Prevalence Of Epilepsy Research Articles

Prevalence and related factors of epilepsy in children and adolescents with cerebral palsy: a systematic review and meta-analysis.

To study the worldwide prevalence and associated factors of epilepsy in children and adolescents with Cerebral Palsy (CP) and to analyze the differences between various subgroups. We identified all potential studies on the prevalence of epilepsy in children and adolescents with CP from PubMed, Web of Science, and Embase. The search time was from the establishment of the database to November 2022. Randomized effects meta-analysis models were used to calculate the prevalence of epilepsy in CP. Subgroup analysis and meta-regression were utilized to further explore heterogeneity between articles and prevalence disparities between subgroups. The funnel plot and Egger's test were used to investigate potential publication bias. Seventy-two articles, comprising 53,969 children and adolescents with CP, were included in this study. The results indicated a total epilepsy prevalence of 38.0% (95% CI: 34.8%-41.2%) in CP. The prevalence of epilepsy was 46.4% (95% CI: 41.4%-51.5%) in clinical sample-based studies and 31.6% (95% CI: 28.7%-34.5%) in population-based studies. Meta-regression demonstrated that the sample source, neonatal seizure, family history of epilepsy, EEG or cranial imaging abnormalities, intellectual/cognitive impairment, and topographical types of CP were heterogeneous contributors to the epilepsy prevalence in CP. Approximately one-third of children and adolescents with CP have epilepsy, and the sample source can significantly impact the total prevalence of epilepsy. Neonatal seizures, family history of epilepsy, EEG abnormalities, cranial imaging abnormalities, severe intellectual disability, and quadriplegia may be contributing factors to epilepsy comorbid in CP. Further study is required to verify the strength of these associations with epilepsy. This study aids in identifying the clinical characteristics of young people with CP at risk of developing epilepsy, which may assist clinicians in the early prevention and diagnosis of epilepsy within this population.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=367766, identifier CRD42022367766.

EPILEPSY IN THE ETHNOCULTURAL ASPECT

Based on a clinical and epidemiological study of epilepsy among the indigenous and non-indigenous population in the Mashtaga settlement of Baku city (2016-2019), 197 patients with various forms of epilepsy aged 0 to 69 years were identified. In parallel, the ethnic aspect of the disease was studied. During the study period, certain ethnic characteristics of the indigenous population were identified, which influenced the prevalence of epilepsy, as well as its social frame and the characteristics of its clinical manifestations. As a result of the study, it turned out to be likely that brain neurons in male Asians in the northeast of the Great Silk Road and Hispanics in South America are relatively more prone to developing excessive neuronal discharges.

Age-Related Changes in Epilepsy Characteristics and Response to Antiepileptic Treatment in Autism Spectrum Disorders.

Despite the high prevalence of epilepsy in individuals with autism spectrum disorder (ASD), there is little information regarding whether seizure characteristics and treatment effectiveness change across age. Using an online survey, seizure characteristics, effectiveness of antiepileptic treatments, comorbidities, potential etiologies, and ASD diagnosis were collected from individuals with ASD and seizures. We previously reported overall general patterns of treatment effectiveness but did not examine the effect of seizure characteristics or age on antiepileptic treatment effectiveness. Such information would improve the personalized medicine approach to the treatment of seizures in ASD. Survey data from 570 individuals with ASD and clinical seizures were analyzed. Seizure severity (seizure/week) decreased with age of onset of seizures, plateauing in adolescence, with a greater reduction in generalized tonic-clonic (GTC) seizures with age. Seizure severity was worse in those with genetic disorders, neurodevelopmental regression (NDR) and poor sleep maintenance. Carbamazepine and oxcarbazepine were reported to be more effective when seizures started in later childhood, while surgery and the Atkins/modified Atkins Diet (A/MAD) were reported to be more effective when seizures started early in life. A/MAD and the ketogenic diet were reported to be more effective in those with NDR. Interestingly, atypical Landau-Kleffner syndrome was associated with mitochondrial dysfunction and NDR, suggesting a novel syndrome. These interesting findings need to be verified in independent, prospectively collected cohorts, but nonetheless, these data provide insights into novel relationships that may assist in a better understanding of epilepsy in ASD and provide insight into personalizing epilepsy care in ASD.

