Risk Of Epilepsy Research Articles

The Effect of Maternal Exposure to Air Pollutants and Heavy Metals during Pregnancy on the Risk of Neurological Disorders Using the National Health Insurance Claims Data of South Korea.

The objective of this study was to evaluate the effects of high levels of maternal exposure to ambient air pollution and heavy metals on risks of autism spectrum disorder (ASD) and epilepsy using the National Health Insurance claims data of South Korea. The data of mothers and their newborns from 2016 to 2018 provided by the National Health Insurance Service were used (n = 843,134). Data on exposure to ambient air pollutants (PM2.5, CO, SO2, NO2, and O3) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during pregnancy were matched based on the mother's National Health Insurance registration area. SO2 (OR: 2.723, 95% CI: 1.971-3.761) and Pb (OR: 1.063, 95% CI: 1.019-1.11) were more closely associated with the incidence of ASD when infants were exposed to them in the third trimester of pregnancy. Pb (OR: 1.109, 95% CI: 1.043-1.179) in the first trimester of pregnancy and Cd (OR: 2.193, 95% CI: 1.074-4.477) in the third trimester of pregnancy were associated with the incidence of epilepsy. Thus, exposure to SO2, NO2, and Pb during pregnancy could affect the development of a neurologic disorder based on the timing of exposure, suggesting a relationship with fetal development. However, further research is needed.

The causal effect of serum 25-hydroxyvitamin D levels on epilepsy: A two-sample Mendelian randomization study.

Observational studies have shown an association between 25-hydroxyvitamin D (25(OH)D) and epilepsy, but it is unclear whether the association is causal. Therefore, we applied Mendelian randomization (MR) analysis to determine the causal relationship between serum 25(OH)D levels and epilepsy. We conducted a two-sample Mendelian randomization (TSMR) study to investigate the association between serum 25(OH)D levels and epilepsy using pooled statistics from genome-wide association studies (GWAS). Data for 25(OH)D came from a GWAS comprising 417,580 participants, and data for epilepsy were obtained from the International League Against Epilepsy (ILAE) consortium. Five methods were used to analyze TSMR, including the inverse variance weighting method, MR Egger method, weighted median method, simple model, and weighted model. In the sensitivity analysis, MR Egger and MR PRESSO methods were used to test for pleiotropy, inverse variance weighting and MR Egger in Cochran's Q statistics were used to test for heterogeneity. MR analyzed the relationship between 25(OH)D and different types of epilepsy, and the results showed that a 1 standard deviation increase in natural log-transformed serum 25(OH)D levels was associated with reduced risk for juvenile absence epilepsy (IVW OR = 0.985; 95% confidence interval (CI): 0.971-0.999; P-value = 0.038). There was no apparent heterogeneity and horizontal gene pleiotropy. Higher serum levels of 25(OH)D were a protective factor for adolescent absence epilepsy, but had no effect on other types of epilepsy.

Association between gout and epilepsy in adults – a retrospective cohort study with 244,964 primary care outpatients

BackgroundRecently there has been a rising interest in the identification of possible risk factors for epilepsies. In the present study, we investigated the potential association between gout and epilepsy in an outpatient cohort in Germany. MethodsUsing the IQVIA Disease Analyzer database, we identified 112,482 patients with gout treated in outpatient departments. These were matched 1:1 to non-gout patients based on sex, age, yearly consultation frequency during the follow-up period, and diagnoses associated with an increased epilepsy risk documented prior to or on the index date. Cox regression models were used to evaluate the association between gout and epilepsy. ResultsWithin 10 years after the index date, epilepsy had been diagnosed in 2.2% of gout and 1.6% of non-gout patients (log-rank p<0.001). In the regression analysis, we observed a significant association between gout and subsequent epilepsy (HR: 1.32; 95% CI: 1.21–1.44). The association was significant in all age groups, but strongest in the youngest age group (18–50) (HR: 1.86; 95% CI: 1.44–1.2.41). ConclusionOur study demonstrates that gout is associated with an increased incidence of epilepsy. This finding could help us to understand the mechanisms of epilepsy and better protect affected individuals in the future.

