Short-term Seizure Research Articles

Anchoring temporal convolutional networks for epileptic seizure prediction.

Objective. Accurate and timely prediction of epileptic seizures is crucial for empowering patients to mitigate their impact or prevent them altogether. Current studies predominantly focus on short-term seizure predictions, which causes the prediction time to be shorter than the onset of antiepileptic, thus failing to prevent seizures. However, longer epilepsy prediction faces the problem that as the preictal period lengthens, it increasingly resembles the interictal period, complicating differentiation.Approach. To address these issues, we employ the sample entropy method for feature extraction from electroencephalography (EEG) signals. Subsequently, we introduce the anchoring temporal convolutional networks (ATCN) model for longer-term, patient-specific epilepsy prediction. ATCN utilizes dilated causal convolutional networks to learn time-dependent features from previous data, capturing temporal causal correlations within and between samples. Additionally, the model also incorporates anchoring data to enhance the performance of epilepsy prediction further. Finally, we proposed a multilayer sliding window prediction algorithm for seizure alarms.Main results. Evaluation on the Freiburg intracranial EEG dataset shows our approach achieves 100% sensitivity, a false prediction rate (FPR) of 0.09 per hour, and an average prediction time (APT) of 98.92 min. Using the CHB-MIT scalp EEG dataset, we achieve 97.44% sensitivity, a FPR of 0.12 per hour, and an APT of 93.54 min.Significance. These results demonstrate that our approach is adequate for seizure prediction over a more extended prediction range on intracranial and scalp EEG datasets. The APT of our approach exceeds the typical onset time of antiepileptic. This approach is particularly beneficial for patients who need to take medication at regular intervals, as they may only need to take their medication when our method issues an alarm. This capability has the potential to prevent seizures, which will greatly improve patients' quality of life.

Association Between Postsurgical Functional Connectivity and Seizure Outcome in Patients With Temporal Lobe Epilepsy.

Despite the success of presurgical network connectivity studies in predicting short-term (1-year) seizure outcomes, later seizure recurrence occurs in some patients with temporal lobe epilepsy (TLE). To uncover contributors to this recurrence, we investigated the relationship between functional connectivity and seizure outcomes at different time points after surgery in these patients. Patients included were clinically diagnosed with unilateral mesial TLE after a standard clinical evaluation and underwent selective amygdalohippocampectomy. Healthy controls had no history of seizures or head injury. Using resting-state fMRI, we assessed the postsurgical functional connectivity node strength, computed as the node's total strength to all other nodes, between seizure-free (Engel Ia-Ib) and nonseizure-free (Engel Ic-IV) acquisitions. The change over time after surgery in different outcome groups in these nodes was also characterized. Patients with TLE (n = 32, mean age: 43.1 ± 11.9 years; 46.8% female) and 85 healthy controls (mean age: 37.7 ± 13.5 years; 48.2% female) were included. Resting fMRI was acquired before surgery and at least once after surgery in each patient (range 1-4 scans, 5-60 months). Differences between patients with (n = 30) and without (n = 18) seizure freedom were detected in the posterior insula ipsilateral to the resection (I-PIns: 95% CI -154.8 to -50.1, p = 2.8 × 10-4) and the bilateral central operculum (I-CO: 95% CI -163.2 to -65.1, p = 2.6 × 10-5, C-CO: 95% CI -172.7 to -55.8, p = 2.8 × 10-4). In these nodes, only those who were seizure-free had increased node strength after surgery that increased linearly over time (I-CO: 95% CI 1.0-5.2, p = 4.2 × 10-3, C-CO: 95% CI 1.0-5.2, p = 5.5 × 10-3, I-PIns: 95% CI 1.6-5.5, p = 0.9 × 10-3). Different outcome groups were not distinguished by node strength before surgery. The findings suggest that network evolution in the first 5 years after selective amygdalohippocampectomy surgery is related to seizure outcomes in TLE. This highlights the need to identify presurgical and surgical conditions that lead to disparate postsurgical trajectories between seizure-free and nonseizure-free patients to identify potential contributors to long-term seizure outcomes. However, the lack of including other surgical approaches may affect the generalizability of the results.

