Treated Epilepsy Patients Research Articles

Effect of Childhood Epilepsy and Antiepileptic Drugs on Visual Evoked Potential Response and Optical Coherence Tomography

Abstract Background The experience of evoked potentials in patients with epilepsy is sparse. Earlier studies in the literature, especially during the 1970s and 1980s, were conducted in previously treated epilepsy patients primarily to investigate drug effects or drug toxicity on afferent nerve conduction within the central nervous system. Aim of the Study to investigate effect of idiopathic childhood epilepsy per se on VEP and OCT and effect of two antiepileptic medications on them and correlate that with clinical symptoms if present. Patients and Methods this is a biphasic study, 1st one is case control and 2nd phase is a controlled clinical prospective trial, conducted in the neuro-pediatric outpatient clinic of Ain Shams University. This study enrolled 50 epileptic children drug naïve and 50 age and sex matched healthy controls, both groups were subjected to pattern reversed visual evoked potential and only 28 of the patients and 28 of the control group were subjected to ocular coherence tomography, starting from March 2021. The 50 patients were divided into 2 groups, the first one enrolled 23 patients that received levitracetam and the 2nd one enrolled 27 patients that received valproate. Both groups were followed up over 24 months and follow up VEP and OCT done to compare the two groups and correlate with the baseline parameters. Results 66% of the patients’ group was boys while 34% were girls, with mean age 10.5± 3.47. By measuring VEP in the two groups the mean P100 latency in the right eye and the left one of the control group was 110.4±3.76ms and 111.25±3.92ms respectively while in the patients group was 114.94±12.81ms and 115.37±11.88ms respectively that showed significant difference between the two groups with p- value 0.020 and 0.023 respectively. Conclusion there was prolonged latency in the epileptic children before starting AEDs more than the control group. This means that there was a disruption of the neural circuit by the epilepsy due to disruption of gabamenergic neurotransmitter system which plays an important role in mediating responses of cells in the visual cortex and retina and assists in shaping the receptive fields of the pyramidal cells in the superficial layers of the occipital cortex.

Sleep and Epilepsy

Sleep and epilepsy have a complex interrelationship that is influenced by various factors, including the distinct stages of sleep. Non-rapid eye movement sleep promotes epileptic activity, while rapid eye movement sleep suppresses it. Seizures can be triggered by sleep, while sleep deprivation increases seizure susceptibility. Epilepsy disrupts sleep architecture and quality, leading to sleep disturbances and comorbidities, like sleep apnea and restless legs syndrome. Excessive daytime sleepiness and fatigue can result from epilepsy and the sedating effects of antiseizure medications. Sleep-related epilepsy exhibits seizures predominantly during sleep, with specific patterns related to sleep stages. Antiseizure medications can directly impact sleep quality and should be carefully considered when treating epilepsy patients with comorbid sleep disorders. Understanding the bidirectional relationship between sleep and epilepsy is crucial for effective management. Optimizing treatment strategies requires recognizing the effects of antiseizure medications on sleep, and addressing sleep-related issues in individuals with epilepsy.

Epileptic seizure detection from electroencephalogram (EEG) signals using linear graph convolutional network and DenseNet based hybrid framework

A clinical condition known as epilepsy occurs when the brain's regular electrical activity is disturbed, resulting in a rapid, aberrant, and excessive discharge of brain neurons. The electroencephalogram (EEG) signal is the measurement of electrical activity received from the nerve cells of the cerebral cortex to make precise diagnoses of disorders, which is made crucial attention for treating epilepsy patients in recent years. The concentration on grid-like data has been a significant drawback of existing deep learning-based automatic epileptic seizure detection algorithms from raw EEG signals; nevertheless, physiological recordings frequently have irregular and unordered structures, making it challenging to think of them as a matrix. In order to take advantage of the implicit information that exists in seizure detection, graph neural networks have received a lot of attention. These networks feature interacting nodes connected by edges whose weights can be either dictated by temporal correlations or anatomical junctions. To address this limitation, a novel hybrid framework is proposed for epileptic seizure detection by using linear graph convolution neural network (LGCN) and DenseNet. When compared to previous deep learning networks, DenseNet achieves the model's higher computational accuracy and memory efficiency by reducing the vanishing gradient problem and enhancing feature propagation in each of its layers. The Stockwell transform (S-transform) is used to preprocess from the raw EEG signal and then group the resulting matrix into time-frequency blocks as inputs for the LGCN to use for feature selection and after the Densenet uses for classification. The proposed hybrid framework outperforms the state-of-the-art in seizure detection tasks, achieving 98% accuracy and 98.60% specificity in extensive experiments on the publicly available CHB-MIT EEG dataset.

