Seizure-related Injuries Research Articles

The Humanistic and Economic Burden of Pediatric Focal Seizures in the United States.

To better understand the humanistic and economic burden of focal seizures in children 2-12 years old. We conducted a targeted literature review by searching MEDLINE for English-language publications reporting on children 2-12 years old with focal seizures published in the United States since 2008. Thirty-five publications were included. Incidence of focal seizures was 23.2 to 47.1 per 100,000 children per year; prevalence was 2.0 per 1,000 children, and ranged from 1.6 - 2.6 per 1,000 in patients of any age. Life expectancy was 47.3-61.8 years among children 3-12 years old. Patients took several antiepileptic drugs and experienced frequent seizures, sleep disorders, mood disorders, migraine, and seizure-related injuries (eg, bone fractures, sprains, open wounds). Children with focal seizures scored below average on cognitive assessments and up to 42%, 16%, and 19% had depression, anxiety, and attention-deficit disorder, respectively. Patients of any age had about 10 outpatient visits (2 epilepsy-related), 2 inpatient visits (less than 1 epilepsy-related), and 24 procedures (1 epilepsy-related) per year. Medication adherence was low: only half of pediatric patients maintained ≥90% adherence over 6 months. Annual total health care costs among patients of any age ranged from $18,369 - 38,549; first-year total health care costs for children were $19,883. Incidence and prevalence of focal seizures is high and the humanistic and economic burdens are significant. Future studies focused exclusively on children with focal seizures are needed to more precisely describe the burden. We also suggest further research and implementation of methods to improve medication adherence as an approach to lessen burden on these young patients.

Tonic-clonic seizures in idiopathic generalized epilepsies: Prevalence, risk factors, and outcome.

We investigated the prevalence of generalized tonic-clonic seizures (GTCSs) in patients with idiopathic generalized epilepsy (IGE) and the risk factors associated with them. We also studied the seizure outcome in patients with IGEs. In this retrospective study, all patients with a diagnosis of IGE were recruited at the epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2019. Age, gender, age at seizure onset, seizure type(s), EEG findings, and seizure outcome of all patients were registered. A total of 601 patients with IGE were studied; 516 patients (86%) had GTCSs. The ROC curve showed that reporting GTCSs was significantly associated with the time since the start of the disease (P=.0001; area under the curve=0.71 [95% CI: 0.66-0.76]; a cutoff point of 4years [sensitivity=61% and specificity=76%]). Age at onset was 3.3years later in patients with GTCSs compared with that in patients without GTCSs. Generalized spike-wave complexes during interictal EEG recording were more frequently observed among patients without GTCSs. Generalized tonic-clonic seizures were significantly associated with experiencing seizure-related injuries. Valproate reduced the risk of experiencing GTCSs significantly (OR: 0.58; 95% CI: 0.34-0.99; P=.04). Generalized tonic-clonic seizures do not affect the seizure outcome in patients with IGEs per se, but how we manage them significantly affects the seizure outcome in these patients. Failure to prescribe valproate for women with IGE, particularly when another first-line treatment has failed, may not be in a patient's best interests.

Seizure-related injury and postictal aggression in refractory epilepsy patients

ObjectiveIn the general population, injury related to seizures often involves falls, head trauma, soft tissue injuries, burns and fractures. Additionally, postictal deleterious behavior changes can by experienced by patients. We seek to identify the risk for seizure-related injury (SRI) and postictal aggression (PIA) in patients with refractory epilepsy. MethodsSelf-reported SRI and PIA were gathered through a seizure questionnaire as part of the epilepsy center’s seizure safety protocol. Retrospective review of questionnaire, clinical course, and demographic data was completed. Statistical analysis of variables of interest was done using nonparametric methods. Results126 patient questionnaires were completed over a one-year duration. Most patients reported seizure related injury (56.3 %) and postictal aggression (52.4 %). Increased disease duration was associated with seizure related injury and its severity (Kwallis p = 0.025), with number of antiepileptic drugs (AEDs) as significant factors (p = 0.012). Postictal aggression was also associated with a longer duration of epilepsy (Ranksum p = 0.037, t-test p = 0.04) and higher seizure frequency (p = 0.017). Patients who reported seizure related injury and postictal aggression were on more AEDs (p = 0.0003, p = 0.01, respectively), with first-generation AEDs being most contributory. ConclusionThe majority of patients with seizures report seizure-related injuries and postictal aggression. Duration and AED regimen are significant risk factors and screening practices can potentially guide safety measures and recommendations.

Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures.

Focal to bilateral tonic-clonic seizures are associated with lower quality of life, higher risk of seizure-related injuries, increased chance of sudden unexpected death, and unfavourable treatment outcomes. Achieving greater understanding of their underlying circuitry offers better opportunity to control these seizures. Towards this goal, we provide a network science perspective of the interactive pathways among basal ganglia, thalamus and cortex, to explore the imprinting of secondary seizure generalization on the mesoscale brain network in temporal lobe epilepsy. Specifically, we parameterized the functional organization of both the thalamocortical network and the basal ganglia-thalamus network with resting state functional MRI in three groups of patients with different focal to bilateral tonic-clonic seizure histories. Using the participation coefficient to describe the pattern of thalamocortical connections among different cortical networks, we showed that, compared to patients with no previous history, those with positive histories of focal to bilateral tonic-clonic seizures, including both remote (none for >1 year) and current (within the past year) histories, presented more uniform distribution patterns of thalamocortical connections in the ipsilateral medial-dorsal thalamic nuclei. As a sign of greater thalamus-mediated cortico-cortical communication, this result comports with greater susceptibility to secondary seizure generalization from the epileptogenic temporal lobe to broader brain networks in these patients. Using interregional integration to characterize the functional interaction between basal ganglia and thalamus, we demonstrated that patients with current history presented increased interaction between putamen and globus pallidus internus, and decreased interaction between the latter and the thalamus, compared to the other two patient groups. Importantly, through a series of 'disconnection' simulations, we showed that these changes in interactive profiles of the basal ganglia-thalamus network in the current history group mainly depended upon the direct but not the indirect basal ganglia pathway. It is intuitively plausible that such disruption in the striatum-modulated tonic inhibition of the thalamus from the globus pallidus internus could lead to an under-suppressed thalamus, which in turn may account for their greater vulnerability to secondary seizure generalization. Collectively, these findings suggest that the broken balance between basal ganglia inhibition and thalamus synchronization can inform the presence and effective control of focal to bilateral tonic-clonic seizures. The mechanistic underpinnings we uncover may shed light on the development of new treatment strategies for patients with temporal lobe epilepsy.

Oestrogen receptor ERα and ERβ agonists ameliorate oxidative brain injury and improve memory dysfunction in rats with an epileptic seizure.

What is the central question of this study? Could different hormonally active substances, including oestrogen receptor (ER) agonists, protect against oxidative brain damage and memory impairment induced by a single epileptic seizure in rats? If so, which signalling mechanisms are involved in their anti-inflammatory effects? What is the main finding and its importance? Chronic administration of oestrogen, progesterone, ER modulators/agonists or blockade of testosterone exhibited anti-inflammatory and antioxidant actions on single seizure-induced neuronal injury, while ER agonists additionally improved memory function and up-regulated CREB signalling and hippocampal GABA(A)α1 receptor density, suggesting that ERα or ERβ receptor activation may be beneficial in protecting against seizure-related oxidative brain injury and cognitive dysfunction. The susceptibility to epileptic seizures is dependent on sex as well as fluctuations in oestrogen levels, while exogenous oestrogen was shown to have no effect or to facilitate or to inhibit seizure activity. Oestrogen receptors (ERs) mediate antioxidant and anti-inflammatory actions in several inflammatory models, but the involvement of ERs in seizure-induced neuronal injury has not been evaluated previously. In order to assess the effects of resveratrol, progesterone, oestradiol (E2), an anti-testosterone (cyproterone acetate; CPA), a selective ER modulator (tamoxifen; TMX) and ERα/ERβ agonists (propyl pyrazole triol (PPT), diarylpropionitrile (DPN)) on oxidative brain damage and memory impairment due to epileptic seizure, male Wistar rats (n=120) received one of the treatment choices either in drinking water or intraperitoneally for 31 days, and epileptic seizure was induced on the 28th day by injection of a single-dose of pentylenetetrazole (45mgkg-1 ). The results demonstrate that chronic pretreatment with resveratrol, progesterone, E2, CPA or TMX suppressed most of the inflammatory parameters indicative of oxidative neuronal injury, while treatment with the ER agonists DPN or PPT were found to be even more effective in limiting the oxidative damage. Treatment with DPN resulted in the up-regulation of cAMP response element-binding protein (CREB) and brain-derived neurotrophic factor (BDNF) expression, while PPT up-regulated expression of CREB without affecting BDNF levels. Moreover, both ER agonists provided protection against seizure-induced memory loss with a concomitant increase in hippocampal GABA(A)α1-positive cells. In conclusion, ER agonists, and more specifically ERβ agonist, appear to provide maximum protection against seizure-induced oxidative brain injury and associated memory dysfunction by up-regulating the expression of CREB, BDNF and GABA(A)α1 receptors.