Effect of onchocerciasis elimination measures on the incidence of epilepsy in Maridi, South Sudan: a 3-year longitudinal, prospective, population-based study

High onchocerciasis transmission predisposes endemic communities to a high epilepsy burden. The 4·4% epilepsy prevalence documented in 2018 in Maridi, South Sudan, prompted the strengthening of onchocerciasis elimination measures. Community-directed treatment with ivermectin was implemented annually in 2017, 2018, and 2019, interrupted in 2020, and re-implemented biannually in 2021. We aimed to assess the effect of these interventions, along with slash and clear vector control on the incidence of epilepsy, including nodding syndrome. In this longitudinal, prospective, population-based study, we did a two-stage house-to-house epilepsy survey before (May 10-30, 2018) and after (March 9-19, 2022) the strengthening of onchocerciasis elimination interventions in South Sudan. Strengthening also included the implementation of a community-based slash and clear vector control method that we initiated in 2019 at the Maridi dam (the main blackfly breeding site). Eight sites were surveyed near the Maridi dam and inclusion required residence in one of these sites. All household residents were first screened by community workers, followed by confirmation of the epilepsy diagnosis by trained clinicians. The primary outcome was epilepsy incidence, including nodding syndrome, which was assessed via self-reported new-onset epilepsy in the previous 4 years of each survey, confirmed by clinician assessment. The preintervention survey included 17 652 people of whom 736 had epilepsy (315 female and 421 male), and the post-intervention survey included 14 402 people of whom 586 had epilepsy (275 female and 311 male). When biannual community-directed treatment with ivermectin was initiated in 2021, the intervention's coverage rose by 15·7% (95% CI 14·6-16·8); although only 56·6% of the population took ivermectin in 2021. Between 2018 and 2022, epilepsy incidence decreased from 348·8 (307·2-395·8) to 41·7 (22·6-75·0) per 100 000 person-years. Similarly, the incidence of nodding syndrome decreased from 154·7 (127·6-187·3) to 10·4 (2·7-33·2) per 100 000 person-years. The identified risk factors for epilepsy were: living closer to the Maridi dam, being aged between 6 and 40 years, not taking ivermectin, and being male. In onchocerciasis-endemic areas with high epilepsy prevalence, strengthening onchocerciasis elimination interventions can decrease the incidence of epilepsy, including nodding syndrome. Additional efforts are needed to increase community-directed treatment with ivermectin coverage and sustain blackfly control in Maridi. Research for Health in Humanitarian Crisis, European Research Council, Research Foundation-Flanders, Research Foundation-Flanders, the Italian Agency for Development Cooperation, and La Caixa Foundation.

Association of neighborhood deprivation with white matter connectome abnormalities in temporal lobe epilepsy.

Social determinants of health, including the effects of neighborhood disadvantage, impact epilepsy prevalence, treatment, and outcomes. This study characterized the association between aberrant white matter connectivity in temporal lobe epilepsy (TLE) and disadvantage using a US census-based neighborhood disadvantage metric, the Area Deprivation Index (ADI), derived from measures of income, education, employment, and housing quality. Participants including 74 TLE patients (47 male, mean age = 39.2 years) and 45 healthy controls (27 male, mean age = 31.9 years) from the Epilepsy Connectome Project were classified into ADI-defined low and high disadvantage groups. Graph theoretic metrics were applied to multishell connectome diffusion-weighted imaging (DWI) measurements to derive 162 × 162 structural connectivity matrices (SCMs). The SCMs were harmonized using neuroCombat to account for interscanner differences. Threshold-free network-based statistics were used for analysis, and findings were correlated with ADI quintile metrics. A decrease in cross-sectional area (CSA) indicates reduced white matter integrity. Sex- and age-adjusted CSA in TLE groups was significantly reduced compared to controls regardless of disadvantage status, revealing discrete aberrant white matter tract connectivity abnormalities in addition to apparent differences in graph measures of connectivity and network-based statistics. When comparing broadly defined disadvantaged TLE groups, differences were at trend level. Sensitivity analyses of ADI quintile extremes revealed significantly lower CSA in the most compared to least disadvantaged TLE group. Our findings demonstrate (1) the general impact of TLE on DWI connectome status is larger than the association with neighborhood disadvantage; however, (2) neighborhood disadvantage, indexed by ADI, revealed modest relationships with white matter structure and integrity on sensitivity analysis in TLE. Further studies are needed to explore this relationship and determine whether the white matter relationship with ADI is driven by social drift or environmental influences on brain development. Understanding the etiology and course of the disadvantage-brain integrity relationship may serve to inform care, management, and policy for patients.

