-sectional study in a Colombian population. Patients and their medical records were analyzed from the services of Rheumatology in Bogotá and met the criteria for SLE, according to the American College of Rheumatology (ACR) revised criteria for the classification of SLE.In a reference group of late-onset SLE patients (98 participants, with an onset after 50 years of age) and a group of conventional SLE patients (72 participants, with an onset of age of 49 years or less), multiple clinical variables (age, clinical criteria for lupus, alopecia, weight loss, fever, Raynaud's phenomenon) and multiple serological variables (blood count, blood chemistry profile, autoantibodies) were analyzed. Additionally, the HLA class II (DRB1) of all the patients was genotyped, including an additional group of patients without the autoimmune disease. Statistical analysis was performed using the STATA 10.0 package. In the group of late-onset lupus, there was a higher frequency of pleurisy (p = 0.002), pericarditis (p = 0.026), dry symptoms (p = 0.029), lymphopenia (p = 0.007), and higher titers of rheumatoid factor (p = 0.001) compared with the group of conventional SLE. Late-onset SLE patients had a lower seizure frequency (p = 0.019), weight loss (p = 0.009), alopecia (p < 0.001), and Raynaud's phenomenon (p = 0.013) compared to the conventional SLE group. In late-onset SLE, HLA DR17 (DR3) was found more frequently compared with individuals without autoimmune disease (OR 3.81, 95% CI 1.47 to 10.59) (p = 0.0016). In the Colombian SLE population analyzed, there may be a probable association of several clinical and serologic variants, which would allow the differentiation of variables in the presentation of the disease among patients with late-onset SLE vs. conventional SLE.

Emotion processing and psychogenic non-epileptic seizures: A cross-sectional comparison of patients and healthy controls

PurposeThis exploratory study aimed to examine emotion-processing styles in patients with psychogenic non-epileptic seizures (PNES), compared to healthy individuals, and to explore associations of emotion processing with other psychological measures and seizure frequency, using the new Emotional Processing Scale (EPS-25), which had not previously been used in this patient group. MethodsFifty consecutive patients with PNES referred for psychotherapy completed a set of self-report questionnaires, including the Emotional Processing Scale (EPS-25), Clinical Outcome in Routine Evaluation (CORE-10), Short Form-36 (SF-36), Patient Health Questionnaire (PHQ-15), and Brief Illness Perception Questionnaire (BIPQ). Responses on the EPS-25 were compared to data from 224 healthy controls. ResultsPatients with PNES had greater emotion processing deficits across all dimensions of the EPS-25 than healthy individuals (suppression/unprocessed emotion/unregulated emotion/avoidance/impoverished emotional experience). Impaired emotion processing was highly correlated with psychological distress, more frequent and severe somatic symptoms, and a more threatening understanding of the symptoms. Emotion processing problems were also associated with reduced health-related quality of life on the mental health (but not the physical health) component of the SF-36. The unregulated emotions sub-scale of the EPS was associated with lower seizure frequency. ConclusionThe results showed clear impairments of emotion processing in patients with PNES compared to healthy individuals, which were associated with greater psychological distress and reduced mental health functioning. These findings seem to support the face validity of the EPS-25 as a measure for PNES patients and its potential as a tool to assess the effectiveness of psychological interventions.

Ecstatic seizures

Ecstatic seizures is a rare manifestation of epilepsy. They were described for the first time by F.M. Dostoevsky. Currently, the description of ecstatic seizures is possible to find in the scientific literature. The description of the own observation of a patient with emotional-affective seizures is presented. A role of the anterior insular cortex in the ecstatic seizures origin is discussed. The similarities between the feelings reported during ecstatic seizures and the feelings experienced under the effect of stimulant addictive drugs are described. The possible reasons of the low frequency of emotional-affective seizures are considered.