Perceptions of teachers regarding the inclusion of epilepsy education in life skills for primary learners and teachers in Limpopo and Mpumalanga provinces (South Africa)

Background. Epilepsy is a frequent neurological condition with complicated effects, and it is characterized by seizures that can last quite a long time. It is important that people around treat epilepsy patients with understanding and be able to help them during seizures.Objective: to determine the perceptions of teachers regarding epilepsy education being included in life skills education considering that teachers spend a great deal of time with school students.Material and methods. The study employed an exploratory-descriptive design to explore primary school teachers' perceptions regarding the need to include epilepsy in life skills education. It was conducted in Limpopo and Mpumalanga provinces in South Africa. Data were collected from 20 primary school teachers in Limpopo and Mpumalanga using semi-structured interviews. Only primary school teachers who teach life skills were interviewed to reach data saturation.Results. The respondents revealed their knowledge that epilepsy is a disease associated with falling, shivering movements/ seizures, releasing saliva in a bubble foam, and being unconscious. However, they showed insufficient understanding regarding some aspects and expressed the opinion that there is a need of including epilepsy in life skills education, because it will assist the learners and teachers in knowing more about epilepsy. The participants consider that since epileptic seizure is an unpredictable condition that can happen to anyone, at any time, they feel it is important that learners and teachers are educated about it. For this purpose, they suggested various teaching methods and the necessary areas of knowledge about epilepsy.Conclusion. The findings of the study revealed that the inclusion of epilepsy in life skills education will enhance the knowledge and understanding of epilepsy through learning the aspects that have been suggested by the participants.

Retracted: Clinical Study on Electronic Medical Neuroelectric Stimulation Based on the Internet of Things to Treat Epilepsy Patients with Anxiety and Depression.

[This retracts the article DOI: 10.1155/2021/6667309.].

Women of childbearing age: What antiseizure medications are they taking?

Women of childbearing age: What antiseizure medications are they taking?

P11.08.A Clinical practice evidence for perampanel in epilepsy patients with tumour aetiology

Abstract Background Real-world studies can provide information on those patients routinely excluded from clinical trials such as epilepsy patients with tumour aetiology. Perampanel (PER) is a once-daily oral anti-seizure medication for focal-onset seizures, with or without focal to bilateral tonic-clonic seizures, and generalised tonic-clonic seizures. This study evaluated PER’s effectiveness and safety when used in everyday clinical practice to treat epilepsy patients with tumour aetiology. Material and Methods Patients with epilepsy with tumour aetiology were identified from a pooled analysis of 44 prospective/retrospective/cross-sectional clinical practice studies. Retention was assessed after 3, 6 and 12 months of PER treatment. Effectiveness assessments comprised responder rate (≥50% seizure frequency reduction), seizure freedom rate (no seizures since at least the prior visit), and the proportions of patients with unchanged or worsening seizure frequency. Adverse events (AEs), psychiatric AEs, and AEs leading to discontinuation were also evaluated. Results Overall, 127 patients with focal-onset and/or generalised-onset seizures with tumour aetiology were identified (mean age, 46.6 years; 54.8% male; mean duration of epilepsy, 9.7 years). Seizure types at baseline were focal-onset only (97.6%), generalised-onset only (1.6%), and focal-onset and generalized-onset (0.8%). Mean (standard deviation) PER doses at baseline and last visit were 2.6 (1.4) and 5.8 (2.5) mg/day, respectively. At 3, 6 and 12 months, retention rates were 88.0%, 79.5% and 65.3%, respectively. Reasons for discontinuation included AEs (16.8%) and lack of efficacy (5.3%). Mean time under PER treatment was 11.0 months. At 12 months, 71.2% of patients were responders and 38.3% were seizure free; 11.9% and 3.4% of patients had unchanged and worsening seizure frequency, respectively. At the last visit (last observation carried forward), responder and seizure freedom rates were 66.9% and 34.2%, respectively, and the percentages of patients with unchanged or worsening seizure frequency were 15.3% and 6.8%, respectively. AEs were reported for 36.2% of patients, most frequently dizziness/vertigo (13.8%) and somnolence (9.5%). AEs led to discontinuation of 16.8% of patients over 12 months and 13.0% of patients experienced psychiatric AEs. Conclusion PER was effective and generally well tolerated when used to treat patients with epilepsy with tumour aetiology in clinical practice. Supported by Eisai

Clinical Study on Electronic Medical Neuroelectric Stimulation Based on the Internet of Things to Treat Epilepsy Patients with Anxiety and Depression.