Early versus late switch over of antiseizure medications from intravenous to the oral route in children with seizures: Single-blinded, randomized controlled trial (ELAIO trial)

IntroductionEarly switch-over of anti-seizure medications (ASMs) from intravenous to oral route may reduce the duration of hospitalization, drug acquisition costs, and behavioral upset in hospitalized children with seizures. ObjectiveThe primary objective was to compare short-term seizure recurrence within 1 week in hospitalized children aged 1 month to 18 years with new-onset/breakthrough seizures after an early versus late switch-over from intravenous to the oral route of ASMs. Secondary objectives were to compare the incidence of status epilepticus, duration of hospital stay, drug acquisition costs, and caregiver-reported satisfaction scores in both groups. MethodsIn this single-blind randomized controlled trial, patients with seizures were categorized based on the number of ASMs required and the history of status epilepticus. Patients in each category were randomized in a 1:1 ratio into either early or late switch-over (ES or LS) groups. In the ES groups, ASMs were tapered one-by-one between 0 and 24 hours of seizure freedom, while in the LS groups, they were tapered one-by-one between 24 and 48 hours of seizure freedom. ResultsA total of 112 children were enrolled in the study, with 56 in each arm. Seizure recurrence at 1 week and 12 weeks was comparable in ES and LS groups (3/55 vs. 1/54 at 1 week, p=0.61; 7/49 vs. 6/49 at 12 weeks, p=0.98). Drug acquisition costs were significantly lower in the ES group (393±274 vs. 658±568 INR, p=0.002). Thrombophlebitis and dysphoria were significantly more common in the LS group (p=0.008 and 0.03, respectively). ConclusionThe early switch-over of ASMs from intravenous to oral route is safe without any significant increased risk of short-term seizure recurrence and also associated with a reduction in the incidence of thrombophlebitis and ASM acquisition costs. Trial registration NoCTRI/2021/03/032145

P09.01.A IMPACT OF TIMING OF ANTISEIZURE MEDICATION WITHDRAWAL ON SEIZURE RECURRENCE IN GLIOMA PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract BACKGROUND Withdrawal of antiseizure medication treatment (ASM) can be considered after completion of antitumour treatment in glioma patients who no longer suffer from seizures. We compared the risk of recurrent seizures after ASM withdrawal between patients with short-term, medium-term versus long-term seizure freedom after antitumour treatment. MATERIAL AND METHODS In this retrospective observational study, the primary outcome was time to recurrent seizure, from the starting date of no ASM treatment up to 36 months follow-up. Cox proportional hazards models were used to study the effect of risk factors on time to recurrent seizure. Stratification was done with information known at baseline. Short-term seizure freedom was defined as ≥3 months, but <12 months; medium-term as 12-24 months; and long-term as ≥24 months seizure freedom from the date of last antitumour treatment. RESULTS This study comprised of 109 patients; 31% (34/109) were in the short-term, 29% (32/109) in the medium-term, and 39% (43/109) in the long-term group. A recurrent seizure was experienced by 44% (15/34) of the patients in the short-term, 31% (10/32) in the medium-term, and 44% (19/43) in the long-term group. Seizure recurrence risk was similar between patients in the short-term group as compared to the medium-term (cause-specific adjusted hazard ratio [aHR]=0.65 [95%CI=0.29-1.46]) and long-term group (cause-specific aHR=1.04 [95%CI=0.52-2.09]). CONCLUSION Seizure recurrence risk is relatively similar between patients with short-term, medium-term, and long-term seizure freedom after completion of antitumour treatment.

Re-appraisal of callosotomy: rates and predictors of short-term seizure outcome in pediatric epileptic encephalopathy

BackgroundEpilepsy is a chronic debilitating disease especially in pediatric population. Most of reported studies for corpus callosotomy as a palliative surgery in drug-resistant cases are on limited number of cases and there is scarcity in literature for outcomes reported from developing countries. Here, we present our study on a large series of cases with analysis of potential predicators outcomes in the era of more expensive devices like vagal nerve stimulation to give a litany on a universal epilepsy surgery procedure which had been missed in the literature through the last decade.ResultsAn observational retrospective study was done reviewing 129 patients with PEE underwent open microscopic corpus callosotomy. Total and drop attack seizure outcomes were studied after surgery. Potential outcomes predictors studied are: preoperative EEG and MRI. Preoperative IQ impairment epilepsy duration, age at diagnosis, MRI finding, IQ score, EEG findings, history of infantile spasm and extent of callosotomy done. All the recorded outcomes were substantially improved after callosotomy in our study population of 129 pediatric patients. The median (IQR) preoperative drop attack frequency was 70 (21–140) which decreased to 3 (0–14) postoperatively. Similarly, the number of anti-epileptics used by patients had a median of 3 (2–4) which decreased to 2 (2–3) after the surgery. All patients were experiencing status epilepticus which disappeared in 72% of the patients after callosotomy. Preoperative normal MRI was a predictor for drop attack favorable outcome and mild preoperative impairment of IQ was a predictor of favorable total seizure and drop attack outcome.ConclusionsCorpus callosotomy is a well-tolerated palliative procedure for drug-resistant generalized epilepsy notably, drop attacks which had its notorious effect on quality of life of pediatric patients and their families, no appreciable prognostic factors for favorable outcome were clearly observed except for normal preoperative MRI, mild preoperative IQ affection, and complete callosotomy.