Epilepsy in Guinea: The experience of a free consultation

Purpose to characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea. Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs. Results Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 75% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p = .048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p < .001). Burns were more likely to occur among females (p = .02). There is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.

Epilepsy in Guinea: The experience of a free consultation

Purpose to characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea. Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs. Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 75% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p = .048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p < .001). Burns were more likely to occur among females (p = .02). There is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.

Loss of responsiveness in psychogenic non-epileptic seizures.

The aim of this study was to investigate the frequency of loss of responsiveness (LOR) in patients with psychogenic non-epileptic seizures (PNES) and to characterize the patients' clinical variables that may be associated with such a manifestation. In this retrospective study, all patients with documented PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 to 2018, were investigated. During the study period, data was available for 324/325 patients with PNES. In total, 275 patients (85%) reported LOR during their seizures, but this was not the case for 49 patients (15%). The model, generated by regression analysis, was shown to be significant (p=0.0001) and LOR could be predicted in 84% of the patients. Closed eyes during seizures (OR: 4.4; 95%CI: 2.101-9.235; p=0.0001) and seizure-associated injury (OR: 3.5; 95%CI: 1.402-8.686; p=0.007) were significantly associated with LOR based on the model. Patients with PNES may frequently report LOR, which is significantly associated with seizure-related injuries. Therefore, it is important to apply appropriate management strategies for patients with PNES and LOR in order to prevent or decrease the possibility of any associated consequences, including ictal injury.

Impact of seizure-related injuries on quality of life.

Our aim is to assess the types and frequency of seizure-related injuries and to determine their effects on Quality of Life (QoL). Fifty-seven patients with epilepsy were included to our study. The demographic and clinical data of all the participants were recorded. All patients completed the Quality of Life in Epilepsy Inventory 89 (QOLIE-89). Injury types were classified as burns, head trauma, dental traumas, fractures, body injuries, penetrating traumas, road injuries, and drowning. Forty-two patients had seizure-related physical injury history whereas 15 of them declared no history of injury. Lower education levels and more frequent seizures were associated with higher seizure-related injury rates (p < 0.05). The most common types of seizure-related injuries were head trauma (22%) and fractures (17%). Fifty-seven (64%)of the injuries took place at home. There was no difference in QOLIE-89 scores between patients with or without seizure-related injury. Multiple injuries, admission to emergency, older than 20years of the first seizure-related injury, and shorter than 10years after last seizure-related injury are negatively effective on the QoL scores. Patients with epilepsy are likely to have seizure-related injuries which may be severe but do not affect the patients' QoL. Seizure-related injuries most commonly occur at home and therefore simple precautions (supervised bathing, using microwave ovens instead of classical stoves, avoiding electric irons and electric heaters, and sleeping close to the floor to avoid falling) taken to reduce the incidence of seizure-related injuries will help reduce hospitalizations and will also be cost-effective.

Are Seizure Detection Devices Ready for Prime Time?