With the continuous development and improvement of the level of medical technology in our country in recent years, the treatment of epilepsy has been constantly updated and developed. Nerve electrical stimulation is considered to be a very effective method for treating epilepsy with anxiety and depression. There are many traditional methods for the treatment of epilepsy. For example, vagus nerve stimulation (VNS) has been applied earlier, and the therapeutic effect has been confirmed, but it will cause serious complications and is easier to be uncomfortable; deep brain stimulation for epilepsy is still in the immature stage, and there is no final conclusion. Therefore, this article proposes a clinical study on the treatment of patients with epilepsy with anxiety and depression based on the electronic medical nerve stimulation of the Internet of Things. First of all, this article uses the literature method to study the causes of epilepsy and previous treatment methods. Then, we designed an experimental study of epilepsy with depression based on the Internet of Things electronic medical neuroelectric stimulation therapy and selected the core quality of life questionnaire, SDS, and SAS as observation indicators. Finally, the comparison of epilepsy symptoms and depression and anxiety between the control group and the observation group before and after treatment was analyzed. The results of the experiment showed that, among the 50 subjects in the study, the observation group that used electrical nerve stimulation therapy had 5 people who stopped seizures after treatment, accounting for 10%, while in the control group of traditional drug treatment methods, after treatment, only one person stopped the seizure, accounting for 2%. In addition, the SAS and SDS scores of the observation group were also lower than those of the control group. Therefore, the use of nerve electrical stimulation to treat epilepsy with anxiety and depression symptoms has better performance and can help patients recover as soon as possible.

Seizure-related injuries in inadequately treated epilepsy patients: A case-control study

PurposeTo compare epilepsy-related injuries in untreated or inadequately treated patients and patients on adequate treatment. MethodsIn a cross-sectional case-control study, seizure-related injuries in patients who were either on no treatment or inadequate treatment were compared with another group of patients receiving appropriate evidence-based epilepsy treatment. The inadequately treated patients or ‘cases’ were drawn from an outreach epilepsy clinic while the adequately treated patients or ‘controls’ were recruited from a tertiary care facility providing comprehensive epilepsy management. ResultsThe odds of injury were eight times higher in inadequately treated patients or cases compared to the adequately treated patients or controls. After adjusting for gender, epilepsy duration, seizure frequency, current medication, and number of AEDs, the odds of injury were 15. 8 times higher in the cases. Major injuries such as burns, fractures, and tooth injuries were also higher in the cases. ConclusionUntreated or inadequately treated epilepsy patients have a significantly higher risk of injuries. With adequate treatment, some of the risks of injury can be mitigated.

Polygonogram and isobolographic analysis of interactions between various novel antiepileptic drugs in the 6-Hz corneal stimulation-induced seizure model in mice.

Pharmacotherapy with two antiepileptic drugs in combination is usually prescribed to epilepsy patients with refractory seizures. The choice of antiepileptic drugs in combination should be based on synergistic cooperation of the drugs with respect to suppression of seizures. The selection of synergistic interactions between antiepileptic drugs is challenging issue for physicians, especially, if 25 antiepileptic drugs are currently available and approved to treat epilepsy patients. The aim of this study was to determine all possible interactions among 5 second-generation antiepileptic drugs (gabapentin (GBP), lacosamide (LCM), levetiracetam (LEV), pregabalin (PGB) and retigabine (RTG)) in the 6-Hz corneal stimulation-induced seizure model in adult male albino Swiss mice. The anticonvulsant effects of 10 various two-drug combinations of antiepileptic drugs were evaluated with type I isobolographic analysis associated with graphical presentation of polygonogram to visualize the types of interactions. Isobolographic analysis revealed that 7 two-drug combinations of LEV+RTG, LEV+LCM, GBP+RTG, PGB+LEV, GBP+LEV, PGB+RTG, PGB+LCM were synergistic in the 6-Hz corneal stimulation-induced seizure model in mice. The additive interaction was observed for the combinations of GBP+LCM, GBP+PGB, and RTG+LCM in this seizure model in mice. The most beneficial combination, offering the highest level of synergistic suppression of seizures in mice was that of LEV+RTG, whereas the most additive combination that protected the animals from seizures was that reporting additivity for RTG+LCM. The strength of interaction for two-drug combinations can be arranged from the synergistic to the additive, as follows: LEV+RTG > LEV+LCM > GBP+RTG > PGB+LEV > GBP+LEV > PGB+RTG > PGB+LCM > GBP+LCM > GBP+PGB > RTG+LCM.