Long-term Outcome of Seizure Control and Neurologic Performance After Limited Hippocampal Radiofrequency Thermocoagulation for Mesial Temporal Lobe Epilepsy

Limited hippocampal radiofrequency thermocoagulation (RFTC) for patients with mesial temporal lobe epilepsy was associated with good short-term seizure control and few complications. We aimed to demonstrate the neuropsychologic outcomes and assess the prognostic factors of long-term seizure control in these patients. We included all patients with mesial temporal lobe epilepsy who underwent limited hippocampal RFTC from January 2016 to December 2020. Clinical data of age, sex, seizure control before and after operation were all corrected. Pre- and postoperative neuropsychologic function including full-scale intelligence quotient (FSIQ), memory quotient, and the Mini-Mental State Examination was used. Thirty-one patients (17 female and 14 male) with a mean epilepsy duration of 22.3 years and seizure frequency of 5.7 times per month were included. The intraoperative seizure rate was 19.3%, and a higher preoperative seizure frequency (P= 0.001) and longer duration of epilepsy (P= 0.042) were associated with the occurrence of intraoperative seizures. The postoperative FSIQ scores were significantly better than preoperative scores (mean 92.1 vs. 89.7, P= 0.014). Nine patients (29%) who underwent limited hippocampal RFTC were seizure-free at 1 year of follow-up. Responders represented 58% (n= 18) of patients at 1 year. The mean follow-up period was 34.7 ± 13.3 months. Five patients remained seizure free and 13 patients are still responders at the last follow-up visits. Long-term seizure frequency was 2.32 ± 2.86 times per month. Limited hippocampal RFTC is a safe stereotactic minimal invasive procedure with good neuropsychologic outcome and acceptable efficacy of seizure reduction in appropriately selected patients.

LOCL-09 SHORT-TERM SEIZURE OUTCOMES IN PATIENTS WITH TREATED WITH LASER INTERSTITIAL THERMAL THERAPY

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment modality for intracranial tumor and radiation necrosis (RN). A transient increase in edema following LITT typically resolves within three months post-procedure. We sought to characterize the short-term seizure outcomes during this period for patients undergoing LITT for tumor or RN. A retrospective analysis of 86 consecutive patients treated with LITT from 2015-2019 at a single institution was conducted. Data on baseline demographics, treatment details, and clinical course were collected. Thirty-one (36%) had a seizure within one year following LITT, 19 (22%) of which occurred within the first 90 days post-LITT (71% of all seizures). Forty-three (50%) patients had documented pre-LITT seizures, with 27 (63% of all seizures) of those occurring within 90 days pre-LITT. Between patients with and without post-LITT seizures within the first 90 days, there were no significant differences in gender, age, pre-LITT KPS, pre-LITT volume, pre-LITT resection, pre-LITT stereotactic radiotherapy, pre-LITT chemo- or immuno-therapy, use of AEDs or steroids before or after LITT, location, or pathology at the time of treatment. Patients with seizures in the first 90 days post-treatment were significantly more likely to have received pre-LITT whole brain radiotherapy (WBRT) (32% vs. 9%, p=0.02). Of the 18 patients with pre-LITT seizures within 90 days, 9 (50%) were entirely seizure free in the 90-day post-LITT period. In summary, seizure is a known complication of LITT for intracranial lesions, with the majority occurring in the first 90 days post-procedure. WBRT was significantly associated with 90-day post-LITT seizure, which may represent a diminished neurologic reserve in these patients. These findings may help guide clinicians in determining patients appropriate for LITT and those who may require closer monitoring and longer AED tapers in the short-term period following ablation.