Standards for testing and clinical validation of seizure detection Beniczky S, Ryvlin P. Epilepsia. 2018;59(S1):9-13. doi:10.1111/epi.14049To increase the quality of studies on seizure detection devices, we propose standards for testing and clinical validation of such devices. We identified 4 key features that are important for studies on seizure detection devices: subjects, recordings, data analysis and alarms, and reference standard. For each of these features, we list the specific aspects that need to be addressed in the studies, and depending on these, studies are classified into 5 phases (0-4). We propose a set of outcome measures that need to be reported, and we propose standards for reporting the results. These standards will help in designing and reporting studies on seizure detection devices, they will give readers clear information on the level of evidence provided by the studies, and they will help regulatory bodies in assessing the quality of the validation studies. These standards are flexible, allowing classification of the studies into one of the 5 phases. We propose actions that can facilitate development of novel methods and devices. User-based evaluation of applicability and usability of a wearable accelerometer device for detecting bilateral tonic-clonic seizures: a field study Meritam P, Ryvlin P, Beniczky S. Epilepsia. 2018;59(S1):48-52. doi:10.1111/epi.14051Clinical validation studies of seizure detection devices conducted in epilepsy monitoring units (EMUs) can be biased by the artificial environment. We report a field (phase 4) study of a wearable accelerometer device (Epi-Care) that has previously been validated in EMUs for detecting bilateral tonic–clonic seizures (BTCS). Seventy-one patients using the device (or their caregivers) completed the modified Post-Study System Usability Questionnaire. Median time patients had been using the device was 15 months (range = 24 days to 6 years). In 10% of cases, patients stopped using the device due to reasons related to the device. The median sensitivity (90%) and false alarm rate (0.1/day) were similar to what had been determined in EMUs. Patients and caregivers were overall satisfied with the device (median = 5.5 on the 7-point Likert scale), considered the technical aspects satisfactory, and considered the device comfortable and efficient. Adverse effects occurred in 11% but were only mild: skin irritation at the wrist and interference with home electronic appliances. In 55%, the device influenced the number of seizures logged into the seizure diary, and in 40%, it contributed to fewer seizure-related injuries. This field study demonstrates the applicability and usability of the wearable accelerometer device for detecting BTCS. Wearable devices for sudden unexpected death in epilepsy prevention Ryvlin P, Ciumas C, Wisniewski I, Beniczky S. Epilepsia. 2018;59(S1):61-66. doi:10.1111/epi.14054Sudden unexpected death in epilepsy (SUDEP) is most often associated with the occurrence of generalized tonic–clonic seizures (GTCS), a seizure type that can now be detected with high sensitivity and specificity by wearable or bed devices. The recent development in such devices and their performance offer multiple opportunities to tackle SUDEP and its prevention. Reliable GTCS detection might help physicians optimize antiepileptic treatment, which could in turn reduce the risk of SUDEP. Generalized tonic–clonic seizures–triggered alarms can lead to immediate intervention by caregivers that are also likely to decrease the odd of SUDEP. The biosignals used to detect GTCS might provide novel SUDEP biomarkers, in particular, by informing on several important characteristics of the ictal and postictal periods (type of GTCS, duration of tonic phase, rotation in the prone position, presence and duration of postictal immobility and bradycardia, rise in electrodermal activity). Other biosensors not yet used for detecting GTCS might provide complementary information, such as the presence and intensity of ictal/postictal hypoxemia. The above biomarkers, if strongly predictive, could help identify patients at very high risk of SUDEP, enabling better assessment of individual risk, as well as selection of appropriate patients for clinical studies aiming at preventing SUDEP. The same biosignals could also be used as ancillary biomarkers to test the impact of various interventions before moving to highly challenging randomized controlled trials with SUDEP as a primary outcome.

Oral health and dental status in people with epilepsy in rural China

Purpose: We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China.Methods: A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed “Oral health and Dental status Questionnaire”. Univariate and multivariate analyses were used to explore the relationships between seizure frequency and oral health and dental status.Results: A total of 875 people participated. Almost two thirds (65.8%) reported brushing their teeth at least once a day but 634 (73.0%) brushed their teeth for less than 3 min each time. Only 80 (9.1%) had visited a dental clinic in the previous year. Multivariate logistic regression analysis showed that having 1–4 seizures/month (OR 0.60, 95%CI 0.40-0.90) or >4 seizures/month (OR 0.38, 95%CI 0.22-0.66) was associated with decreased odds of brushing teeth at least once a day, and higher seizure frequency was associated with increased odds of dental injury due to seizures (OR 2.07, 95%CI 1.22–3.50 for <1 seizure/month; OR 2.12, 95%CI 1.25–3.58 for 1–4 seizures/month; OR 3.09, 95%CI 1.57–6.07 for >4 seizures/month).Conclusion: Seizure frequency was significantly associated with seizure-related dental injury, and with the lack of good oral health practice. Improvement in the oral health of people with epilepsy in resource-poor areas should be encouraged.