Epilepsy: knowledge and attitudes of physiotherapists, occupational therapists, and speech therapists.

Physiotherapists, occupational therapists, and speech therapists play a key role in the treatment of children with epilepsy. We performed a survey of therapists' knowledge of and attitudes towards epilepsy in two regions of Germany, the city of Leipzig and the rural district of Zwickau. Therapists of 29/68 (43%) outpatient practices and 4/9 (44%) hospitals took part. In total, 195 therapists participated: 63 (32%) physiotherapists, 74 (38%) occupational therapists, and 58 (30%) speech therapist. In 65%, epilepsy was subject of vocational training. Of all therapists, 8% claimed they had not treated epilepsy patients so far. During professional life, 43% had witnessed a seizure. Of all therapists, 44% correctly assumed a seizure could result in death. During a seizure, 42% would perform the obsolete measure of placing something solid in the patient's mouth, and 41% would administer a prescribed rescue medication. More information on epilepsy was requested by 92%.Conclusion: Most therapists treat patients with epilepsy, and almost half have already witnessed a seizure. Often, however, epilepsy is not subject of vocational training. The risk of a fatal outcome of a seizure is underestimated, and many therapists would perform obsolete measures. Knowledge of seizure management should be transmitted to therapists especially during vocational training.

Epilepsy Surgery in 2019 : A Time to Change.

Epilepsy has been known to humankind since antiquity. The surgical treatment of epilepsy began in the early days of neurosurgery and has developed greatly. Many surgical procedures have stood the test of time. However, clinicians treating epilepsy patients are now witnessing a huge tide of change. In 2017, the classification system for seizure and epilepsy types was revised nearly 36 years after the previous scheme was released. The actual difference between these systems may not be large, but there have been many conceptual changes, and clinicians must bid farewell to old terminology. Paradigms in drug discovery are changing, and novel antiseizure drugs have been introduced for clinical use. In particular, drugs that target genetic changes harbor greater therapeutic potential than previous screening-based compounds. The concept of focal epilepsy has been challenged, and now epilepsy is regarded as a network disorder. With this novel concept, stereotactic electroencephalography (SEEG) is becoming increasingly popular for the evaluation of dysfunctioning neuronal networks. Minimally invasive ablative therapies using SEEG electrodes and neuromodulatory therapies such as deep brain stimulation and vagus nerve stimulation are widely applied to remedy dysfunctional epilepsy networks. The use of responsive neurostimulation is currently off-label in children with intractable epilepsy.

Principle components analysis for seizures prediction using wavelet transform

Epilepsy is a disease in which frequent seizures occur due to abnormal activity of neurons. Patients affected by this disease can be treated with the help of medicines or surgical procedures. However, both of these methods are not quite useful. The only method to treat epilepsy patients effectively is to predict the seizure before its onset. It has been observed that abnormal activity in the brain signals starts before the occurrence of seizure known as the preictal state. Many researchers have proposed machine learning models for prediction of epileptic seizures by detecting the start of preictal state. However, pre-processing, feature extraction and classification remains a great challenge in the prediction of preictal state. Therefore, we propose a model that uses common spatial pattern filtering and wavelet transform for preprocessing, principal component analysis for feature extraction and support vector machines for detecting preictal state. We have applied our model on 23 subjects and an average sensitivity of 93.1% has been observed for 84 seizures.

