Seizure-related Injuries Research Articles

Therapeutic yield of comprehensive inpatient treatment for patients with intellectual disability and epilepsy - A prospective observational study.

In people with intellectual disability (ID), prevalence of epilepsy can be over 40-times higher than in normally intelligent people, impacting quality of life (QoL) of those affected. Patients with ID are often excluded from clinical trials, resulting in limited evidence regarding treatment. This study aimed to evaluate effects of a comprehensive inpatient treatment program on seizure outcome and QoL and to identify predictive factors for improvement in these measures. This prospective observational study included people with epilepsy (PWE) and ID (IQ < 70) who underwent comprehensive inpatient treatment in a tertiary epilepsy center. The program consisted of adjustments of anti-seizure medication (ASM) and various interventions such as occupational therapy, ergotherapy, logopedics, physiotherapy and counseling services, requiring a minimum hospital stay of 14days. Outcome was measured by the Liverpool Seizure Severity Scale (LSSS), Glasgow Epilepsy Outcome Scale (GEOS), Aberrant Behavior Checklist (ABC), and Liverpool Adverse Events Profile (LAEP), alongside global QoL (numerical rating scale; 10 best, 0 worst) by caregivers. Seizure outcome was classified as "favorable" for patients experiencing not more than one seizure per month without any seizure-related injuries in the last 2months. Data were collected within 2weeks prior to admission and 8weeks post-discharge. Wilcoxon signed rank tests and regression analysis were used to assess the effects of inpatient treatment and to identify predictive factors. A total of 65 patients (30 female, median age 32years) were included. During their hospital stays, number of ASM was reduced significantly, but not the total ASM dosage. Inpatient treatment led to a significant improvement in favorable seizure outcome (25% before admission vs. 46% after discharge; p=0.004) and ASM adverse effects (LAEP median 34.0 vs. 31.0; p=0.006). QoL ratings improved significantly post-treatment (rating scale median 4.0 vs. 6.0; p=0.0015). A significant improvement of global QoL after discharge compared to the time point before admission was independently associated with a reduction of ASM number during hospital stay (p=0.011). In general, higher global QoL after discharge was independently associated with a favorable seizure outcome (p<0.001) and lower scores for ASM adverse effects (p=0.03). In PWE and ID, a comprehensive inpatient treatment program may be helpful to reduce burden of seizures and of ASM adverse effects as well as to improve global QoL. A reduction of the number of ASM may facilitate improvement of global QoL.

A call for better information about epilepsy: The next of kin perspective.

For next of kin (NK) to people with epilepsy (PWE) insufficient knowledge about the disease might have a negative impact on disease management, utilization of the health care system and conveyance of attitudes in the society. The aim of this study was to investigate to which degree Norwegian NK to PWE called for and obtained relevant information about different epilepsy-related issues. We invited NK visiting the homepage of the Norwegian Epilepsy Association to complete an online questionnaire regarding information about epilepsy. The survey was accessible for a five-month period. 231 NK fulfilled the questionnaire. Almost 90 % of the respondents called for more information about specific topics, such as seizure management and premature death in epilepsy, in addition to more general information about the disease. Those who experienced high levels of psychological distress were particularly in need of more information about all epilepsy-related issues. Depending on the subject, the proportion of respondents that reported not to have obtained information on specific issues varied from 42 % to 88 %. Good seizure control in the person they cared for was significantly associated with receiving insufficient information about seizure management, seizure-related injuries, concentration and memory, and borderline significant about depression and anxiety. The majority of Norwegian NK to PWE call for more and better information about the disease. Perceived lack of information among close relatives was associated with high levels of emotional stress. This should be a wake-up call for healthcare professionals working with this patient group.

Parental stress, coping mechanisms and predictors of parental stress among parents of children with epilepsy

Objectives: To investigate the parental stress and coping mechanisms in parents of children with epilepsy (CWE) and to determine the predictors of parental stress. Methods: Parents of CWE (n=323) were evaluated for parental stress (PS) with a modified Abidin’s parental stress index short-form scale (PSI-SF) and the coping mechanisms by modified ways of coping of Folkman and Lazarus. PS was defined by calculating 90 percentile values of the PSI total score. Results: A significantly higher mean parental stress index total and parenting distress subscale score was observed in females than in males. The percentage of PS was 10.52% among the parents of CWE. Distancing was the dominant coping mechanism used by the parents of CWE. Type of family, seizures, duration of illness, number of drugs used, seizure-related injuries, neighbour know child taking antiepileptic drugs and seeking social support were found to be the significant predictors of parental stress in the combined group. Seeking social support was found to be the common predictor for PS in both sexes, whereas duration of illness and number of drugs used were specific to females only. Conclusions: Interventions need to be designed to improve the mental health and information seeking among the parents of CWE to reduce parental stress and to improve the quality of life of the caregiver and the cared.