Partial (Focal) Epilepsy: Epidemiological, Clinical, Paraclinical, Etiological, Therapeutic And Evolutionary Aspects In The Neurology Department Of TheAmirou Boubacar Diallo National Hospital

Introduction: The prevalence of epilepsy in sub-Saharan Africa is high and therefore constitutes a major public health problem. In Niger, the hospitalization rate is 29.5%. The aim of the study is to improve the management of patients living with epilepsy. The objective of the study is to contribute to improving the management of patients living with epilepsy. Methods: This was a retrospective and prospective cross-sectional study in the neurology department of the Amirou Boubacar Diallo National Hospital from May 2017 to December 2022. Results: Our study involved 75 epileptic patients out of 5546 patients who consulted for epileptic seizures, or 0.5%. The sex ratio (M/F) was 1.27. Average age of 17.2 years. Time to treatment less than 2 days in 62.67%. Clinical manifestations with motor signs represented 65.33% and 34.66% of the psychological manifestations. No seizure triggers were found in 50.67% of cases. Familial epilepsy was found in 16% of cases. Head trauma was the personal antecedent in 4% of cases. Consanguinity was found in 48% of cases. Physical examination was abnormal in 6.67% of cases. Secondary generalized focal abnormalities predominated on EEG in 64% of cases and insular localizations in 26.32% of cases. Idiopathic epilepsy was the predominant etiology in 72% of cases. Brain CT was performed in 35% of cases and brain MRI in 12%. Monotherapy was prescribed in 90.67% of our patients. The evolution was favourable in 93.33% of cases. Conclusion: Epilepsy is a common neurological disorder affecting patients of all ages, especially young subjects.

Fetal valproate syndrome (review and case report)

Toxic damages in fetuses and newborns rank highly in perinatal pathology structure, though their true importance is not understood thoroughly. Among toxic encephalopathies of newborns the accent should be given to the conditions caused by administration of medicines by a pregnant woman. The use of medicines, especially neurotropic, during pregnancy is often forced. The widespread prevalence of epilepsy in women of reproductive age leads, in certain cases, to anticonvulsants administration during pregnancy. The dominance of valproic acid in epilepsy treatment in recent decades requires studying its teratogenic effect in newborns fetal valproate syndrome. The fetal valproate syndrome has casuistic nature and polymorphic phenomenology.
 The clinical case study is presented of a newborn with fetal valproate syndrome (born to a mother who took valproic acid in dose 14 mg/kg per day or 750 mg per day while pregnant, due to Janz syndrome), confirmed by valproic acid presence in the blood of a newborn (47.36 mol/l), with the main clinical manifestation of incomplete cleft palate (hard and soft) without other typical disturbances.
 Most anticonvulsants have a teratogenic effect, and may cause malformations and toxic encephalopathies in fetus and newborns. The similarity of clinical manifestations of intrauterine exposure to various anticonvulsants is associated with the presence of common metabolic links (epoxy and dihydrodiol derivatives of phenytoin, phenobarbital and carbamazepine). In spite of similarity of some teratogenic effect mechanisms, the anticonvulsants nature introduces specific clinical manifestations of these disorders.

Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study.