Balinese Traditional Beliefs and Epilepsy

Purpose: The purpose of this study is to explore Balinese traditional healers perception related to knowledge, belief, and health practice of epilepsy and their influence to the epilepsy patients.Material and Methods: A cross sectional study was carried out between 1st and 20th February 2018. Balinese traditional healers, who were Hindu, and had treated epilepsy patients were recruited and had an interview. Demographic characteristics of respondents were noted.Results: A total of sixteen respondents consisted of eight Balinese traditional healers and eight epilepsy patients were enrolled. It was found 87.5% of respondents said epilepsy was combination of medical and spiritual illness. The abnormality of body temperature (n=5, 62.5%), hereditary disease (n=2, 25%), and blood disorders (n=1, 12.5%) were their knowledge about etiology of epilepsy. The traditional opinion about epilepsy was about ancestor’s sin (n=4, 50%) and black magic (n=4, 50%). The patients were also given vary herbal medication contained plants, oil, roots, fruits, holy water and showed both positive and negative effect to the patients. According to the patients, issues of religious belief, accessibility, affordability, and economy were the reason of coming to the Balinese traditional healers at first.Conclusion: Traditional belief were assumed to have a great impact in health system among Balinese communities along with medical therapy. This traditional belief should be one of health practices consideration while taking care of epilepsy patient.

Eliminating Absence Seizures through the Deep Brain Stimulation to Thalamus Reticular Nucleus.

Deep brain stimulation (DBS) can play a crucial role in the modulation of absence seizures, yet relevant biophysical mechanisms are not completely established. In this paper, on the basis of a biophysical mean-field model, we investigate a typical absence epilepsy activity by introducing slow kinetics of GABAB receptors on thalamus reticular nucleus (TRN). We find that the region of spike and slow-wave discharges (SWDs) can be reduced greatly when we add the DBS to TRN. Furthermore, we systematically explore how the corresponding stimulation parameters including frequency, amplitude and positive input duration suppress the SWDs under certain conditions. It is shown that the SWDs can be controlled as key stimulation parameters are suitably chosen. The results in this paper can be helpful for researchers to understand the thalamus stimulation in treating epilepsy patients, and provide theoretical basis for future experimental and clinical studies.

Increasing KCC2 function as a strategy for the treatment of seizures

Fast synaptic inhibition is mediated by GABAA receptors, which allow Cl− entry into neurons. This occurs due to an inwardly directed Cl− gradient established by KCC2, which extrudes Cl− from neurons. KCC2 dysfunction is a genetic cause of epilepsy and its function is downregulated in many patients with seizure‐related disorders, suggesting a broader role for KCC2 dysfunction in epilepsy. Consequently, it has been hypothesized that increasing KCC2 function would be beneficial in treating epilepsy patients. However, due to the lack of pharmacological activators of KCC2, it has not yet been possible to test this hypothesis.Phosphorylation of KCC2 at residues threonine 906 and threonine 1007 (T906/T1007) reduces KCC2 function. We have created a KCC2‐T906/T1007‐Alanine knock‐in mouse in an attempt to increase KCC2 function in the brain. Basal EGABA values are substantially hyperpolarized in these mice and the rate in which Cl− can be extruded from neurons is increased. This confirms we have developed the first KCC2‐gain‐of‐function mouse model.In three different in vitro models of seizure‐like‐activity, the KCC2‐gain‐of‐function mice showed a prominent reduction in seizure severity. This study provides direct evidence that increasing KCC2 function is a valid therapeutic strategy to alleviate the burden of epilepsy.

Author response: Excess mortality and hospitalized morbidity in newly treated epilepsy patients.

We thank Dr. Sethi for the comment on our article.1 We acknowledge that the association between epilepsy and other conditions may be due to confounders, but the association is present nonetheless; this demonstrates that the larger burden conferred by epilepsy is attributable in part to comorbid conditions. There may even be a triangular relationship among epilepsy, psychiatric, and physical comorbidities, operating through unhealthy lifestyles in terms of diet and physical activity. There was no capacity in our study to reliably assess and account for such lifestyle factors long term. However, this is a worthwhile area for future research, made feasible by the ubiquitous wearable devices capable of tracking physical activity.2

Letter re: Excess mortality and hospitalized morbidity in newly treated epilepsy patients.