Impact of the socioeconomic crisis in Lebanon on people with epilepsy.

The economic crisis in Lebanon, which began in 2019, has affected the healthcare system and patients' incomes. The aim of this study was to analyze the obstacles faced by people with epilepsy (PWE) during this crisis and to assess its impact on their quality of life. The method used was a cross-sectional study conducted among PWE aged 18-65 years, who were asked to complete a comprehensive questionnaire covering sociodemographic aspects, clinical aspects, the impact of the economic crisis, and the QOLIE-31 (version 1.0), validated in English and Arabic, which assesses the quality of life of PWE. 71 patients were included in the study with an average age of 35.2 years [23.5; 62.5] (53.5% were males). Their average QOLIE-31 score was 50.3 (+/- 17.9). A significant proportion (71%) of patients reported difficulties during the crisis, with 25% reporting having had seizure-related injuries in the years 2022-2023 and 36.6% reporting an increase in seizure frequency compared to that prior to 2020. Moreover, many patients had to change (33.8%) or discontinue (18.3%) antiseizure medications, due to drug shortages, rising costs, and high gas prices. To mitigate these challenges, patients sought solutions such as obtaining medications from abroad (34%) or through donations (8%) or purchasing from the black market (8%). Low quality of life was associated with unemployment, low education level, the presence of focal seizures with impaired awareness or generalized seizures, polytherapy, seizure-related injuries, and medication changes during the economic crisis. These results highlight the considerable challenges faced by PWE in Lebanon during the economic crisis, emphasizing the negative effect of the crisis on their quality of life and seizure control. This study analyzed the obstacles faced by 71 people with epilepsy during Lebanon's economic crisis and showed that many patients had to change (33.8%) or discontinue (18.3%) antiseizure medications, due to drug shortages, rising costs, and high gas prices. To mitigate these challenges, patients sought solutions such as obtaining medications from abroad (34%) or through donations (8%) or purchasing from the black market (8%). This affected their quality of life. In fact, low quality of life was associated with unemployment, low education level, focal seizures with impaired awareness or generalized seizures, polytherapy, seizure-related injuries, and medication changes.

Between fear of death and just a warning sign: Seizure severity scales neglect the subjective quality of periictal perceptions

The burden of epilepsy is not only related to seizure frequency; the severity of epileptic seizures considerably affects patient’s lives. A number of seizure severity scales have thus been developed for a systematic assessment. Items considered relevant in these scales mainly pertain to objective features, such as seizure duration, loss of consciousness, and seizure-related injuries. In contrast, subjective experiences of seizures are considered only in their functionality as “warnings”, whereas the quality of subjective perceptions and feelings are disregarded phenomena. This leads to a gap between the often-distressing subjective experiences which people with epilepsy remember from their seizures and the perception of physicians which may negatively impact physician-patient communication and interaction and question their valid use as treatment outcomes. We advocate here to develop new seizure severity assessments in collaboration with patient organizations which integrate also the subjective quality of seizures.

Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria.

Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. This was a cross-sectional descriptive study in a Southeast Nigeria local government area. PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. The Statistical Package for the Social Sciences version 22.0 was used. There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.

Seizure-Related Head Injuries: A Narrative Review.

Epilepsy is one of the most common neurological diseases. Epileptic seizures very often result in head injuries that may lead to many adverse consequences, both acute and chronic. They contribute to the need for hospitalization, modification of treatment, and a general decline in social productivity. The objective of our review is to characterize and assess management aspects of seizure-related head injuries (SRHIs) as an important and frequent clinical problem present in emergency department settings. PubMed and other relevant databases and websites were systematically searched for articles on traumatic brain injuries connected with the occurrence of seizures published from inception to 9 April 2024; then, we reviewed the available literature. Our review showed that SRHIs can lead to various acute complications, in some cases requiring hospitalization and neurosurgical intervention. Long-term complications and cognitive decline after injury might be present, eventually implying a negative impact on a patient's quality of life. Despite being frequent and clinically important, there are still no widely accepted, uniform recommendations for the management of patients with SRHIs. As such, a concise and standardized protocol for the management of seizure-related head injuries in emergency departments is worth consideration.