Correlation between scalp high-frequency oscillations and prognosis in patients with benign epilepsy of childhood with centrotemporal spikes.

The study aimed to explore whether high-frequency oscillations (HFOs) can predict seizure risk and atypical manifestations of benign epilepsy of childhood with centrotemporal spikes (BECTS). We recruited 60 patients and divided them into three groups: (1)seizure-free BECTS, (2) active typical BECTS, and (3) active atypical forms of BECTS. Electroencephalogram was used to record the number, location, average amplitude, and duration of spikes, and spike ripples were analyzed using time-frequency technology. Multivariable logistic regression analysis was used to investigate independent predictive factors for prognosis. The number of sleep spike ripples, rather than spikes, was an independent risk factor for the active period of the disease (odds ratio [OR] = 4.714, p = 0.003) and atypical forms of BECTS (OR = 1.455, p = 0.049); the optimal thresholds for the spike ripple rate were >0 (area under the curve [AUC] = 0.885, sensitivity = 96.15%, specificity = 73.33%) and >0.6/min (AUC = 0.936, sensitivity = 84.21%, specificity = 96.15%), respectively. Furthermore, in typical BECTS, the spike ripple rate showed significant negative correlations with time since the last seizure (ρ = -0.409, p = 0.009) and age (ρ = -0.379, p = 0.016), while the spike rate did not. Spike ripple was a marker for distinguishing typical and atypical forms of BECTS and reflected the risk of seizure recurrence better than the spike alone. The present findings might assist clinicians in BECTS treatment.

The contribution of epidemiology to the understanding of neurodevelopmental disabilities.

Epidemiological approaches have played an important role in creating better understanding of developmental disabilities by delineating their frequency in populations and changes in their frequency over time, by identifying etiological factors, and by documenting pathways to prevention. Both cerebral palsy (CP) and mild intellectual disability are declining in frequency in high-income countries. The diagnosis of autism spectrum disorder has increased in recent decades, but much of this increase is a result of changing approaches to ascertainment and recording. Epidemiological studies have found that most CP is not of birth-asphyxial origin, that most febrile seizures do not pose a major risk for epilepsy, and that folic acid deficiency may contribute to developmental disabilities apart from its effect on neural tube defects. Epidemiological research has shown that an important fraction of neural tube defects and virtually all cases of Reye syndrome are preventable, and recent trials have shown ways to prevent CP. Early psychoeducational interventions in children at risk for mild intellectual disability are an effective and valuable societal investment. Very large population-based studies starting in pregnancy have been launched in Norway, Denmark, and Japan in recent years and these and other population studies promise to continue the epidemiological contribution to a better understanding of developmental disabilities.

The impact of serum magnesium and calcium on the risk of epilepsy: A mendelian randomization study.

To investigate the causal role of serum magnesium and calcium in epilepsy or any of its subtypes through Mendelian randomization (MR) approach. Single nucleotide polymorphisms (SNPs) associated with serum magnesium and calcium were used as the instrumental variables. MR analyses were performed using the summary-level data for epilepsy extracted from International League Against Epilepsy Consortium (15,212 cases and 29,677 controls) to obtain the causal estimates. The analyses were replicated using FinnGen data (7224 epilepsy cases and 208,845 controls), and a meta-analysis was then conducted. The result of combined analyses showed that higher serum magnesium concentrations was associated with a reduced risk of overall epilepsy (odds ratios [OR] = 0.28, 95% confidence interval [CI], 0.12-0.62, p = 0.002). In ILAE, higher serum magnesium was suggestively associated with reduced risks of focal epilepsy (OR = 0.25, 95% CI 0.10-0.62, p = 0.003). However, the results cannot be repeated in sensitivity analyses. As for serum calcium, the results did not reach statistical significance with overall epilepsy (OR = 0.60, 95% CI, 0.31-1.17, p = 0.134). However, genetically predicted serum calcium concentrations showed an inverse association with risk of generalized epilepsy (OR = 0.35, 95% CI, 0.17-0.74, p = 0.006). The current MR analysis did not support a causal relationship between serum magnesium and epilepsy, but showed a causally negative association between genetically determined serum calcium and generalized epilepsy.

Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis.

People with intellectual disabilities (PwID) have a bidirectional relationship with epilepsy. Nearly 25% of PwID have seizures and 30% people with epilepsy are thought to have a significant intellectual impairment. Furthermore, 70% of PwID are thought to have treatment-resistant epilepsy. In the United Kingdom, antiseizure medications (ASMs) are the second most widely prescribed psychotropic agent for PwID. However, it is unclear what the current evidence and patterns is on current prescribing of ASMs, including when and how a case is made to withdraw them. A narrative review along with an analysis of large-scale NHS Digital published data (2015-2020) on several aspects of ASM prescribing by general practices for PwID was undertaken. The review results and data analysis are consolidated and presented as 11 themes to provide a comprehensive overview of the study topic. Recent studies estimate that one-third and one-fifth of PwID are prescribed ASMs. A history of epilepsy is seen as the primary prescribing reason; however, often it is a legacy, and the indication is no longer clear. The proportion receiving ASMs continues to rise with age. This pattern of use does not correlate well with seizure onset. There are limited data on de-prescribing ASMs in PwID. The study population heterogenicity, associated polypharmacy, multimorbidity and higher sudden unexpected death in epilepsy risks are outlined. Suggestions are made from available evidence for improving prescribing practices for PwID and seizures, and key areas for further research in this complex clinical area are outlined.

Risk factors for secondary epilepsy in children with complex febrile seizures and their effect on growth and development-a retrospective cohort study.

Complex febrile seizures are prolonged and can cause neurologic abnormalities, leading to secondary epilepsy and affecting growth and development. At present, the mechanism of secondary epilepsy in children with complex febrile seizures is not clear, and this study aimed to explore the risk factors for secondary epilepsy in children with complex febrile seizures and analyze its effects on the growth and development of children. The data of 168 children with complex febrile seizures admitted to the Ganzhou Women and Children's Health Care Hospital between January 2018 and December 2019 were collected retrospectively and divided into a secondary epilepsy group (n=58) and control group (n=110) according to whether the children had secondary epilepsy or not. The differences in clinical features between the 2 groups were compared, and logistic regression analysis was used to explore the risk factors for secondary epilepsy in children with complex febrile seizures. A nomogram prediction model for secondary epilepsy in children with complex febrile seizures was established and verified using the R 4.0.3 statistical software, and the effect of secondary epilepsy on the growth and development of children was analyzed. Multivariate logistic regression analysis showed that family history of epilepsy, generalized seizures, number of seizures, and duration of seizures were independent influencing factors of secondary epilepsy in children with complex febrile seizures (P<0.05). The dataset was randomly divided into a training set and a validation set, with a sample size of 84 in the training set and 84 in the validation set. The area under the receiver operating characteristic (ROC) curve of the training set was 0.845 (95% confidence interval: 0.756-0.934), and the area under the ROC curve of the validation set was 0.813 (95% confidence interval: 0.711-0.914). Compared with the control group, the Gesell Development Scale score in the secondary epilepsy group was significantly reduced (77.84±8.86 vs. 85.64±8.65, P<0.001). The nomogram prediction model could better identify complex febrile seizures children at high risk of secondary epilepsy. Strengthening intervention in such children may be beneficial for improving their growth and development.