I read with interest the article by Chen et al.1 on the burden of mortality and hospitalized morbidity in newly treated patients with epilepsy in Hong Kong. The authors documented a very high rate of physical and psychiatric comorbidities in the cohort of patients with epilepsy, especially those on enzyme-inducing antiepileptic drugs (EIAEDs). While psychiatric comorbidities in patients with epilepsy have been well-documented and are thought to have a bidirectional relationship, the physical comorbidities (increased cancer, stroke, and cardiovascular disease [CVD] risk) are less well-reported and, if substantiated in other epilepsy population groups, a cause of concern.

The long-term prognosis of epilepsy patients with medically treated over a period of eight years in Turkey.

Objective:The aim of this study was to investigate the effect of demographic and clinical characteristics on temporal changes in seizure control and frequency in medically treated epilepsy patients to guide treatment modalities.Methods:We retrospectively analyzed the association between clinical and demographic characteristics and seizure frequency in 1329 epilepsy patients who were followed up at an outpatient clinic for one to eight years, 2008-2015..Results:Younger age at first seizure (p = 0.0465) and a long disease duration (p = 0.0406) had a negative effect on seizure control in all the epilepsy patients. Febrile convulsions (FCs) (p > 0.0001), perinatal risk (PNR) (p > 0.0002), a family history of epilepsy (FHE) (p > 0.0016), antiepileptic drug (AED) use (p > 0.001), mental retardation (MR) (p > 0.001), and psychiatric disorders (p > 0.0478) were prognostic indictors of temporal changes in seizure frequency. The presence of PNR (p = 0.0416), age at onset of epilepsy (p = 0.034), central nervous system infection (CNSI) (p = 0.04), and AEDs number (p = 0.0282) were prognostic indicators of not remaining seizure free for one year. In those with partial epilepsy, a trauma history (p = 0.05), a longer epilepsy duration (p = 0.0057), and FHE (p = 0.0466) increased the frequency of seizures, whereas cerebrovascular event (CVE) history decreased the seizure frequency (p = 0.0413). In addition, FHE (p = 0.0438) and psychotic disorders (p = 0.0416) increased generalized seizures frequency.Conclusion:In all the epilepsy patients, a younger age at onset and longer duration of epilepsy were associated with a poor prognosis. The presence of PNR, age at onset of epilepsy, CNSI, and AEDs numbers were prognostic indicators of not remaining seizure free for one year. Increasing AEDs number was not effective in controlling seizures in partial epilepsy, but it was effective in controlling seizures in generalized epilepsy.

Excess mortality and hospitalized morbidity in newly treated epilepsy patients.

To assess the burden of mortality and hospitalized morbidity in newly treated epilepsy patients. We extracted relevant data of patients with newly treated epilepsy between September 16, 2005, and September 15, 2010, from the data repository covering all public hospitals in Hong Kong. Patients were followed up until September 15, 2011. Mortality and hospitalized morbidity were assessed, stratified by baseline comorbidities, number of antiepileptic drugs (AEDs) used, and treatment with enzyme-inducing AEDs (EIAEDs). Mortality was compared to the age- and sex-specific general population in Hong Kong. Of the 7,461 newly treated epilepsy patients (55% male; median age 60 years), 2,166 (29%) died during the study period. The standardized mortality ratio was 5.09 (95% confidence interval [CI] 4.88-5.31), and was higher among those with physical or psychiatric baseline comorbidity (5.46; 95% CI 5.22-5.71) than those without (3.28; 95% CI 2.87-3.73). Standardized hospitalization ratio was 6.76 (95% CI 6.70-6.82). Baseline physical comorbidity-free patients (n = 3,514) exhibited higher risk of developing stroke (standardized incidence ratio [SIR] 4.96; 95% CI 4.19-5.84) and ischemic heart disease (SIR 4.18; 95% CI 3.54-4.91), and male patients had elevated risk of developing cancer (SIR 2.30; 95% CI 1.75-2.97). Patients treated with EIAEDs had higher risk of being subsequently recorded with new physical comorbidities than those with non-EIAEDs (relative risk [RR] 1.48; 95% CI 1.19-1.85), especially for cerebrovascular disease (RR 1.78; 95% CI 1.14-2.77). Newly treated epilepsy patients bear excess mortality and hospitalization risks. They have higher risk of developing stroke, ischemic heart disease, and cancer. Treatment with EIAEDs was associated with increased overall morbidity.