Pattern of Injuries in Children with Epilepsy: A Hospital-Based Case-Control Study

Abstract Objective The aim of this study is to examine the profile and pattern of injuries in children with epilepsy (CWE) as compared with healthy controls. Materials and Methods This prospective, cross-sectional study conducted over 1 year in a tertiary care pediatric center included consecutive CWE aged 4 to 16 years who had active seizures during the preceding 1 year. A similar number of age- and sex-matched healthy controls were enrolled. Children with acute symptomatic seizures or degenerative neurologic disorders were excluded. Standardized scales were used to assess intelligent quotient, psychopathology, seizure severity, and restriction of daily activities. Results Two hundred and eight CWE (mean age: 107 ± 37months; range: 3.5–16 years) and an equal number of healthy controls (mean age: 108 ± 43 months; range: 3.5–16 years; p = 0.07) were evaluated. The majority of CWE had generalized epilepsy (n = 117, 59.6%) followed by focal epilepsy (n = 84, 40.3%). The mean duration of epilepsy was 47.4 ± 36.3 months. The prevalence of injury was significantly greater in CWE (n = 118/208, 56.7%) compared with controls (n = 56/208, 26.9%; p &lt; 0.001). CWE suffered significantly greater number of 293 injuries in the past 1 year in contrast to 83 injuries in controls (p &lt; 0.001). In CWE, the majority of injuries were unrelated to seizures (n = 85/118, 72%, 211 injuries), while only one-third (n = 33/118, 27.9%, 82 injuries) suffered seizure-related injuries. The incidence of injures unrelated to seizures and that of seizure-related injuries were similar (2.48 seizure-related injuries per person per year). Among CWE, a comparison of the injury versus noninjury group showed a significantly longer duration of epilepsy (53 ± 34 vs. 40 ± 38 months, p &lt; 0.007), higher prevalence of underlying structural etiology in generalized epilepsy (34.7 vs. 13.3%, p &lt; 0.001), higher mean seizure severity and restriction of daily activity scores, and higher prevalence of hyperactivity (36.4 vs. 18.9%, p = 0.006) and intellectual disability (35.6 vs. 10%, p &lt; 0.001) in the injury group. Injuries on the head, face, and upper limb were significantly more in CWE as compared with controls, and tongue injuries were found only in CWE (p =&lt; 0.05), and were seen significantly more as seizure-related injury (n = 7 vs. 1, p &lt; 0.001) compared with non-seizure-related injuries. The majority of injuries in children with CWE and controls were mild in nature (n = 112, 53.8% vs. n = 54, 26%; p &lt; 0.001). Conclusions The prevalence of injuries among CWE aged between 4 and 16 years is high and is significantly greater than in healthy controls, although the majority of injuries are mild in severity in both and are non-seizure-related injuries. Longer duration of epilepsy, higher seizure severity, and restriction of daily activities, and higher prevalence of underlying structural etiology, hyperactivity, and intellectual disability are associated with injuries in CWE.

The impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy at a referral hospital in Ethiopia.

The world continues to be challenged by the Coronavirus disease 2019 (COVID-19) and preventive measures like maintaining social distancing and lockdowns challenge patients to attend regular follow-ups and get a refill for medication that causes adherence problems. Hence, this study attempts to assess the impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy. A total of 276 patients with epilepsy were enrolled in the study. Data collection was carried out through medical record reviews and patient interviews. Patients who visited Zewditu Memorial Hospital from August to September 2021 and those who had follow-up at least for two years before the outbreak of the pandemic were included. The data was analyzed using SPSS v.24. About 69.6% of patients were adherent to their treatment and 83.3% of the patients had a seizure-free period of less than 1 year. Ninety (32.6%) of the participants missed their treatment follow-up during the pandemic, mainly due to fear of being infected with COVID-19. Sixty-eight (24.6%) patients have experienced increased seizure episodes during the pandemic as compared to the previous times. Moreover, 56 (20.3%) participants were not taking their antiseizure medications (ASMs) during the pandemic because of the unavailability of medications and they discontinued hospital visits for their medication refills. Among those who missed their treatment follow-up, 20% had seizure-related physical injuries. Only educational level has a significant association with visiting health facilities during the pandemic. Thus, participants who completed college and above (OR = 2.58, 95% CI (1.32-6.38)) were more likely to attend their follow-up during the pandemics as compared to participants who can't read and write. The present study revealed that COVID-19 might have impacts on treatment follow-up and medication adherence due to fear of infection, travel restrictions and the indirect impact on the availability and affordability of medications. These might lead to poor treatment outcomes like increased seizure frequency and seizure-related physical injuries.