Community-directed treatment with ivermectin (CDTi) is used to eliminate onchocerciasis. However, despite 25 years of annual CDTi in Mahenge, Tanzania, the prevalence of onchocerciasis and onchocerciasis-associated epilepsy remained high in certain rural villages. Therefore, in 2019, bi-annual CDTi was introduced in the area. This study assessed the impact of the programme on the incidence of epilepsy in four villages. Door-to-door epilepsy surveys were conducted prior to (2017/18) and after (2021) implementing a bi-annual CDTi program. All household members were screened for epilepsy symptoms using a validated questionnaire, and suspected cases were examined by a medical doctor to confirm/reject the diagnosis of epilepsy. The prevalence and annual incidence of epilepsy, including nodding syndrome, were calculated with 95% Wilson confidence intervals with continuity correction. The latter was also done for CDTi coverage in 2016 and 2021. Precisely 5,444 and 6,598 persons were screened for epilepsy before and after implementing the intervention. The CDTi coverage of the overall population was 82.3% (95%CI: 81.3-83.2%) in 2021 and sustained in both distribution rounds (81.5% and 76.8%). The coverage was particularly high in children and teenagers aged 6 to 18 years (93.2%, 95%CI: 92.1-94.2%). The epilepsy prevalence remained similar: 3.3% (95%CI: 2.9-3.9%) in 2017/18 versus 3.1% (95%CI: 2.7-3.5%) in 2021. However, the incidence of epilepsy declined from 177.6 (95%CI: 121.2-258.5) in 2015-2017 and 2016-2018 to 45.5 (95%CI: 22.2-89.7) in 2019-2021 per 100,000 persons-years. The incidence of probable nodding syndrome varied from 18.4 (95%CI: 4.7-58.5) to 5.1 (95%CI: 0.3-32.8). None of the nine incidence cases of epilepsy for which information on ivermectin intake was available took ivermectin in the year they developed their first seizures. A bi-annual CDTi programme should be implemented in areas with high prevalence of onchocerciasis and epilepsy. High CDTi coverage among children is particularly important to prevent onchocerciasis-associated epilepsy.

Fractures in people with epilepsy: A nationwide population-based cohort study.

The objective of this study was to determine the age, gender, and site-specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018. PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site-specific fractures. We also calculated gender and age-specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios (RR) were estimated for the number and type of ASM as well as comorbid conditions. Out of 13 818 prevalent epilepsy cases, 6383 (46.2%) were females, and 7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during the study period and ~8 people out of 1000 in the general population. The most frequent sites in terms of PP both in PWE and controls, were fractures of the lower arm, hip and femur, and lower leg. Significant differences in PP for all fracture locations were observed between PWE and controls (P < 0.001). The noticeable differences of ∼100 times higher PP were observed for fractures of the skull and jaw in PWE. IRR of any fracture in PWE was 272.84/10 000 person-years; higher in the older age groups and among people who received >2 ASM. Fracture risk was increased with the use of >2 ASM (OR: 1.56; 95% CI: 1.32-1.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10-1.38). This population-based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE.

The Traf2 and NcK interacting kinase inhibitor NCB-0846 suppresses seizure activity involving the decrease of GRIA1

Epilepsy, one of the most common neurological disorders, is characterized by spontaneous recurrent seizures. Temporal lobe epilepsy (TLE) is one of the most common medically intractable seizure disorders. Traf2-and NcK-interacting kinase (TNIK) has recently attracted attention as a critical modulation target of many neurological and psychiatric disorders, but its role in epilepsy remains unclear. In this study, we hypothesized the involvement of TNIK in epilepsy and investigated TNIK expression in patients with intractable TLE and in a pilocarpine-induced rat model of epilepsy by western blotting, immunofluorescence, and immunohistochemistry. A pentylenetetrazole (PTZ)-induced epilepsy rat model was used to determine the effect of the TNIK inhibitor NCB-0846 on behavioral manifestations of epilepsy. Coimmunoprecipitation (Co-IP)/mass spectrometry (MS) was used to identify the potential mechanism. Through Co-IP, we detected and confirmed the main potential TNIK interactors. Subcellular fractionation was used to establish the effect of NCB-0846 on the expression of the main interactors in postsynaptic density (PSD) fractions. We found that TNIK was primarily located in neurons and decreased significantly in epilepsy model rats and TLE patients compared with controls. NCB-0846 delayed kindling progression and decreased seizure severity. Co-IP/MS identified 63 candidate TNIK interactors in rat hippocampi, notably CaMKII. Co-IP showed that TNIK might correlate with endogenous GRIA1, SYN2, PSD-95, CaMKIV, GABRG1, and GABRG2. In addition, the significant decrease in GRIA1 in hippocampal total lysate and PSDs after NCB-0846 treatment might help modify the progression of PTZ kindling. Our results suggest that TNIK contributes to epileptic pathology and is a potential antiepileptic drug target.