Occupational exposure to pesticides as a potential risk factor for epilepsy

Epilepsy is a chronic neurological disorder in which brain activity becomes abnormal, causing seizures. In a previous study we found that environmental exposure to pesticides was associated with a greater risk of epilepsy. The present study examined possible occupational risk factors that may contribute to the occurrence of epilepsy in farmers and pesticide applicators (sprayers). A case-referent study was conducted on 19,704 individuals over a 17-year study period (2000–2016). Epilepsy cases (n = 5091) were collected from Hospital records and referents (non-epilepsy cases, n = 14.613) from the Centre for Prevention of Occupational Risks, both from Almería (South-Eastern Spain). A significant increased risk of having epilepsy was found in farmers working in intensive agriculture (high-yield greenhouse crops) compared to extensive agriculture (open-air crops). The risk was greater for farmers residing in rural areas with high pesticide use (intensive farming crops in plastic greenhouses) and for those not wearing protective gloves. As for sprayers, the greatest risk of epilepsy was observed in those not wearing face mask, and in those living in areas with high pesticide use (greenhouse intensive agriculture). Overall, this study supports previous findings on the association between epilepsy and pesticide exposure in the general population, and extends the risk to farmers occupationally exposed to pesticides, mainly those engaged in intensive agriculture.

Biomarkers as prognostic determinants of epilepsy after post-acute central nervous system insults: a systematic review and meta-analysis (P3-5.017)

<h3>Objective:</h3> To conduct a systematic review of biofluid biomarkers to test their association with the risk of post-CNS insult epilepsy. <h3>Background:</h3> It remains unknown if there are shared common biological pathways of an epileptogenic mechanism associated with a range of cerebral insults i.e., stroke, traumatic brain injury, and infections; and if certain biological markers could predict the risk of post-CNS insult epilepsy. <h3>Design/Methods:</h3> We searched articles until January 25, 2022, in PubMed, Embase, PsycINFO, Google Scholar, and Web of Science. The primary outcome was the difference in mean biomarker levels in patients with post-CNS insult epilepsy compared to patients without post-CNS insult epilepsy. We used the modified quality score based on the Reporting Recommendations for Tumor Marker Prognostic Studies for risk of bias assessment. For each biomarker, the level difference was calculated using the pooled standardized mean difference (SMD) and 95% confidence intervals (CI). (PROSPERO CRD42021297110) <h3>Results:</h3> We included 22 studies of 1499 cases with post-CNS insult epilepsy and 7929 controls with no post-CNS insult epilepsy. They investigated 47 biomarkers in blood or cerebrospinal fluid (CSF). Of 22 studies, 21 had moderate-to-high risk of bias. A meta-analysis was possible for only 19 biomarkers. Only blood glucose levels in four studies were significantly higher in patients with post-stroke epilepsy (PSE) than in patients without PSE (SMD 0.44; CI 0.19 to 0.69). From individual studies, 15 biomarkers in blood and seven in CSF were significantly associated with post-CNS insult epilepsy. <h3>Conclusions:</h3> While several biomarkers were found to be associated with epilepsy due to CNS insults, we do not recommend using the reported biomarkers for use in clinical settings or clinical trials. A significant limitation of these studies is that they included fewer patients with CNS insults who developed post-cerebral insult epilepsy. Collaborative efforts to promote biomarker discovery are therefore warranted. <b>Disclosure:</b> Mr. Misra has nothing to disclose. Ms. Khan has nothing to disclose. The institution of Dr. Lam has received research support from NIH. Dr. Mazumder has nothing to disclose. Ms. Eldem has nothing to disclose. Dr. Gururangan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell Inc. Dr. Gururangan has stock in Ceribell Inc. The institution of Dr. Gururangan has received research support from NIH-NINDS. The institution of Dr. Gururangan has received research support from Leon Levy Foundation. Dr. Hickman has nothing to disclose. Dr. Goswami has nothing to disclose. Mrs. Funaro has nothing to disclose. The institution of Joan Montaner has received research support from spanish govt. Joan Montaner has received intellectual property interests from a discovery or technology relating to health care. Dr. Quinn has nothing to disclose. Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker. Dr. Mishra has nothing to disclose.