Characteristics and Risk Factors of Seizure-related Injuries in Patients Presenting with Seizures to the Emergency Room

Background: The goal of this study was to investigate the incidence and type of seizurerelated injuries (SRIs) in patients presenting with seizures to the emergency department (ED) and to determine the risk factors of SRIs.Methods: In this retrospective cross-sectional study, we surveyed all seizure patients aged 18 years and older who visited the ED of Yeungnam University Hospital between October 2017 and September 2019. We excluded patients who developed seizures secondary to cardiac arrest or acute head trauma.Results: A total of 165 patients were enrolled and SRIs occurred in 33 patients (20.0%). The most common SRI was head injury (35.3%), followed by soft tissue injury (29.4%) and orolingual injury (17.6%). Most injuries were single, minor injury and required little or no treatment. Death occurred in one patient (3.0%) with SRIs due to intracranial hemorrhage. On univariate analysis, young age (&lt;i&gt;p&lt;/i&gt;&lt;0.001), history of alcohol use disorder (&lt;i&gt;p&lt;/i&gt;=0.005), hypertension (&lt;i&gt;p&lt;/i&gt;=0.022) and stroke (&lt;i&gt;p&lt;/i&gt;=0.032), falling during seizure (&lt;i&gt;p&lt;/i&gt;&lt;0.001), seizure cluster (&lt;i&gt;p&lt;/i&gt;=0.001), convulsive status epilepticus (&lt;i&gt;p&lt;/i&gt;=0.034), generalized tonic-clonic seizure (&lt;i&gt;p&lt;/i&gt;=0.010), initial blood ammonia level (&lt;i&gt;p&lt;/i&gt;=0.007), and alcohol-related seizure (&lt;i&gt;p&lt;/i&gt;=0.032) predicted the occurrence of SRIs. All patients with SRIs were independent in daily activities. On multiple logistic regression analysis, five variables remained significant: young age (&lt;i&gt;p&lt;/i&gt;=0.037), history of alcohol use disorder (&lt;i&gt;p&lt;/i&gt;=0.040), falling during seizure (&lt;i&gt;p&lt;/i&gt;&lt;0.001), seizure cluster (&lt;i&gt;p&lt;/i&gt;=0.013), and convulsive status epilepticus (&lt;i&gt;p&lt;/i&gt;=0.032).Conclusions: Young age, history of alcohol use disorder, falling during seizure, seizure cluster, and convulsive status epilepticus predicted SRIs in people presenting with seizure.

Clinical profile, management and risk factors for seizure-related burn injuries among patients with epilepsy in southwest China

ObjectiveThe epidemiological information associated with seizure-related burn injuries is lacking in China. Therefore, this study aims to analyze the clinical profile, management, outcome, and risk factors of burns that are directly caused by seizures among epileptic patients, and identify the epidemiological characteristics to develop effective preventive strategies. MethodsThis study was conducted between January 2002 and December 2022 in a large Chinese burn center. Data including clinical profile, wound treatment, and outcome were analyzed. A multiple linear regression was used to screen the risk factors for the length of hospital stay (LOS), and a multiple logistic regression was used to screen the contributory factors for the amputation. ResultsA total of 184 burn patients (55.98 % females) were enrolled, with a 0.78 % incidence rate during the study period. The mean age of the patients was 36.16 years (SD: 17.93). Patients aged 20–29 were the most affected age groups (23.37 %). Most burns were caused by flame, accounting for 60.33 % (111/184) of all cases. In total, 76.09 % of the 184 patients underwent at least one operation, and 35 patients (19.02 %) still required amputation during the study period. Burn sites (hands) had the greatest impact on amputation (OR = 3.799), followed by flame burns (OR = 3.723). The mean LOS/TBSA was 6.90 ± 8.53 d, and a larger TBSA, full-thickness burns, and a higher number of operations were identified as the risk factors for a longer LOS. There was one death among the 184 patients, with a mortality rate of 0.54 %. ConclusionThis study demonstrates that burn injuries are extremely harmful to individuals with epilepsy in China because they are at high risk of amputation and disability. Effective healthcare education and preventive programs that focus on lifestyle modifications and seizure control should be implemented to reduce the burn incidence in these populations.