Robot-assisted, real-time, MRI-guided laser interstitial thermal therapy for pediatric patients with hypothalamic hamartoma: surgical technique, pitfalls, and initial results.

Real-time, MRI-guided laser interstitial thermal therapy (MRgLITT) has been reported as a safe and effective technique for the treatment of epileptogenic foci in children and adults. After the recent approval of MRgLITT by the European Medicines Agency in April 2018, the authors began to use it for the treatment of hypothalamic hamartomas (HHs) in pediatric patients with the assistance of a robotic arm. In this study, the authors report their initial experience describing the surgical technique, accuracy of the robotic arm, safety, and efficacy. The laser fiber was placed with the assistance of the stereotactic robotic arm. The accuracy of the robotic arm for this procedure was calculated by comparing the intraoperative MRI to the preoperative plan. Common demographic and seizure characteristics of the patients, laser ablation details, complications, and short-term seizure outcomes were prospectively collected. Sixteen procedures (11 first ablations and 5 reablations) were performed in 11 patients between 15 months and 17 years of age (mean age 6.4 years) with drug-resistant epilepsy related to HHs. The mean target point localization error was 1.69 mm. No laser fiber needed to be repositioned. The mean laser power used per procedure was 4.29 W. The trajectory of the laser fiber was accidentally ablated in 2 patients, provoking transient hemiparesis in one of these patients. One patient experienced postoperative somnolence and syndrome of inappropriate antidiuretic hormone secretion, and 2 patients had transient oculomotor (cranial nerve III) palsy. Fifty-four percent of the patients were seizure free after the first ablation (mean follow-up 22 months, range 15-33 months). All 5 patients who experienced an epilepsy relapse underwent a second treatment, and 4 remain seizure free at least 5 months after reablation. In the authors' experience, the robotic arm was sufficiently accurate for laser fiber insertion, even in very young patients. MRgLITT appears to be an effective treatment for selected cases of HH. MRgLITT for HH is a minimally invasive procedure with appealing safety features, as it allows delivery of energy precisely under real-time MRI control. Nonetheless, complications may occur, especially in voluminous HHs. The amount of delivered energy and the catheter cooling system must be closely monitored during the procedure. A larger sample size and longer follow-up duration are needed to judge the efficacy and safety of MRgLITT for HH more rigorously. This initial experience was very promising.

An integrated risk model stratifying seizure risk following brain tumor resection among seizure-naive patients without antiepileptic prophylaxis.

The natural history of seizure risk after brain tumor resection is not well understood. Identifying seizure-naive patients at highest risk for postoperative seizure events remains a clinical need. In this study, the authors sought to develop a predictive modeling strategy for anticipating postcraniotomy seizures after brain tumor resection. The IBM Watson Health MarketScan Claims Database was canvassed for antiepileptic drug (AED)- and seizure-naive patients who underwent brain tumor resection (2007-2016). The primary event of interest was short-term seizure risk (within 90 days postdischarge). The secondary event of interest was long-term seizure risk during the follow-up period. To model early-onset and long-term postdischarge seizure risk, a penalized logistic regression classifier and multivariable Cox regression model, respectively, were built, which integrated patient-, tumor-, and hospitalization-specific features. To compare empirical seizure rates, equally sized cohort tertiles were created and labeled as low risk, medium risk, and high risk. Of 5470 patients, 983 (18.0%) had a postdischarge-coded seizure event. The integrated binary classification approach for predicting early-onset seizures outperformed models using feature subsets (area under the curve [AUC] = 0.751, hospitalization features only AUC = 0.667, patient features only AUC = 0.603, and tumor features only AUC = 0.694). Held-out validation patient cases that were predicted by the integrated model to have elevated short-term risk more frequently developed seizures within 90 days of discharge (24.1% high risk vs 3.8% low risk, p < 0.001). Compared with those in the low-risk tertile by the long-term seizure risk model, patients in the medium-risk and high-risk tertiles had 2.13 (95% CI 1.45-3.11) and 6.24 (95% CI 4.40-8.84) times higher long-term risk for postdischarge seizures. Only patients predicted as high risk developed status epilepticus within 90 days of discharge (1.7% high risk vs 0% low risk, p = 0.003). The authors have presented a risk-stratified model that accurately predicted short- and long-term seizure risk in patients who underwent brain tumor resection, which may be used to stratify future study of postoperative AED prophylaxis in highest-risk patient subpopulations.