Online Information Gaps in Access to Community Health Literacy about Epilepsy Surgery: A Preliminary Content Analysis of Online Health Education Materials in the United States (S35.008)

<h3>Objective:</h3> To evaluate website content designed to provide epilepsy surgery information to patients. <h3>Background:</h3> Surgery is an important treatment for patients with medically refractory epilepsy. An increasing number of patients are turning to the Internet to obtain health information, but a previous study in the United Kingdom demonstrated poor readability and gaps in content from epilepsy surgery online resources. In this study, we used a US-based search strategy to analyze website content to determine the frequency of inclusion for key concepts relevant to the understanding of epilepsy surgery evaluation, risks, complications and options. <h3>Design/Methods:</h3> Private browser Google search was used to find the top 100 search results for the terms “<i>epilepsy+surgery</i>”. Scientific papers, insurance pages, pay-wall limited and non-text content were excluded. Text content was analyzed for inclusion of important concepts (pre-surgical evaluation, complications, risks of continuing to live with seizures, types of surgery, complimentary diagrams/audiovisual material). Comparison of content inclusion was performed as a function of organization types (level 4 epilepsy centers, community health websites) and location (US-based or non-US-based) using the chi-square test. <h3>Results:</h3> Preliminary analysis of 100 Google search results yields 76 websites and 24 exclusions. The inclusion rate of surgical complication content is positively correlated with non-level 4 epilepsy centers (76.9% vs 23.8%, p&lt;0.001), community health websites (100% vs 25.0%, p&lt;0.001), and non-US-based organizations (100% vs 29.2%, p=0.02). Higher rates of content addressing responsive neurostimulation surgery are correlated with level 4 epilepsy center designation (58.7% vs 38.5%, p=0.04). <h3>Conclusions:</h3> The majority of online health content is relatively incomplete with regards to multiple key concepts important for understanding a person’s surgical candidacy and the process of epilepsy surgery. Our findings suggest academic organizations, including level 4 epilepsy centers, need to broaden online health education resources for epilepsy surgery. More comprehensive publicly accessible information may lead to better shared decision-making. <b>Disclosure:</b> Ms. Ho has nothing to disclose. Mr. Seneviratne has nothing to disclose. Dr. Correa has received personal compensation in the range of $0-$499 for serving as a Consultant for Independent Medical Consultants. Dr. Correa has received personal compensation in the range of $0-$499 for serving as a Consultant for Atheneum Partners. Dr. Correa has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Correa has stock in Aidin Inc. Dr. Correa has received research support from Genentech. Dr. Correa has received research support from Psi Upsilon Foundation Inc.

Increased ozone exposure is associated with decreased risk of epilepsy: A hospital-based study in southwest China

To investigate the association between O3 and the number of outpatient visits for epilepsy in Chongqing, the most populous municipality in China, we conducted a time-series study including 99,740 epilepsy outpatient visits from January 2014 to December 2019 (2191 days). During the study period, the mean maximum 8-h average O3 was 70.63 μg/m3, which was below the WHO guideline (100 μg/m3). Negative and statistically significant associations of O3 were observed at lag 0, lag 1, and lag 01 to lag 03. Meanwhile, O3 exposure of lag 03 yielded the strongest estimates for outcomes: per 10-μg/m3 increase in O3 at lag 03 corresponded to −0.770% (95% CI: −1.419%, −0.122%) decrease in outpatient visits for epilepsy. In addition, the effect estimates were stronger in females than in males, in people aged ≥65 years than in younger populations, and in cool seasons than in warm seasons. Taken together, there was a significant negative association between short-term exposure to low concentrations of O3 and outpatient visits for epilepsy. These findings may contribute to the understanding of the relationship between air pollutants and epilepsy and other neurological diseases.