Seizure-related injury SRI: Prevalence and predictors in Khartoum State, Sudan 2020–2021

Seizure-related injury SRI: Prevalence and predictors in Khartoum State, Sudan 2020–2021

Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations

Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion's characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients. Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed. A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury. Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.

A - 113 Strengths-Based Neuropsychology in Neurological Surgery: a Neuropsychiatric Case Study of Treatment Refractory Right-Sided Focal Seizures.

Psychiatric comorbidity is high among patients with epilepsy, found more frequently with right-sided seizure foci. Neurosurgical intervention is often the standard of care for refractory epilepsy; unfortunately, psychiatric symptoms can impact a patient's compliance and participation in the pre-surgical process. This pre-surgical epilepsy case illustrates the importance of neuropsychological evaluation in clarifying the relationship between cognitive functioning and long-standing psychiatric comorbidities to inform surgical candidacy. A 20-year-old, left-handed, bilingual Caucasian female with seven years of education with cortical dysplasia associated with intractable right-hemisphere localization-related epilepsy underwent neuropsychological evaluation for progressive short-term memory and word-finding difficulty as part of a pre-surgical workup. A clinical interview, neuropsychological testing, and comprehensive review of available electronic medical records (EMR) were completed. Neuropsychological estimates of current intellectual functioning were low average but variable, revealing a relative strength in non-verbal learning and memory compared to verbal abilities. Self-report emotional measures evidenced clinically elevated levels of anxiety and depression and reduced quality of life due to epilepsy. Psychiatric diagnoses included attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, oppositional defiant disorder, and panic attacks. EMR and clinical interview indicated medication non-compliance, alcohol intoxication, dysregulated sleep hygiene, seizure-related injuries, and history of status epilepticus. Consistent with the literature, this pre-surgical case demonstrated significant psychiatric symptoms in the context of right-sided treatment refractory epilepsy. While psychiatric comorbidities contributed to non-adherence with medical recommendations, under-functioning in vocational goals, and general hopelessness, the neuropsychological evaluation revealed strengths that impacted surgical candidacy and rapport-building that facilitated patient engagement and understanding of the surgical process.

The cost-effectiveness of a real-time seizure detection application for people with epilepsy

ObjectivesAutomated seizure detection modalities can increase safety among people with epilepsy (PWE) and reduce seizure-related anxiety. We evaluated the potential cost-effectiveness of a seizure detection mobile application for PWE in Singapore. MethodsWe used a Markov cohort model to estimate the expected changes to total costs and health outcomes from a decision to adopt the seizure detection application versus the current standard of care from the health provider perspective. The time horizon is ten years and cycle duration is one month. Parameter values were updated from national databases and published literature. As we do not know the application efficacy in reducing seizure-related injuries, a conservative estimate of 1% reduction was used. Probabilistic sensitivity analysis, scenario analyses, and value of information analysis were performed. ResultsAt a willingness-to-pay of $45,000/ quality-adjusted life-years (QALY), the incremental cost-effectiveness ratio was $1,096/QALY, and the incremental net monetary benefit was $13,656. Probabilistic sensitivity analyses reported that the application had a 99.5% chance of being cost-effective. In a scenario analysis in which the reduction in risk of seizure-related injury was 20%, there was a 99.8% chance that the application was cost-effective. Value of information analysis revealed that health utilities was the most important parameter group contributing to model uncertainty. ConclusionsThis early-stage modeling study reveals that the seizure detection application is likely to be cost-effective compared to current standard of care. Future prospective trials will be needed to demonstrate the real-world impact of the application. Changes in health-related quality of life should also be measured in future trials.

First seizure from sleep: Clinical features and prognosis.