Quality of life of persons with epilepsy in Mahenge, an onchocerciasis-endemic area in Tanzania: A cross-sectional study

ObjectiveThis study investigated the quality of life (QoL) of adults with epilepsy living in Mahenge, an onchocerciasis-endemic area in Tanzania with a high prevalence of onchocerciasis-associated epilepsy (OAE). MethodsBetween February and December 2020, persons with epilepsy (PWE) were recruited from four rural villages in Mahenge: Mdindo, Msogezi, Mzelezi, and Sali. For PWE who could not answer the questionnaire due to their mental or physical disability, a family member was asked to answer the questions instead. The Quality of Life in Epilepsy Inventory-31 (QOLIE-31) questionnaire used contained seven domains. The raw domain scores were transformed to 0–100% subscales, with higher scores indicating better QoL. The global QoL was calculated from the subscales using the overall QOLIE-31 score formula. ResultsIn total, 96 PWE were enrolled in the study with a median age of 28 (range: 18–60) years, of whom 45 (47%) were male. The questionnaires were answered by PWE (54.8%) or one of their family members (45.2%). Most PWE were single (81%), and half never attended school. About two-thirds (65%) of PWE were suspected of having OAE, and a third (31%) had a history of head nodding seizures. Most PWE were treated with phenobarbital (85.4%) and had high treatment adherence (96.9%). Still, the number of seizures per week ranged from 0 to 7, with a median of one. The mean global QOLIE-31 score was 66.9 (range: 38.3–92.1) out of 100.0. Predictors of lower QoL were living in Sali Village and experiencing seizures the week before the interview. In contrast, completing primary school and switching to second-line anti-seizure medication were predictors of higher QoL. ConclusionIn order to improve the QoL of PWE in Mahenge, it is vital to optimize anti-seizure medication regimens to decrease the frequency of seizures and to increase the schooling of PWE.

Comorbidity of epilepsy and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

Epilepsy and attention-deficit/hyperactivity disorder (ADHD) are common neurological and neuropsychiatric disorders, respectively, that can exist as comorbidities. However, the degree of comorbidity between both disorders has never been quantified based on a systematic review with meta-analysis. We performed a systematic search of the literature in Embase, PubMed, PsychINFO and the Cochrane Library on June 20, 2022. In a meta-analysis of 63 studies with a total sample size of 1,073,188 individuals (172,206 with epilepsy and 900,982 with ADHD) from 17 countries, the pooled prevalence of ADHD in epilepsy was 22.3% (95% CI 20.3-24.4%). The highest pooled prevalence was 12.7% (95% CI 9-17.1%) for ADHD-I subtype, whereas the pooled prevalence of epilepsy in ADHD was 3.4% (95% CI 2.53-4.21%). However, substantial heterogeneity in comorbidity rates was observed and partially attributed to the following factors: sample size, sample specification, geographical variations and diagnostic methods. Our study highlights the need for increased awareness of this diagnostic co-occurrence, and research is warranted to elucidate the underlying pathophysiological mechanisms.

Are Patients with Syndromic Craniosynostosis at Greater Risk for Epilepsy than Patients with Nonsyndromic Craniosynostosis?

The aim of this study was to determine whether patients with syndromic craniosynostosis (SCS) are at increased risk for epilepsy relative to patients with nonsyndromic craniosynostosis (NSCS). A retrospective cohort study was completed using the Kids' Inpatient Database (KID). All patients diagnosed with craniosynostosis (CS) were included. The primary predictor variable was study grouping (SCS vs. NSCS). The primary outcome variable was a diagnosis of epilepsy. Descriptive statistics, univariate analyses and multivariate logistic regression were performed to identify independent risk factors for epilepsy. The final study sample included a total of 10,089 patients (mean age, 1.78years±3.70; 37.7% female). 9278 patients (92.0%) had NSCS, and the remaining 811 patients (8.0%) had SCS. A total of 577 patients (5.7%) had epilepsy. Not controlling for other variables, patients with SCS were at increased risk for epilepsy relative to patients with NSCS (OR 2.1, P < 0.001). After controlling for all significant variables, patients with SCS were no longer at increased risk for epilepsy relative to patients with NSCS (OR 0.73, P= 0.063). Hydrocephalus, Chiari malformation (CM), obstructive sleep apnea (OSA), atrial septal defect (ASD), gastro-esophageal reflux disease (GERD) were all independent risk factors (P < 0.05) for epilepsy. Syndromic craniosynostosis (SCS) in itself is not a risk factor for epilepsy relative to NSCS. The greater prevalence of hydrocephalus, CM, OSA, ASD, and GERD, all of which were risk factors for epilepsy, in patients with SCS relative to patients with NSCS likely explains the greater prevalence of epilepsy in SCS relative to NSCS.