Epilepsy surgery in patient with monogenic epilepsy related to SCN8A mutation.

Epilepsy surgery is superior to prolonged medical therapy in patients with drug-resistant focal epilepsy, but reports on epilepsy surgery outcomes for patients with a genetic etiology are limited, especially in adults. This is the first documented report of a stereoelectroencephalography (SEEG) evaluation and resective surgery outcome in an adult patient with epilepsy related to SCN8A mutation. We describe a patient with epilepsy related to SCN8A mutation which was reported as a variant of uncertain significance at time of his pre-surgical evaluation and reclassified as likely pathogenic about 3years after resective epilepsy surgery. Most of his pre-surgical evaluation results suggested right temporal lobe epilepsy, but few reported semiological symptoms, ictal SPECT, and neuropsychology results were discordant, and brain MRI was non-lesional. Therefore, SEEG was recommended; ultimately, seizures were localized to the right hippocampus. He was seizure-free for 1.5years after right anterior temporal lobectomy, then reported three focal to bilateral tonic-clonic (FBTC) seizures in the subsequent 12months (preoperatively, 6 focal impaired awareness seizures and 4-6 FBTC per year). This case demonstrates that epilepsy surgery reduced seizure burden in a patient with SCN8A-related epilepsy granting him short-term seizure freedom after resection, and then decreased seizure frequency after relapse compared to the preoperative baseline.

Factors Associated with Short-Term Seizure Recurrence in Extratemporal Epilepsy Surgery

Introduction: Drug-resistant extratemporal epilepsy is the second cause of referral to epilepsy surgery. Objectives: To identify factors associated with short-term seizure recurrence following extratemporal epilepsy surgery. Materials and Methods: We performed a retrospective study of 19 consecutive patients who underwent surgery for drug-resistant extratemporal epilepsy at the National Institute of Neurology and Neurosurgery of Havana, Cuba, from September 2014 to October 2019. All patients had at least one year of postoperative follow-up. Fisher's exact test was used to search for an association between dichotomous variables. A value of p≤0.05 was considered significant. Results: After one year of follow-up, seizure freedom reached 31.6% (Engel I) and 36.8% showed significant improvement in the number of seizures (Engel II). The frontal location (p=0.046) and incomplete resection of the epileptogenic zone (p=0.017), bilateral interictal discharges on the preoperative electroencephalogram (EEG) (p=0.017), the presence of epileptiform discharges on the postsurgical EEG (p=0.001), and the occurrence of seizures after the sixth month of surgery (p=0.001), were associated with seizures recurrence. Conclusions: After one year, 31.6% of patients operated on for extratemporal epilepsy were seizure-free. The incomplete resection of the epileptogenic zone and the presence of epileptogenic discharges in the postsurgical EEG, and the presence of seizures after the sixth month of surgery were the most significant factors of seizure recurrence.

Treatment with High-Dose Prednisolone in Vigabatrin-Refractory Infantile Spasms.

This research aimed to study the short-term seizure outcomes following treatment with 8 mg/kg/day prednisolone in children with infantile spasms (IS) refractory to vigabatrin. We hypothesized that high-dose prednisolone may result in similar rates of electroclinical remission when compared to published ACTH rates. All consecutive children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without IS, who had been treated with vigabatrin as first-line anti-seizure medication (ASM) followed by high-dose oral prednisolone (8 mg/kg/day; maximum 60 mg/day) in cases who did not respond to vigabatrin, were included. Clinical and electroclinical response (ECR) at 2 weeks following initiation of treatment and adverse effects were assessed. Sixty-five children were included. A genetic etiology was seen in 38.5% cases. Complete ECR was seen in 30.8% (20/65) of the patients 2 weeks after vigabatrin. Complete ECR was noted in 77.8% (35/45) of the patients, 2 weeks after prednisolone initiation in children who failed vigabatrin, and this was sustained at 6 weeks in 66.7% (30/45) patients. Prednisolone was generally well tolerated. High-dose (8 mg/kg/day) oral prednisolone resulted in sustained complete ECR (at 6 weeks) in two-thirds of the children with hypsarrhythmia or hypsarrhythmia variant on EEG with/without parentally reported IS. It was generally well tolerated and found to be safe.

Towards a Treatment for Neuroinflammation in Epilepsy: Interleukin-1 Receptor Antagonist, Anakinra, as a Potential Treatment in Intractable Epilepsy.