Patients with a first-ever unprovoked seizure commonly have subsequent seizures and identifying predictors of recurrence has important management implications. Both prior brain insult and epileptiform abnormalities on electroencephalography (EEG) are established predictors of seizure recurrence. Some studies suggest that a first-ever seizure from sleep has a higher likelihood of recurrence. However, with relatively small numbers and inconsistent definitions, more data are required. Prospective cohort study of adults with first-ever unprovoked seizure seen by a hospital-based first seizure service between 2000 and 2015. Clinical features and outcomes of first-ever seizure from sleep and while awake were compared. First-ever unprovoked seizure occurred during sleep in 298 of 1312 patients (23%), in whom the 1-year cumulative risk of recurrence was 56.9% (95% confidence interval [CI] 51.3-62.6) compared to 44.2% (95% CI 41.1-47.3, p < .0001) for patients with first-ever seizure while awake. First-ever seizure from sleep was an independent predictor of seizure recurrence, with a hazard ratio [HR] of 1.44 (95% CI 1.23-1.69), similar to epileptiform abnormalities on EEG (HR 1.48, 95% CI 1.24-1.76) and remote symptomatic etiology (HR 1.47, 95% CI 1.27-1.71). HR for recurrence in patients without either epileptiform abnormalities or remote symptomatic etiology was 1.97 (95% CI 1.60-2.44) for a sleep seizure compared to an awake seizure. For first seizure from sleep, 76% of second seizures also arose from sleep (p < .0001), with 65% of third seizures (p < .0001) also from sleep. Seizures from sleep were less likely to be associated with injury other than orolingual trauma, both with the presenting seizure (9.4% vs 30.6%, p < .0001) and first recurrence (7.5% vs 16.3%, p = .001). First-ever unprovoked seizures from sleep are more likely to recur, independent of other risk factors, with recurrences also usually from sleep, and with a lower risk of seizure-related injury. These findings may inform treatment decisions and counseling after first-ever seizure.

Prevalence and risk factors/predictors of seizure-related injuries among children with Epilepsy at the University of Benin Teaching Hospital, Benin City

Prevalence and risk factors/predictors of seizure-related injuries among children with Epilepsy at the University of Benin Teaching Hospital, Benin City

Seizure Outcomes With Cannabidiol (CBD) in Pediatric Versus Adult Patients With Lennox-Gastaut Syndrome (LGS) and Dravet Syndrome (DS): Subgroup Analysis of BECOME, a Caregiver Survey (P14-1.006)

<h3>Objective:</h3> To characterize and quantify seizure-related outcomes in pediatric (&lt;18 years) versus adult (≥18 years) patients from the cross-sectional caregiver survey BECOME (BEhavior, COgnition, and More with Epidiolex^®). <h3>Background:</h3> A substantial proportion of caregivers reported improvements in seizure and nonseizure outcomes in the primary analysis of the survey. <h3>Design/Methods:</h3> The US-based caregivers (N=498) of patients with LGS (80%) or DS (20%) who received ≥3 months of CBD treatment (Epidiolex^®, 100 mg/mL oral solution) compared the past month with the period before CBD initiation. The online survey included multiple-choice and rank-order questions; changes were rated using a symmetrical 5- and 7-point Likert scale (from worsening to improvement). <h3>Results:</h3> Mean (standard deviation) patient age: 16 (11) years; median (IQR) CBD dose: 14 mg/kg/d (8–19 mg/kg/d); median concomitant ASMs: 4. Most caregivers of pediatric (n=315) and adult (n=183) patients reported any improvement (possible, definite minor, or definite major) in seizure frequency (84% each) and severity (77% and 75%). Worsening in seizure frequency was reported by 7% and 5% of caregivers of pediatric and adult patients, respectively; 10% and 6% reported any worsening in seizure severity. Caregivers of pediatric and adult patients reported any decrease in the frequency of specific seizure type as follows: convulsive (72% each), drop (71% each), nonconvulsive/nondrop (66% and 69%), and night-time seizures (61% and 63%). Similar proportions of caregivers of pediatric and adult patients reported improvements in seizure-free days/week for ≥1 seizure type (65% and 70%) and seizure freedom in the past month (18% and 15%). Many respondents in both groups reported reductions in rescue medication use (57% each), emergency room visits (56% and 51%), hospitalizations (55% and 50%), and occurrence of seizure-related injuries (48% and 49%). <h3>Conclusions:</h3> A substantial proportion of caregivers of patients with LGS or DS, regardless of age, reported improvements in seizure-related outcomes with CBD treatment. <b>Disclosure:</b> Dr. Saurer has received personal compensation for serving as an employee of Jazz Pharmaceuticals. Dr. Saurer has stock in Jazz Pharmaceuticals. Dr. Berg has received personal compensation for serving as an employee of COMBINEDBrain. Dr. Berg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurocrin. Dr. Berg has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biomarin. The institution of Dr. Berg has received research support from FamilieSCN2A Foundation. Dr. Dixon-Salazar has received personal compensation for serving as an employee of Lennox-Gastaut Syndrome (LGS) Foundation. Dr. Dixon-Salazar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuelis. Mrs. Meskis has received personal compensation for serving as an employee of Dravet Syndrome Foundation. Ms. Danese has nothing to disclose. Dr. Le has received personal compensation for serving as an employee of Greenwich Biosciences. Dr. Le has stock in Greenwich Biosciences. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for stoke therapeutics. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Encoded Therapeutics. Dr. Perry has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Biosciences. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zogenix. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biomarin. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Taysha. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle Pharma. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stoke Therapeutics. Dr. Perry has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Zogenix. Dr. Perry has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for GW Biosciences.