The Association of Sociodemographic Factors, Postictal Symptoms, and Medical History With Seizure Type in Patients With Epilepsy: A Cross-Sectional Study.

Background Approximately 50 million people globally suffer from epilepsy. The prevalence of epilepsy in Saudi Arabia has been reported at 6.5 per 1,000 persons, affecting nearly 1% of the entire population. However, limited data is available in the country regarding the sociodemographic factors affecting epilepsy and its associated postictal symptoms, which may lead to stigmatization and negatively impact patients. Methods A cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in a survey format. Ethical approval was obtained from the Research Ethics Committee of the Faculty of Medicine at King Abdulaziz University. The study population included patients with epilepsy who visited King Abdulaziz University Hospital's outpatient neurology clinics from October 2021 to March 2022. Results The study participants' average age at the time of the first seizure was 16.5 years, with patients experiencing seizures as early as within the first year of life and as late as 70 years of age. Patients who had had their first seizure during the first year of life did not have any schooling (p<0.0001) and had learning difficulties (p<0.00001). Focal onset impaired awareness seizures were significantly associated with motor weakness (p=0.023) and mood alterations (p=0.014), while postictal fear, anxiety or panic, and sleep disruption were statistically significant for focal onset aware seizures (p=0.015 andp=0.050). Conclusion This study highlights the sociodemographic differences between patients in Saudi Arabia and in other areas. It may also point to novel findings regarding the postictal symptoms associated with the various seizure types.

Parental perspectives on Phelan-McDermid syndrome: Results of a worldwide survey

Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disorder characterised by hypotonia, speech problems, intellectual disability and mental health issues like regression, autism and mood disorders. In the development, implementation and dissemination of a new clinical guideline for a rare genetic disorder like PMS, the parental experienced perspective is essential. As information from literature is scarce and often conflicting the European Phelan-McDermid syndrome guideline consortium created a multi-lingual survey for parents of individuals with PMS to collect their lived experiences with care needs, genotypes, somatic issues, mental health issues and parental stress. In total, we analysed 587 completed surveys from 35 countries worldwide. Based on parental reporting, PMS appeared to be caused by a deletion of chromosome 22q13.3 in 78% (379/486) of individuals and by a variant in the SHANK3 gene in 22% (107/486) of the individuals. Parents reported a wide variety of developmental, neurological, and other clinical issues in individuals with PMS. The most frequently experienced issues were related to speech and communication, learning disabilities/intellectual disability, and behaviour. While most reported issues were present across all age groups and genotypes, the prevalence of epilepsy, lymphoedema, and mental health issues do appear to vary with age. Developmental regression also appeared to begin earlier in this cohort than described in literature. Individuals with PMS due to a 22q13.3 deletion had a higher rate of kidney issues and lymphoedema compared to individuals with SHANK3 variants. Parental stress was high, with specific contributing factors being child and context related in accordance with the PMS phenotype. The survey results led to various validated recommendations in the European PMS guideline including an age specific surveillance scheme, specific genetic counselling, structured healthcare evaluations on sleep and communication and a focus on family well-being.

Retention of Cenobamate in the Real World (P4-1.005)