Factors affecting reorganisation of memory encoding networks in temporal lobe epilepsy

In temporal lobe epilepsy (TLE) due to hippocampal sclerosis reorganisation in the memory encoding network has been consistently described. Distinct areas of reorganisation have been shown to be efficient when associated with successful subsequent memory formation or inefficient when not associated with successful subsequent memory. We investigated the effect of clinical parameters that modulate memory functions: age at onset of epilepsy, epilepsy duration and seizure frequency in a large cohort of patients. We studied 53 patients with unilateral TLE and hippocampal sclerosis (29 left). All participants performed a functional magnetic resonance imaging memory encoding paradigm of faces and words. A continuous regression analysis was used to investigate the effects of age at onset of epilepsy, epilepsy duration and seizure frequency on the activation patterns in the memory encoding network. Earlier age at onset of epilepsy was associated with left posterior hippocampus activations that were involved in successful subsequent memory formation in left hippocampal sclerosis patients. No association of age at onset of epilepsy was seen with face encoding in right hippocampal sclerosis patients. In both left hippocampal sclerosis patients during word encoding and right hippocampal sclerosis patients during face encoding, shorter duration of epilepsy and lower seizure frequency were associated with medial temporal lobe activations that were involved in successful memory formation. Longer epilepsy duration and higher seizure frequency were associated with contralateral extra-temporal activations that were not associated with successful memory formation. Age at onset of epilepsy influenced verbal memory encoding in patients with TLE due to hippocampal sclerosis in the speech-dominant hemisphere. Shorter duration of epilepsy and lower seizure frequency were associated with less disruption of the efficient memory encoding network whilst longer duration and higher seizure frequency were associated with greater, inefficient, extra-temporal reorganisation.

Subjective sleep quality in epilepsy patients with sleep-related seizures

Sleep quality is expected to be poor in epilepsy patients with sleep-related seizures as a consequence of the disruptive effect of seizures themselves on sleep patterns, a potentially heightened pre sleep emotional arousal due to patient’s worries about having seizures during sleep and associated sleep comorbidities. This study is aimed at investigating subjective sleep quality and features in adult patients with seizures occurring exclusively or predominantly during sleep. Patients affected with Nocturnal Frontal Lobe Epilepsy were not included. Fifty-seven subjects ( 18–72 years of age; 27 males), 27 (47.3%) diagnosed with sleep related undetermined epilepsy and 30 (52.7%) with focal epilepsy based on clinical, awake/sleep EEG and brain MRI findings, were investigated. Most of the patients (94%) had <1 seizure per month, with the seizures being in most cases generalized convulsive seizures during sleep. All the patients were given Pittsburgh questionnaire (PQ), Morningness – Eveningness Questionnaire (MEC), STAI 1 and 2, Beck Depression inventory (BDI). Patients reporting snoring and/or witnessed apneas during sleep underwent a nocturnal polysomnographic screening for obstructive sleep apnea (OSA). At the time of the questionnaire compiling the patients had had at least 1 seizure during the previous month (seizures recency) in 19% of the cases and they all were on antiepileptic drugs at bed time, with valproate, levetiracetam and carbamazepine, alone (89.5%) or in combination (10.5%) being the most frequently used drugs. Fifty-seven healthy subjects matched for age and sex served as controls. Univariate analyses were preliminary performed in comparing categorical (chi square test) and continuous variables ( T -test) between patients and controls and patients with PSQI >5 and those with PSQI <5. Neither PSQI total score (5.2 ± 3.6 in patients and 5.3 ± 3.4 in controls) nor its components differ significantly between patients and controls. PSQI >5 patients (39%) and PSQI <5 patients (61%) do not differ significantly for age (47.1 ± 15.0 vs. 43.9 ± 15.0 years), sex (41% vs. 50% males), STAI 1 ( 46.2 ± 13.2 vs. 37.9 ± 9.6) and STAI2 scores (44.2 ± 10.5 vs. 39 ± 10.7), BDI (12.8 ± 8.0 vs. 9.1 ± 9.0), MEQ chronotype, OSA prevalence (15.8% vs. 7.1%). As for illness-related parameters, PSQI >5 patients proved to have a significantly longer illness duration than PSQI <5 patients (17.5 ± 18.2 years vs 8.2 ± 0.3 years; p = 0.035) and a higher rate of seizures recency (54.5% vs. 15.4%; p = 0.04). Our data indicate that subjective sleep quality in adult patients with seizures occurring exclusively or predominantly during sleep is not poorer than in healthy controls. Patients’ sleep quality is influenced by some illness related parameters, with poor sleep quality being associated with longer disease duration and seizure recency. The relatively low frequency of seizures along with a blunting effect of antiepileptic treatment on arousal instability during sleep may explain the finding of a substantially good sleep quality in our patients series. However also epilepsy patients’ life style and their good compliance to sleep hygiene rules may account for a preserved sleep quality. The Authors wish to thank the technogists Valter Rustioni, Daniele Marchese, Laura Spelta, Federica Camasso for their technical support.