Seizure-Related Injuries among Patients with Epilepsy at the Douala General Hospital, Cameroon: A Retrospective Cohort Study

Abstract Background Seizures can lead to injuries in patients with epilepsy (PWE). This study seeks to determine the 1-year incidence, types, and associated factors of seizure-related injuries in PWE compared with that of patients without epilepsy. Methods A retrospective cohort study was carried out at the Douala General Hospital, Douala, Cameroon. Patients with active epilepsy within the past 5 years were compared to patients without epilepsy after matching them by age and gender during a 12-month period. Data was collected from patient records using a questionnaire and analyzed using the SPSS version 20 software. The chi-square test was used to compare the proportions of injuries at a significant level of p &lt; 0.05 and a confidence interval (CI) of 95%. Results A total of 155 participants were recruited in each group. Note that 51.6% were males, and the mean age was 25.46 ± 16.35 years. The 1-year incidence of all injuries was 26.5% in PWE against 16.8% among patients without epilepsy, respectively (p = 0.038; odds ratio = 1.8, 95% CI: 1.03–3.10). Soft tissue injury was higher in PWE (82.9%, p &lt; 0.05) compared to those without epilepsy (50%), whereas patients without epilepsy had more cases of burns compared to PWE (p &lt; 0.05). PWE and having frequent seizures with falls and those on more than one antiseizure medication had an increased risk of injuries (p &lt; 0.05). Conclusion PWE have a double risk of having mild soft tissue injuries attributed to epileptic seizures. The risk is increased in PWE having seizures with falls and those taking more than one antiseizure medication.

Performance, impact and experiences of using wearable devices for seizure detection in community-based settings: a mixed methods systematic review.

There is growing scientific evidence that wearable devices for seizure detection (WDD) perform well in controlled environments. However, their impact on the health and experience of patients with epilepsy (PWE) in community-based settings is less documented. We aimed to synthesize the scientific evidence about the performance of wearable devices used by PWE in community-based settings, and their impact on health outcomes and patient experience. We performed a mixed methods systematic review. We performed searches in PubMed, Google Scholar, Web of Science and Embase from inception until December 2022. Independent reviewers checked studies published in English for eligibility based on predefined inclusion and exclusion criteria. We collected information about studies, wearable devices, their performance, and their impact on health outcomes and patient experience. We used a narrative method to synthetize separately data for each question. We assessed the quality of included studies with the QUADAS-C and MMAT tools. On a total of 9,595 publications, 10 studies met our eligibility criteria. Study populations included mostly PWE who were young (≤18 years) and/or their caregivers. Participants were living at home in most studies. Accelerometer was the wearable device mostly used for seizure detection. Wearable device performance was high (sensitivity ≥80% and false alarm rate ≤1/day), but some concerns remained due to false alarms according to qualitative studies. There was no significant effect of wearable device on quality of life (QoL) measures and no study reported quantitatively other health outcomes. Qualitative studies reported positive effect of wearable devices on QoL, seizure management and seizure-related injuries. Overall, patients reported that the device, especially the accelerometer, was suitable, but when the device was too visible, they found it uncomfortable. Study quality was low to medium. There is low quality scientific evidence supporting the performance of WDD in a home environment. Although qualitative findings support the positive impacts of wearable devices for patients and caregivers, more quantitative studies are needed to assess their impact on health outcomes such as QoL and seizure-related injuries.