Thrombin and the Protease-Activated Receptor-1 in Organophosphate-Induced Status Epilepticus.

Organophosphates (OP) are a major threat to the health of soldiers and civilians due to their use as chemical weapons in war and in terror attacks. Among the acute manifestations of OP poisoning, status epilepticus (SE) is bearing the highest potential for long-term damages. Current therapies do not prevent brain damage and seizure-related brain injuries in OP-exposed humans. Thrombin is a serine protease known to have a fundamental function in the clotting cascade. It is highly expressed in the brain where we have previously found that it regulates synaptic transmission and plasticity. In addition, we have found that an excess of thrombin in the brain leads to hyperexcitability and therefore seizures through a glutamate-dependent mechanism. In the current study, we carried out in vitro, ex vivo, and in vivo experiments in order to determine the role of thrombin and its receptor PAR-1 in paraoxon-induced SE. Elevated thrombin activity was found in the brain slices from mice that were treated (in vitro and in vivo) with paraoxon. Increased levels of PAR-1 and pERK proteins and decreased prothrombin mRNA were found in the brains of paraoxon-treated mice. Furthermore, ex vivo and in vivo electrophysiological experiments showed that exposure to paraoxon causes elevated electrical activity in CA1 and CA3 regions of the hippocampus. Moreover, a specific PAR-1 antagonist (SCH79797) reduced this activity. Altogether, these results reveal the importance of thrombin and PAR-1 in paraoxon poisoning. In addition, the results indicate that thrombin and PAR-1 may be a possible target for the treatment of paraoxon-induced status epilepticus.

Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy.

Epilepsy-related injuries and accidents (ERIA) are a frequent cause of hospitalisation and represent a relevant burden for patients with epilepsy. In particular, osteoporosis and other gender-specific aspects may increase the risk of seizure-related fractures and injuries in women with epilepsy. The aim of this analysis is to determine the prevalence and clinical nature of ERIA in a cohort of women with epilepsy, to identify possible determinants including osteoporosis and to give an overview of the current knowledge of clinically important prophylactic and therapeutic aspects. In total, 167 women (mean age 39.0 years, range 18-67years) with established diagnosis of epilepsy (mean disease duration 18.2 years, range 0-64) were analysed for the occurrence of ERIA. Overall, 22 patients (13.2%) reported at least one ERIA (mean number 3.4, ± 3.1) during the last three months prior to enrollment. The most frequent types of ERIA were lacerations (n = 7/22; 31.8%), abrasions, cuts, bruises or hematoma (n = 6/22, 27.3%), burns (n = 3/22, 13.6%), and fractures (n = 3/22, 13.6%). Moreover, one seizure-related road traffic accident with consecutive trauma (4.5%) was reported. Ictal falls, periictal abnormalities of behaviour and missing seizure freedom were associated with ERIA. Furthermore, female patients with ERIA had a significantly reduced quality of life (QoL, p = 0.002) and increased anxiety (p = 0.008) compared to patients without ERIA. A review of the pertinent literature suggests decreased bone mineral density and use of enzyme-inducing AEDs to be risk factors for ERIA in women with epilepsy. ERIA represent relevant complications for women with epilepsy and are associated with a lower QoL and anxiety compared with non-affected controls. Improvement of anticonvulsive treatment and therapy for osteoporosis or osteomalacia may help to decrease ERIA and the associated burden.

Automatic Computer-Based Detection of Epileptic Seizures.