Febrile Infection-Related Epilepsy Syndrome (FIRES) is a unique catastrophic epilepsy syndrome, and the development of drug-resistant epilepsy (DRE) is inevitable. Recently, anakinra, an interleukin-1 receptor antagonist (IL-1RA), has been increasingly used to treat DRE due to its potent anticonvulsant activity. We here summarized its effects in 38 patients (32 patients with FIRES and six with DRE). Of the 22 patients with FIRES, 16 (73%) had at least short-term seizure control 1 week after starting anakinra, while the remaining six suspected anakinra-refractory cases were male and had poor prognoses. Due to the small sample size, an explanation for anakinra refractoriness was not evident. In all DRE patients, seizures disappeared or improved, and cognitive function improved in five of the six patients following treatment. Patients showed no serious side effects, although drug reactions with eosinophilia and systemic symptoms, cytopenia, and infections were observed. Thus, anakinra has led to a marked improvement in some cases, and functional deficiency of IL-1RA was indicated, supporting a direct mechanism for its therapeutic effect. This review first discusses the effectiveness of anakinra for intractable epileptic syndromes. Anakinra could become a new tool for intractable epilepsy treatment. However, it does not currently have a solid evidence base.

Seven-tesla quantitative magnetic resonance spectroscopy of glutamate, γ-aminobutyric acid, and glutathione in the posterior cingulate cortex/precuneus in patients with epilepsy.

The posterior cingulate cortex (PCC)/precuneus is a key hub of the default mode network, whose function is known to be altered in epilepsy. Glutamate and γ-aminobutyric acid (GABA) are the main excitatory and inhibitory neurotransmitters in the central nervous system, respectively. Glutathione (GSH) is the most important free radical scavenging compound in the brain. Quantification of these molecules by magnetic resonance spectroscopy (MRS) up to 4 T is limited by overlapping resonances from other molecules. In this study, we used ultra-high-field (7 T) MRS to quantify their concentrations in patients with different epilepsy syndromes. Nineteen patients with temporal lobe epilepsy (TLE) and 16 with idiopathic generalized epilepsy (IGE) underwent magnetic resonance imaging scans using a 7-T research scanner. Single-voxel (8 cm3 ) MRS, located in the PCC/precuneus, was acquired via stimulated echo acquisition mode. Their results were compared to 10 healthy volunteers. Mean concentrations of glutamate, GABA, and the glutamate/GABA ratio did not differ between the IGE, TLE, and healthy volunteer groups. The mean ± SD concentration of GSH was 1.9 ± 0.3 mmol·L-1 in healthy controls, 2.0 ± 0.2 mmol·L-1 in patients with TLE, and 2.2 ± 0.4 mmol·L-1 in patients with IGE. One-way analysis of variance with post hoc Tukey-Kramer test revealed a significant difference in the concentration of GSH between patients with IGE and controls (P=.03). Short-term seizure freedom in patients with epilepsy was predicted by an elevated concentration of glutamate in the PCC/precuneus (P=.01). In patients with TLE, the concentration of GABA declined with age (P=.03). Patients with IGE have higher concentrations of GSH in the PCC/precuneus than healthy controls. There is no difference in the concentrations of glutamate and GABA, or their ratio, in the PCC/precuneus between patients with IGE, patients with TLE, and healthy controls. Measuring the concentration of glutamate in the PCC/precuneus may assist with predicting drug response.

Seizure freedom as an outcome in epilepsy treatment clinical trials.

Seizure freedom is recognized as the goal of epilepsy treatment by patients, families, and in treatment guidelines and is associated with notably improved quality of life. However, many studies of epilepsy treatments (including antiseizure medications/antiepileptic drugs, neurostimulation, and dietary therapies) fail to report data on seizure freedom. Even among studies that include this outcome, methods for defining and analyzing seizure freedom vary considerably. Thus, the available data are often difficult to interpret and comparisons between studies are particularly challenging. Although these issues had been identified over a decade ago, there remains a lack of clarity and standardized methods used in analyzing and reporting seizure freedom outcomes in studies of epilepsy treatments. In addition, it remains unclear whether short-term seizure freedom outcomes from pivotal clinical trials are predictive of longer-term seizure freedom outcomes for patients with treatment-refractory epilepsy. Ultimately, the limitations of the available data lead to the potential for misinterpretation and misunderstanding of seizure freedom outcomes associated with the spectrum of available treatments when examining treatment options for patients. Clearly defined outcome analyses of seizure freedom attainment and duration are essential in future clinical studies of treatment for seizures to guide treatment selection and modification for patients.