Sleep and mood disorders in epilepsy

Epilepsy has a prevalence of 1% in general population, sleep disorders are common complications. Determine the frequency of sleep disorders (SD) and excessive daytime sleepiness (EDS) in patients with epilepsy and to identify the factors that are related to those described. The factors analyzed included age, sex, type of epilepsy, duration of epilepsy disease, nocturnal seizures, frequency of seizures, electroencephalogram (EEG) interictal pathological, altered brain MRI, antiepileptic drug (AED) used; sleep quality, daytime sleepiness and mood disorders. 58 patients were evaluated by interview and questionnaires on sleep quality (Pittsburgh scale), the degree of EDS (Epworth scale) and anxiety-depression (hospital depression and anxiety (HAD). The rest of the data were obtained from medical history. SD among patients with epilepsy studied had a prevalence of 55%. Significant differences were found between patients with sleep disorders versus (vs) patients with normal sleep in the following variables: frequency of difficulty (1 attacks/month: 8 (25%) vs 1 (4%): p 0.03), EDS (Epworth scale) 8 (25%) vs 1 (4%): p 0.03), presence of anxiety (HAD scale) 11 (22%) vs 3 (6%): p 0.001; presence of depression (HAD scale) 1 (4%) vs 10 (20%): p 0003. No significant differences between epileptic patients with and without sleep disorders when analyzing the rest of the variables. Sleep disorders are common among patients with epilepsy and are associated with a higher frequency of daytime sleepiness, anxiety and depression. It was shown that epileptic patients with sleep disorders showed a significant difference in seizure frequency of 1 time/month. However, this difference was not observed with a lower seizure frequency, possibly due to insufficient sample size. This would also explain the lack of association of other variables such as temporal lobe epilepsy, interictal EEG, AED disease and sleep disorders. While it is known the deleterious effect of epilepsy on sleep architecture, it is important to consider mood disorders predisposing factors of such alterations. Laura Zuccolo.

Epilepsy in primary cerebral tumors: The characteristics of epilepsy at the onset (results from the PERNO study – Project of Emilia Romagna Region on Neuro‐Oncology)