Automatic computer-based seizure detection and warning devices are important for objective seizure documentation, for SUDEP prevention, to avoid seizure related injuries and social embarrassments as a consequence of seizures, and to develop on demand epilepsy therapies. Automatic seizure detection systems can be based on direct analysis of epileptiform discharges on scalp-EEG or intracranial EEG, on the detection of motor manifestations of epileptic seizures using surface electromyography (sEMG), accelerometry (ACM), video detection systems and mattress sensors and finally on the assessment of changes of physiologic parameters accompanying epileptic seizures measured by electrocardiography (ECG), respiratory monitors, pulse oximetry, surface temperature sensors, and electrodermal activity. Here we review automatic seizure detection based on scalp-EEG, ECG, and sEMG. Different seizure types affect preferentially different measurement parameters. While EEG changes accompany all types of seizures, sEMG and ACM are suitable mainly for detection of seizures with major motor manifestations. Therefore, seizure detection can be optimized by multimodal systems combining several measurement parameters. While most systems provide sensitivities over 70%, specificity expressed as false alarm rates still needs to be improved. Patients' acceptance and comfort of a specific device are of critical importance for its long-term application in a meaningful clinical way.

Impact of poorly controlled epilepsy in the Republic of Guinea

PurposeTo characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea. MethodsGuinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs. ResultsOf 257 participants (143 children, 122 female), 25% had untreated epilepsy and 72% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures, and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p = 0.048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p < 0.001). Burns were more likely to occur among females (p = 0.02). ConclusionsThere is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.

Onset Detection of Epileptic Seizures From Accelerometry Signal.

Epileptic seizures are the result of any abnormal asynchronous firing of cortical neurons. Seizures are abrupt and pose a risk of injury and fatal harm to the patient. Epilepsy affects patients quality of life (QOL) and imposes financial, social, and physical burden on the patient. The unpredictability associated with seizures further adds to the reduced QOL and increases dependence on caregivers and family members. A seizure triggered alarm system can reduce the risk of seizure-related injuries and aid in improving patient's QOL. This study presents real-time onset detection of seizures from accelerometry signal. An automated approach based on statistical machine learning is employed to learn the onset of seizures. To search for the optimal parameter that simultaneously maximizes detection sensitivity (sens) while minimizing false alarm rate (FAR) and latency, the epoch length is varied from $t=\{1,~10s\}$. Linear and non-linear time-varying dynamical patterns were extracted from every epoch using Poincaré plot analysis. The correlation patterns were learned using a kernalized support vector data descriptor. The preliminary analysis on accelerometry data collected from 8 epileptic patients with 9 generalized tonicclonic seizures (GTCS) shows promising results. The proposed algorithm detected all GTCS events (sens: 100%, FAR: 1. 09/24h) at 8s from onset. The proposed algorithm can lead to a sensitive, specific, and a relatively short-latency detection system for real-time remote monitoring of epileptic patients.

Predictors of Seizure-Related Injuries in an Epilepsy Cohort from North India.

Background and PurposeTo identify predictors of seizure-related injury (SRI) and death in people with epilepsy (PWE) in a North Indian cohort.MethodsThis ambispective cohort study included PWE registered in an epilepsy clinic in Delhi between May 2010 and December 2011. Five hundred twenty-six patients were enrolled and followed for 25 months. Patients were categorized into two groups based on SRI/no SRI during the study period. We analyzed various factors to identify predictors of SRI and death.ResultsOf 526 patients, 355 (67.5%) reported having no SRIs and 171 (32.5%) had sustained an SRI. Among patients with SRI, 72.5% were male; 62% of those with no SRI were male. The injury type included soft tissue (60%), head trauma (20%), dental trauma (10%), orthopedic (10%), and burns (5%). On univariate analysis, factors predicting SRI occurrence were male gender, abnormal birth history (p < 0.01), abnormal mental status (p < 0.01), seizure duration (p < 0.04), daytime seizures (p < 0.05), dependence on a caregiver (p < 0.008), and uncontrolled seizures (p < 0.001), history of cluster seizures or status epilepticus (p < 0.001), occurrence of generalized tonic-clonic seizures (GTCS), and use of >3 antiepileptic drugs (p < 0.008). On multiple logistic regression analysis, male gender, uncontrolled seizures, history of cluster seizures or status epilepticus, and GTCS were significant risk factors. Sixteen deaths occurred in our cohort, and 13 fit the definition of probable sudden unexpected death in epilepsy (SUDEP). Most patients with SUDEP had an unwitnessed event (69.2%). The only significant factor in predicting death was uncontrolled seizures.ConclusionsMale gender, occurrence of GTCS, uncontrolled seizures, and history of cluster seizures or status epilepticus predicted SRI occurrence in PWE. Precautions should be taken by caregivers of patients with these risk factors, to prevent injury.