Short-term outcomes and predictors of post-surgical seizures in patients with supratentorial low-grade gliomas

To explore the predictive factors and short-term outcomes of post-surgical seizures in patients with supratentorial low-grade gliomas (LGGs). A consecutive series of 70 supratentorial LGG patients with seizures were reviewed to determine the predictors and short-term outcomes of seizures. Univariate analyses and multivariate logistic regression analyses were performed to determine the predictive factors associated with postoperative seizure outcomes. We identified the preoperative seizure frequency threshold by plotting a receiver operating characteristic curve. A Kaplan-Meier curve was constructed to illustrate the seizure-free survival rate of our cohort over time. 54 patients who remained seizure -free post-surgery were classified into the Engel class I, and the other 16 patients whose seizures relapsed were classified into Engel classes II–IV. Univariate and multivariate logistic regression analyses showed that the preoperative seizure frequency (X2 = 16.069, P = 0.001), extent of resection (x2 = 5.031, P = 0.025), IDH1 mutation (x2 = 4.435, P = 0.035) and adjuvant chemotherapy of temozolomide (X2 = 4.081, P = 0.043) were related to the postoperative short-term seizure outcome. The ROC curve indicated that the area under the curve for the preoperative seizure frequency test was 0.805 (95% confidence interval 0.690–0.920, p < 0.05), which corresponded to an optimal threshold of 2 preoperative seizures. The IDH1WT status and adjuvant chemotherapy with temozolomide were related to a better post-operative seizure outcome. Within the first year after the surgical resection, seizures reoccurred among 16 patients (22.9%) with a mean time of 10.8 months. The preoperative seizure frequency, extent of resection, IDH1 status, and adjuvant chemotherapy with temozolomide were predictive factors of short-term postoperative seizure outcomes for supratentorial LGGs. To obtain a favorable seizure outcome, early intervention and removal are warranted. IDH1 mutation is the predictive biomarker of postoperative seizure outcomes. The adjuvant chemotherapy with temozolomide appears to be associated with better seizure outcomes, and it may be useful in helping to control the postoperative seizures.

Models of community-based primary care for epilepsy in low- and middle-income countries.

To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries. A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles. The 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.

Value of transcranial direct current polarisation in people with focal drug resistant epilepsy

Drug resistant epilepsy (DRE) accounts for about one third of people with epilepsy (PWE), even after introduction of more than twenty antiepileptic drugs. Accordingly, Cathodal transcranial direct current stimulation (Cathodal tDCS) considered as a neuromodulation protocol which is emerging to reduce cortical excitability and consider as potential antiepileptic therapy. To investigate whether Cathodal tDCS can modify seizure frequency in People with drug resistant focal epilepsy, assessed by clinical evaluation, seizure diary and electroencephalography (EEG). A randomized, double blind, placebo controlled clinical trial on 20 PWE diagnosed with focal DRE were enrolled in our study. The patients were randomized into 2 groups. First Group received real 5-day sessions of cathodal tDCS over the area of most frequent interictal epileptiform discharges (ED) or the area of suspected ictal onset. The second group received sham sessions. Outcome indicators were baseline and post sessions (4 weeks) seizure diary and ED which were counted per hour. Patients subgroups were matched as regard the baseline characteristics. The percentage reduction of ED was greater for real stimulation versus the placebo group (p = 0.0124). also, the percentagereduction of seizure frequency was greater for real stimulation group versus the placebo group (p = 0.0308). Our study shows that cathodal tDCS is a promising therapeutic tool for short term seizure reduction in chronic drug resistant focal epilepsy patients.