To present new information on the semiology and short-term evolution of seizures associated with primary brain tumors (PBTs) in a prospective study. This study is a section of the PERNO study--Project of Emilia Romagna Region on Neuro-Oncology, the main aim of which is to collect prospectively all cases of PBTs occurring in the Emilia-Romagna region, northeast Italy (3,983,346 population) from January 2009 to December 2011, to allow epidemiologic, clinical, and biomolecular studies. The epilepsy section of the PERNO study included all the patients who experienced seizures, either as first symptom of the tumor or appearing during the course of the disease. Each patient was interviewed by the referring neurologist with a specific interest in epilepsy. The patients who entered the study were followed up with visits on a quarterly basis. We collected 100 cases with full clinical, neuroradiologic, and pathologic data. The majority (79%) had high grade PBTs (glioblastoma in 50 cases), whereas the remaining patients had low-grade gliomas, mostly localized in the frontal (60%), temporal (38%), and parietal (28%) lobes. Seizures were the first symptom of the tumor in 72 cases. Overall, the initial seizures were tonic-clonic (48%) (without clear initial focal signs in more than half of the patients), focal motor (26%), complex partial (10%), and somatosensitive (8%). The majority of cases (60%) had isolated seizures or a low seizure frequency at the onset of the disease, whereas a high seizure frequency or status epilepticus was observed in 18% and 12% of cases, respectively. Ninety-two patients underwent surgical removal of the tumor, which was either radical (38%) or partial (53%). Seven patients underwent only cerebral biopsy. In the 72 patients in whom seizures were the first symptom, the mean time to the surgical treatment was 174 days, with a significant difference between high grade (95 days) and low grade (481 days) gliomas. At the time of our first observation, the majority of patients (69%) had already undergone surgical removal, with a mean follow-up of 3 months after the procedure. Overall, 39 patients (56%) were seizure free after tumor removal. The good outcome did not depend on presurgical seizure frequency or tumor type, although there was a trend for better results with low-grade PBTs. These data provide evidence that seizures are strictly linked to the tumoral lesion: They are the initial symptom of the tumor, reflect the tumor location and type, are usually resistant to antiepileptic treatment, and may disappear after the treatment of the lesion.

Cognitive correlates of interictal epileptiform discharges in adult patients with epilepsy in China

ObjectiveLearning difficulties or cognitive impairment has been observed in many patients with epilepsy. Evidence from neurophysiologic and functional neuroimaging suggests that epileptic seizures and/or epileptiform activity can be the dominant factors inhibiting specific brain areas. However, most previous studies were focused on cognitive performance in children. In this study, we analyzed a new cohort of adult patients with frequent interictal epileptiform discharges (IEDs). MethodsData from 67 adult patients with epilepsy were reviewed. Electroencephalography (EEG)-video recording and cognitive testing were performed, and the IED index was estimated as a percentage assigned to one of four categories (<1%, 1–10%, 10–50%, and >50%) during either wakefulness or sleep. Correlations of cognitive test results and clinical characteristics of IED categories were analyzed. The effects of the frequency, duration, location, and sleep–wake cycles of IEDs on cognition (intelligence and memory capacity) were analyzed. ResultsPatients with an IED index >10% showed impaired performance on the Chinese Wechsler Adult Intelligence Scale (WAIS-RC) and the Chinese Wechsler Memory Scale (WMS). This effect was detected independently from other IED frequencies and other IED-related variables, such as duration, distribution, and location. The impact of waking or sleeping IEDs was of equal importance in contributing to impaired WAIS-RC and WMS performance. ConclusionAn IED frequency of more than 10% in both waking and sleeping EEGs is associated with impaired cognitive performance in adult patients. However, whether patients with a high IED frequency but low seizure frequency will benefit from antiepileptic treatment should be examined in future studies.

S12-2. Possible application of mismatch negativity in patients with epilepsy in a clinical research

It is well known that the mismatch negativity (MMN) has multiple generators: one in the temporal lobe and another in the frontal lobe. To investigate the effect of an epileptic focus on MMN, we compared the MMN of patients with temporal lobe epilepsy (TLE) with various seizure frequencies with the MMN of healthy controls. The MMN was consistently altered in TLE with the use of multiple types of stimuli. The MMN was enhanced at fronto-central sites and reduced at mastoid sites. TLE patients with lower seizure frequencies showed larger MMN amplitudes for deviant responses to phonetic stimulation at Fz. Taken together, our findings show that epileptic foci in the temporal lobe affect frontal and temporal function differently. The diminished MMN at mastoid sites may reflect dysfunction of the temporal lobe in TLE. In contrast, the enhanced MMN at fronto-central sites may reflect an increase in hyperexcitability or hypersynchronous activity. The results are consistent with previous reports of changes in frontal lobe function in TLE. In addition, we present a case of longitudinal changes of the MMN in TLE.