User-based evaluation of applicability and usability of a wearable accelerometer device for detecting bilateral tonic-clonic seizures: A field study.

Clinical validation studies of seizure detection devices conducted in epilepsy monitoring units (EMUs) can be biased by the artificial environment. We report a field (phase 4) study of a wearable accelerometer device (Epi-Care) that has previously been validated in EMUs for detecting bilateral tonic-clonic seizures (BTCS). Seventy-one patients using the device (or their caregivers) completed the modified Post-Study System Usability Questionnaire. Median time patients had been using the device was 15months (range = 24days-6years). In 10% of cases, patients stopped using the device due to reasons related to the device. The median sensitivity (90%) and false alarm rate (0.1/d) were similar to what had been determined in EMUs. Patients and caregivers were overall satisfied with the device (median = 5.5 on the 7-point Likert scale), considered the technical aspects satisfactory, and considered the device comfortable and efficient. Adverse effects occurred in 11%, but were only mild: skin irritation at the wrist and interference with home electronic appliances. In 55% the device influenced the number of seizures logged into the seizure diary, and in 40% it contributed to fewer seizure-related injuries. This field study demonstrates the applicability and usability of the wearable accelerometer device for detecting BTCS.

Electro-behavioral phenotype and cell injury following exposure to paraoxon-ethyl in mice: Effect of the genetic background

Organophosphorus compounds (OP) are irreversible inhibitors of both central and peripheral cholinesterases (ChE). They still represent a major health issue in some countries as well as a terrorist and military threat. In order to design appropriate medical counter-measures, a better understanding of the pathophysiology of the poisoning is needed. Little to nothing is known regarding the impact of the genetic background on OP-induced seizures and seizure-related cell injury. Using two different mouse strains, Swiss and C57BL/6J, exposed to a convulsing dose of the OP pesticide paraoxon-ethyl (POX), our study focused on seizure susceptibility, especially the occurrence of SE and related mortality. We also evaluated the initial neuropathological response and SE-induced cell injury.Following the administration of 2.4 mg/kg POX, more Swiss mice experienced SE than C57BL/6J (55.6% versus 17.2%) but the duration of their SE, based on EEG recordings, was shorter (64.3 ± 19.5 min versus 180.8 ± 36.8 min). No significant difference was observed between strains regarding mortality (33% versus 14%). In both strains limited cell injury was observed in the medial temporal cortex, the dentate gyrus and the CA3 field without inter-strain differences (Fluorojade C-positive cells/mm2). Conversely, only C57BL/6J mice showed cell injury in the CA1 field. There was no obvious correlation between the number of Fluorojade C-positive cells and the duration of the EEG discharges.Our work suggests some differences between Swiss and C57BL/6J mice and lay ground to further studies on the impact of strains in the development of central nervous system toxicity of OP.

Determinants of Felt Stigma among Patients Living with Epilepsy Attending a Tertiary Neurology Clinic in South East Nigeria

Background: Felt stigma is a major social and psychological problem in epilepsy and manifests the fear or expectations of such “reactions” from people. Understanding of the pattern and prevalence of felt stigma gives an insight into the burden of this “second illness” of epilepsy in southeast Nigeria. Methods: Consecutive consenting adult epilepsy patients attending a neurology outpatient in Enugu southeast Nigeria were interviewed. Data on felt stigma was also collected using a scale for collection of stigma data on stigma designed by Jacoby et al. Results: A total of 295 patients were interviewed during the study (165 (55.9%) males and 130 (44.1%) females). About 29.4% (88/295) felt stigmatized and 82.1% of them highly so. Correlates of felt stigma were age of onset (negatively), seizure frequency, duration of epilepsy, use of non-orthodox treatment, seizures occurring in public and the presence of physical injuries. Predictors of felt stigma were having seizures in public (R2 = 0.232, p < 0.001) and seizure related injuries (R2 = 0.277, p < 0.001). Conclusions: Felt epilepsy stigma is common among patients attending urban tertiary hospital in southeast Nigeria. Several preventable factors are associated with this phenomenon hence efforts aimed at preventing epilepsy should also target felt stigma prevention.