<h3>Objective:</h3> This retrospective, observational analysis evaluated cenobamate retention in a nationally representative administrative claims database. <h3>Background:</h3> Real-world experience with cenobamate has yet to be reported in a nationally representative sample. <h3>Design/Methods:</h3> We utilized a sample of patients from HealthVerity Marketplace, which includes more than 150 US commercial, Medicare, and Medicaid payers, to identify a cohort of adults (age ≥18 years) with prevalent epilepsy and at least 1 script for cenobamate (initiated at dosages of 12.5–50 mg) or any of the branded ASMs (brivaracetam, eslicarbazepine, lacosamide, perampanel). Outcomes were blended for branded ASMs. Follow-up began May 2020 and extended until December 31, 2021, with only adjudicated medical and pharmacy claims from patients with complete enrollment history included. The index date for the analysis was Day 1 of cenobamate or branded ASM initiation. Patients had to have at least a year’s worth of follow-up before and after the index date for inclusion in the analysis. Using Kaplan-Meier methods, patients were followed until an incident event occurred (cessation of cenobamate or branded ASM) or end of data collection. <h3>Results:</h3> Data were available from 1943 and 18,954 patients on cenobamate and branded ASMs, respectively, with 195 patients (mean age=38.2 years; % female=46.7%) and 4046 patients (mean age=42.4 years; % female=55.6%) meeting the inclusion/exclusion criteria. Median time to discontinuation was not reached in 12 months of follow-up for cenobamate and was 7.8 months for the branded ASMs. Retention at Months 3, 6, 9, and 12 was 72%, 62%, 58%, and 50%, respectively, for cenobamate, and 66%, 55%, 48%, and 40%, respectively, for branded ASMs (<i>P</i>=0.045). <h3>Conclusions:</h3> Cenobamate was associated with significantly better retention vs 4 pooled branded ASMs in this analysis of real-world use. Unmeasured differences across the 2 groups that impact differential retention outcomes (eg, patient severity, drug load, and use of monotherapy) are potential limitations of this analysis. <b>Disclosure:</b> Dr. Weingarten has received personal compensation for serving as an employee of SK Life Science. Mr. Wade has nothing to disclose. Mr. Mandapati has nothing to disclose. Dr. Schabert has nothing to disclose. Mr. Stern has received personal compensation for serving as an employee of SK Life Science.

Access to health care in patients with epilepsy in Latin America (P4-8.014)

<h3>Objective:</h3> Our objective was to assess the access to epilepsy care in LAC. <h3>Background:</h3> The lifelong prevalence of epilepsy in Latin America and the Caribbean (LAC) stands at an average of 17.8 per 1,000 inhabitants. The treatment gap is greater than 50%, thus more than half are not receiving any type of care. Thus, there is growing concern about the access to health services for epilepsy patients. <h3>Design/Methods:</h3> We conducted a cross-sectional survey regarding access to resources, programs and services related to the care of people with epilepsy in LAC. Neurologists and epilepsy specialists were surveyed either by mail or in-person during the XII Latin American Epilepsy Congress in Medellin, Colombia from October 1st to 4th, 2022. <h3>Results:</h3> 98 of 101 physicians answered our survey in person. Information was obtained from 17 countries in LAC, 37,8% epilepsy specialists and 62.2% neurologists. 85% of physicians reported issues accessing education and work for people with epilepsy. 62.1% countries had prenatal care programs. 78% of physicians reported a high cost of care as the main access barrier. EEG was available in 94.5% countries and CT scan in 82.7%. There were 40 epilepsy surgery programs in 10 of the 17 countries surveyed. 54% countries did not have legislation related to access to epilepsy surgery and 85.6% physicians reported there is no information available regarding this treatment. Epilepsy fellowship programs were reported available in 8 of the 17 countries. <h3>Conclusions:</h3> There is a low prevalence of educational and work opportunities for patients with epilepsy in LAC. Government support is weak, as evidenced by a low prevalence of preventive measures for epilepsy. Most countries have access to neurologists and diagnostic equipment, yet with high cost of ASM. There is a need for improved access in the treatment, evaluation, and education of epilepsy in LAC. <b>Disclosure:</b> Ms. Villegas has nothing to disclose. Dr. Lemus Esquivel has nothing to disclose. Dr. Mayor has nothing to disclose. Paula Martinez has nothing to disclose.

Epilepsy in Niger: An overview of the current situation.

A major public health concern in the world, particularly in sub-Saharan African countries, epilepsy is poorly studied in Niger, and its prevalence in the general population is unknown. Only two hospital-based studies have been published in Niger, reporting an estimated mean hospital prevalence of epilepsy of 24.2% (95% CI: 23.2-25.2), mainly affecting patients younger than 18 years (54.6%, 95% CI: 52.2-57.0), and males (59.8%, 95% CI: 57.4-62.2). To date in Niger, people living with epilepsy (PWE) are usually cared for by non-physician healthcare workers (mainly nurse technicians in mental health), general medical doctors (non-specialist physician), and non-neurologist physicians. In routine practice, these health workers make the diagnosis of epilepsy essentially based on the clinic, i.e., the repetition of epileptic seizures over time (mainly generalized tonic-clonic seizures) because most of them practiced in health centers or district hospitals or regional hospital centers in which electroencephalogram and neuroradiological explorations are of limited access or unavailable as well as a referral neurologist. Only 10 neurologists are currently practicing in Niger for a total population estimated at 21466800 inhabitants by the World Health Organization in 2018. In 41.8% (95% CI: 39.4-43.2) of the cases, the etiology was unknown with neuroradiological explorations and laboratory tests not performed in most cases. Genetic etiologies are the most frequent etiologies (40.8; 95% CI: 38.4-43.2), followed by Structural etiologies (11.7; 95% CI: 10.1-13.3) particularly hypoxic-ischemic brain injury, and infectious etiologies (6.8%; 95% CI: 5.6-8.0), especially cerebral malaria. PWEs are the target of social stigma and discrimination due to erroneous cultural and religious beliefs about epilepsy of the people from Niger. The present review is an update on the different aspects of epilepsy in Niger.