Association of Cognitive and Structural Correlates of Brain Aging and Incident Epilepsy. The Framingham Heart Study. (S19.010)

Association of Cognitive and Structural Correlates of Brain Aging and Incident Epilepsy. The Framingham Heart Study. (S19.010)

The Outcome of Traumatic Intra-diploic Meningoencephalocele with Recurrent seizures - A case report and literature review of 20 cases (P12-1.004)

<h3>Objective:</h3> We highlight an under-recognized epileptic pathology in a 56-year-old left-handed female with progressive right facial numbness and weekly focal seizures characterized by episodic aphasia. Additionally, we provide a thorough literature review of reported IDME patients along with their clinical presentation and outcomes. <h3>Background:</h3> Delayed neurological symptoms may arise years later in traumatic intradiploic meningoencephalocele (IDME) which creates potential diagnostic and therapeutic challenges. <h3>Design/Methods:</h3> Retrospective chart review and literature search. <h3>Results:</h3> 56-year-old left-handed female presented with progressive right facial numbness and focal seizures characterized by episodes of aphasia for a year. Episodes are characterized by worsening right facial numbness followed by garbled speech, word-finding difficulty, and grammatical errors when she attempts to talk or text over the phone, while she remains conscious and is aware of her surroundings. Her only epilepsy risk factor was minor head trauma ten years prior to presentation. Episodes were evaluated in the Epilepsy Monitoring Unit at Cleveland Clinic Foundation. An ictal event characterized by rhythmic sharply contoured delta and theta activity in the left hemisphere, most prominently in the left frontocentral region, This was clinically associated with numbness in the right side of the face progressing into an aphasic seizure. She was found to have left frontoparietal intradiploic meningoencephalocele (IDME) on imaging studies. Positron emission tomography (PET) showing mild metabolism corresponding to Intradiploic meningoencephalocele in left parietal bone, and subtle hypometabolism in the adjacent posterior left frontal lobe operculum. She had a craniotomy for encephalocele resection and mesh cranioplasty. At 3-year follow-up visit, patient was seizure free without residual neurological deficits. She remains on lacosamide 100 mg BID as seizures recurred after attempting to discontinue it. <h3>Conclusions:</h3> Traumatic IDME is a rare disorder and a presentation with seizures specifically is rarely encountered. A cranioplasty and dural repair, with or without resecting the projecting parenchyma, is likely the definitive treatment. <b>Disclosure:</b> Dr. Alsallom has nothing to disclose. Dr. Alzahrany has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Jehi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for wolters kluwer. Dr. Jehi has a non-compensated relationship as a PI with Cleveland Clinic that is relevant to AAN interests or activities.

Characteristics and Surgical Outcomes in a Cohort of Patients with Epilepsy and encephaloceles (P2-1.007)

<h3>Objective:</h3> To describe demographics, clinical characteristics, presurgical data, surgical approach, and outcomes of epilepsy patients with encephaloceles at The University of Kansas Medical Center. <h3>Background:</h3> Drug-resistant epilepsy (DRE) comprises around 1/3 of epilepsy patients. Encephaloceles are increasingly recognized as a DRE cause with an unknown incidence and prevalence. It can take ≥15 years to identify encephaloceles in DRE patients, with severe implications for quality of life and costs of care. In many cases, surgical resection/repair can be curative. <h3>Design/Methods:</h3> IRB approval was obtained. Informed consent was not required from individual patients. Data were retrospectively abstracted from the electronic medical record. Data analysis was performed using REDCap. <h3>Results:</h3> We identified 48 patients with epilepsy and encephaloceles in our Epilepsy Clinic. Twenty-eight (58%) were female; the mean age was 48.6 years (range 25–85). The average time from epilepsy onset to encephalocele discovery was 7.5 years (SD 8.4). Thirty-three (75%) met criteria for DRE. Twenty-three (48%) had no epilepsy risk factors, but in patients that did, trauma was the most frequent (13 pts, 27%). A lack of aura (14 patients, 29%) and psychic aura (déjà vu) (10 patients, 21%) were the two most frequently occurring auras. A slight majority had focal to bilateral tonic-clonic seizures (27 pts, 56%). Most encephaloceles were temporal (97%). A majority of encephaloceles were of unknown etiology (67%); 17% had associated venous sinus stenosis and 11% had trauma and IIH as possible etiologies, respectively. Clinical, imaging, and electrophysiologic evaluation (scalp/invasive EEG) estimated that 68% of encephaloceles caused epilepsy. Nine patients underwent epilepsy surgery. No patient undergoing surgery died. <h3>Conclusions:</h3> Most of our patients with epilepsy and encephaloceles met criteria for DRE. Early encephalocele recognition in DRE patients, followed by a prompt pre-surgical evaluation may impact seizure control, quality of life, and the financial burden of DRE on individual patients and health care systems. <b>Disclosure:</b> Dr. Mafla Delgado has nothing to disclose. Dr. Matloub has nothing to disclose. Dr. Masood has nothing to disclose. Dr. Schatmeyer has nothing to disclose. Miss Holland has nothing to disclose. Dr. Landazuri has nothing to disclose.