Confirming the Brain Death and the Nurse’s Tasks in the Care of Potential Organ Donors and Their Families

Introduction. Transplantology is the youngest area of medicine dealing with organ transplantation that is considered to be the most difficult.Aim. The aim of the work is to analyse the nurse’s tasks in the care of the organ donor after confirming brain death and propagate the idea of transplantology.Case Report. A 52-year-old patient admitted to the hospital at the neurological department after a craniocerebral trauma. Computed tomography of the head showed brain contusion, fractures of the bones of the skull cover, the presence of a small amount of air in the cranial cavity. Immediately after admission, the patient was tangled, conscious, reluctant to answer questions, without paresis and a short-term seizure. Anti-oedema and anti-epileptic treatment was implemented in the neurosurgery department. After starting treatment, there was a temporary improvement, followed by a secondary worsening of brain and brain stem failure with deep cerebral coma. The patient was referred for further treatment in the Intensive Care Unit.Discussion. Organ transplantation involves collecting them from the donor and implanting them into the recipient. The donor can be either a living person (when it comes to paired organs or fragment of the liver as well as the tissues and cells) or the deceased person, who during their life did not express objection to organ donation after their death. The major principle in this case is the pronouncement of brain death, i.e. confirmation of patient’s death resulting in changing the therapeutic goals.Conclusions. Transplantology is an interdisciplinary field of medicine, the success of which relies on the cooperation of many professionals. The nurse takes an active part in the team’s work starting from the donor’s organs eligibility, through transplantation, to the care of the patient after the transplantation. The nurse also participates in building up an atmosphere favourable for good relations with the potential donor’s family. (JNNN 2019;8(3):124–132)

DEPRESSIVE SYMPTOMS ACROSS THE AGE SPAN: FINDINGS FROM AN INTEGRATED EPILEPSY SELF-MANAGEMENT CLINICAL STUDIES DATASET.

Introduction Epilepsy has been reported by the CDC to have a prevalence of 1.2% in the United States, which accounts for roughly 3.4 million adults in 2015. Nearly 1 million of those adults are aged 55 or older.1 Epilepsy is more likely to develop in older adults because risk factors for epilepsy are more common as people age including stroke/cardiovascular disease, neurodegenerative disorders, brain tumor and long-term sequelae of alcohol abuse.2 As our population ages, there will be even more older people with epilepsy. A common comorbidity in epilepsy is depression. While the prevalence of depression in patients with epilepsy varies in literature, it is estimated to be between 15% and 37%.3 The significance of depressive symptoms on quality of life has been shown to be greater than that of short-term seizure control.4 For older people, balancing epilepsy treatment in conjunction with other health problems can present with great difficulty. Many antiepileptic's also have side effects such as bone loss, dizziness and greater risk for falls, which can make someone more likely to fall and become injured.5 This analysis, from a large pooled dataset of multiple epilepsy treatment studies, examined presence and symptom severity of depression in older adults (age > 55) with epilepsy in comparison to younger adults (age Methods Analysis was completed using baseline data and clinical variables from 9 studies of the Managing Epilepsy Well (MEW) Network integrated research database (MEW DB). Patients were divided into two groups; age 18-55 and age greater than or equal to 55. A total of 935 adults participated, out of which 161 (17.2 %) were of age 55 or greater and 774 adults younger than 55 (82.8 %). Other demographics included were gender, race, marital status, highest education level and annual income. Standardized rating scales included Quality of Life in Epilepsy (QOLIE-10) and Patient Health Questionnaire (PHQ-9) for depressive symptoms. The QOLIE-10 scoring was harmonized to accommodate slightly different versions of this scale within the integrated dataset. Results The mean age for older patients was 61.5 vs. 34.4 for younger patients. Approximately 60% of patients in both groups were females. Among older patients 109 (76.2%) were white, 24 (16.8%) African Americans, and 4 (3.1%) Hispanic. Majority of these patients (78.6%) had a college education and 53.4% were either married or co-habiting. Demographics of the under 55 group were largely similar. Mean PHQ-9 score was 8.5 in older patients vs. 9.5 in younger patients (p= 0.07). Amongst older patients, those with moderate-severe depression defined as PHQ-9 > 10 had an average of 7 seizures in 30 days, compared to those with scores 10) in both younger and older groups was associated with worse QOL (p= Conclusions Depression is common in people with epilepsy across the lifespan. Depression is more common in those with poorly controlled epilepsy, and more severe depressive symptoms are associated with poorer quality of life. However, we did not find that these findings were different in older vs. younger patients. Methodological limitations such as the clinical trials’ data source and relatively young age of the sample overall could have biased findings. Future analyses need to sample more elderly people with epilepsy including the “old-old” and those with more extensive medical comorbidity. This research was funded by: This study was supported in part by CDC grants U48DP001930 (CWRU), U48DP005030 (CWRU) U48DP005008 (NYU), 148DP005013 (WA), and 1U48DP005018 (Geisel School of Medicine at Dartmouth) under the Health Promotion and Disease Prevention Research Centers Program.