Active epilepsy prevalence among U.S. adults is 1.1% and differs by educational level—National Health Interview Survey, United States, 2021

This study used the most recent national data from the 2021 National Health Interview Survey (NHIS) to provide updated estimates of the prevalence of active epilepsy (self-reported doctor-diagnosed epilepsy, currently under treatment with antiseizure medicines or had at least 1 seizure in the past 12 months, or both) and inactive epilepsy (self-reported doctor-diagnosed history of epilepsy, not under treatment with antiseizure medicines and with no seizures in the past 12 months) overall and by sex, age groups, race/ethnicity, education level, and health insurance status. In 2021, 1.1% of U.S. adults, (approximately 2,865,000 adults) reported active epilepsy; 0.6% (approximately 1,637,000 adults) reported inactive epilepsy. The prevalence of active epilepsy and inactive epilepsy did not differ by age or sex. Active and inactive epilepsy prevalence differed by educational level. Weighted population estimates are reported for each subgroup (e.g., women; non-Hispanic Blacks) for program or policy development. Although active epilepsy prevalence has remained relatively stable over the past decade, this study shows that more than half of U.S. adults with active epilepsy have ≤high school diploma/GED, which can inform the development and implementation of interventions. Additional monitoring is necessary to examine population trends in active prevalence overall and in subgroups.

The presence and severity of epilepsy coincide with reduced γ-aminobutyrate and cortical excitatory markers in succinic semialdehyde dehydrogenase deficiency.

Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a rare inherited metabolic disorder caused by a defect of γ-aminobutyrate (GABA) catabolism. Despite the resultant hyper-GABAergic environment facilitated by the metabolic defect, individuals with this disorder have a paradoxically high prevalence of epilepsy. We aimed to study the characteristics of epilepsy in SSADHD and its concordance with GABA-related metabolites and neurophysiologic markers of cortical excitation. Subjects in an international natural history study of SSADHD underwent clinical assessments, electroencephalography, transcranial magnetic stimulation (TMS), magnetic resonance spectroscopy for GABA/N-acetyl aspartate quantification, and plasma GABA-related metabolite measurements. A total of 61 subjects with SSADHD and 42 healthy controls were included in the study. Epilepsy was present in 49% of the SSADHD cohort. Over time, there was an increase in severity in 33% of the subjects with seizures. The presence of seizures was associated with increasing age (p = .001) and lower levels of GABA (p = .002), γ-hydroxybutyrate (GHB; p = .004), and γ-guanidinobutyrate (GBA; p = .003). Seizure severity was associated with increasing age and lower levels of GABA-related metabolites as well as lower TMS-derived resting motor thresholds (p = .04). The cutoff values with the highest discriminative ability to predict seizures were age > 9.2 years (p = .001), GABA < 2.57 μmol·L-1 (p = .002), GHB < 143.6 μmol·L-1 (p = .004), and GBA < .075 μmol·L-1 (p = .007). A prediction model for seizures in SSADHD was comprised of the additive effect of older age and lower plasma GABA, GHB, and GBA (area under the receiver operating characteristic curve of .798, p = .008). Epilepsy is highly prevalent in SSADHD, and its onset and severity correlate with an age-related decline in GABA and GABA-related metabolite levels as well as TMS markers of reduced cortical inhibition. The reduction of GABAergic activity in this otherwise hyper-GABAergic disorder demonstrates a concordance between epileptogenesis and compensatory responses. These findings may furthermore inform the timing of molecular interventions for SSADHD.