Long-term Risk of Epilepsy Following Invasive Group B Streptococcus Disease in Neonates in Denmark

The risk of epilepsy after neonatal invasive Group B Streptococcus (iGBS) disease, particularly iGBS sepsis, is poorly understood. To examine the association between neonatal iGBS (sepsis or meningitis) and long-term risk of epilepsy, stratified by sex, prematurity, and maternal socioeconomic position (SEP). This population-based cohort study was conducted in Denmark with an inclusion period from 1997 through 2017 and follow-up until the end of 2018. A general population comparison cohort was randomly sampled and matched up to 10:1 to the exposed cohort. Linkage between Danish national registers were applied for data collection. Participants were infants aged 0 to 89 days. The general population comparison cohort was matched by sex, the child's year and month of birth, and gestational age. SEP was defined by maternal income and education. Hospital-diagnosed iGBS (sepsis or meningitis) during the first 89 days after birth. Epilepsy was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and/or prescription codes for antiepileptic drugs using Danish medical registry data. Cumulative risk (CR) of epilepsy was calculated by treating death as a competing event. Cox proportional hazards regression was used to estimate hazard ratios with 95% CIs. Effect modification by sex, prematurity, and maternal SEP was assessed on an additive scale. A total of 1432 children (792 [55.3%] boys; 1126 [78.6%] with gestational age ≥37 weeks) were identified with iGBS disease: 1264 with sepsis and 168 with meningitis. In the comparison cohort, there were 14 211 children (7869 [55.4%] boys; 11 260 [79.2%] with gestational age ≥37 weeks). The overall (0 to 22 years) CR of epilepsy was 3.6% (95% CI, 2.6%-5.0%) in children with iGBS disease and 2.3% (95% CI, 1.9%-2.7%) in the comparison cohort. The overall CR of epilepsy for iGBS meningitis was 15.1% (95% CI, 8.9%-22.8%) and 2.2% (95% CI, 1.4%-3.4%) for iGBS sepsis. The adjusted hazard ratio for epilepsy in children with iGBS disease was 2.04 (95% CI, 1.46-2.85). Being a boy, born premature, or born to a mother belonging to a low SEP group was associated with an increased risk of epilepsy in later childhood. In this population-based cohort study of 1432 neonates, iGBS disease was associated with a higher incidence of epilepsy in later childhood, notably after meningitis. Premature birth, sex, and low maternal SEP modified the association.

Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

BackgroundFew studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana.MethodsA cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders.ResultsNine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD.ConclusionsOur study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.

Children with corpus callosum anomalies: clinical characteristics and developmental outcomes.

Corpus callosum abnormalities are complex, aetiologically diverse, and clinically heterogeneous conditions. Counselling parents regarding their causes and associated syndromes, and predicting the neurodevelopmental and seizure risk prognosis, is challenging. We describe the clinical characteristics, associated anomalies, and neurodevelopmental outcomes of children with agenesis of corpus callosum (ACC). Fifty-one neonates with ACC/hypoplasia of the corpus callosum were identified over a 17-year period, and their medical records were retrospectively reviewed. Patients were classified into two groups depending on the presence or absence of associated abnormalities. The first group (17 patients, 33.4%) presented with isolated callosal anomalies. The second group included 34 patients (66.6%) with associated cerebral and extracerebral anomalies. We achieved an identifiable genetic aetiology in 23.5% of our cohort. Magnetic resonance imaging was performed in 28 patients (55%), and of these 39.3% had additional brain anomalies. During the study period, five patients died early in the neonatal period and four were lost to follow up. Of the 42 followed patients, 13 (31%) showed normal neurodevelopment, 13 (31%) showed mild delay, and 16 (38%) had a severe delay. Fifteen (35.7%) had epilepsy. We have confirmed that callosal defects are frequently accompanied by brain and somatic anomalies. Additional abnormalities were shown to be significantly associated with developmental delay and increased risk of epilepsy. We have highlighted essential clinical features that may provide diagnostic clues to physicians and we have given examples of underlying genetic disorders. We have provided recommendations about extended neuroimaging diagnostics and widespread genetic testing that may impact upon daily clinical practice. Paediatric neurologists may therefore use our findings to help base their decisions regarding this matter.

Epilepsy risk awareness and background factors in patients with epilepsy and family caregivers

ObjectivesPatients with epilepsy are at risk of various injuries throughout their lives. Awareness of patients and family caregivers about risk factors and self-care prevents potential injuries. This study aimed to investigate epilepsy risk awareness and background factors in patients with epilepsy and family caregivers. MethodsThis descriptive study was conducted with the recruitment of 120 patients with epilepsy and 120 family caregivers who were referred to the Neurological Clinic of Tabriz Razi Hospital in Iran. Data was collected using Persian version of the epilepsy risk awareness questionnaires for patients (3rd Edition) and family caregivers. ResultsThe average age of the patients (65.8% women) was 29.2 and of the family caregivers (58.3% women) 41.5 years. The average score of risk awareness in family caregivers was 82.6 ± 8.8 and higher than that in patients with epilepsy 84.9 ± 8.5 (obtainable score: 0–120). Compared to the maximum score, the average scores of both groups in all domains including epilepsy, personal security, physical health, and mental health were low. A statistically significant relationship was observed between the mean scores of risk awareness and some background variables. ConclusionThe results showed that epilepsy risk awareness in patients and family caregivers is low and there is a need for education and support. By developing education programs for the patient and their family and increasing epilepsy risk awareness, patients can be protected from potential risks and their safety and quality of life can be improved.

Sex hormones and risk of epilepsy: A bidirectional Mendelian randomization study.

Multiple evidence has suggested complex interaction between sex hormones and epilepsy. However, whether there exists a causal association and the effect direction remains controversial. Here we aimed to examine the causative role of hormones in the risk of epilepsy and vice versa. We conducted a bidirectional two-sample Mendelian randomization analysis using summary statistics from genome-wide association studies of major sex hormones including testosterone (N = 425,097), estradiol (N = 311,675) and progesterone (N = 2,619), together with epilepsy (N = 44,889). We further performed sex-stratified analysis, and verified the significant results using summary statistics from another study on estradiol in males (N = 206,927). Genetically determined higher estradiol was associated with a reduced risk of epilepsy (OR: 0.90, 95% CI: 0.83-0.98, P = 9.51E-03). In the sex-stratified analysis, the protective effect was detected in males (OR: 0.92, 95% CI: 0.88-0.97, P = 9.18E-04), but not in females. Such association was further verified in the replication stage (OR: 0.44, 95% CI: 0.23-0.87, P = 0.017). In contrast, no association was identified between testosterone, progesterone and the risk of epilepsy. In the opposite direction, epilepsy was not causally associated with sex hormones. These results demonstrated higher estradiol could reduce the risk of epilepsy, especially in males. Future development of preventive or therapeutic interventions in clinical trials could attach importance to this.