Focal Seizure Types Research Articles

Anti-seizure medication prescription preferences: a Moroccan multicenter study.

The management of epilepsy is mainly based on antiseizure medications (ASMs). More than 20 ASMs have been introduced in clinical practice, providing a multitude of prescription choices. To date, there are no published data on the trends in ASMs prescriptions in Morocco. Therefore, we conducted a survey among practicing neurologists in seven tertiary referral hospitals in Morocco to study the current ASMs prescription preferences and their modifying factors. Our descriptive and analytical cross-sectional study was based on a survey sent between January and April 2022 to neurologists practicing in seven tertiary referral hospitals in Morocco. Information regarding the prescription of ASMs was collected using an exploitation form and analyzed using the SPSS version 13 software. Based on questionnaire responses, our results showed that Valproic acid (96.3%) and Lamotrigine (59.8%) were the two most prescribed ASMs for generalized seizure types. For focal seizure types, Carbamazepine (98.8%) and Levetiracetam (34.1%) were the most commonly prescribed drugs, whereas for combined focal and generalized seizure types, the combination of Valproic acid and Carbamazepine (38.55%) was the most prescribed. Phenobarbital was the most commonly prescribed ASM for status epilepticus (40.2%). These prescription preferences were mainly due to seizure types, cost, health insurance coverage, years of experience, and additional epileptology training (p < 0.05). Our results show a shift in the prescription of ASMs in Morocco. Similar to many other countries, valproic acid and carbamazepine are considered the first-line treatments for generalized and focal seizure types. Some factors remain as major challenges in enhancing epilepsy management in Morocco.

SEEG-based epileptic seizure network modeling and analysis for pre-surgery evaluation

Stereo-electroencephalography is a minimally invasive technique for patients with refractory epilepsy pursuing surgery to reduce or control seizures. Electrodes are implanted based on pre-surgery evaluations and can collect deep brain activities for surgery decisions. This paper presents a methodology to analyze stereo-electroencephalography and assist clinicians by recommending the optimal surgical option and target areas for focal epilepsy patients. A seizure network (graph) model is proposed to characterize the spatial distribution and temporal changes of ictal events. The network nodes and edges correspond to specific epileptogenic regions and propagation/impact pathways (weighted by directed transfer function), respectively. We then employ a K-means clustering strategy to group nodes into a few clusters, from which the target surgical areas can be identified. Ten patients with different types of focal seizures were thoroughly analyzed. Promising consistency between results of our method’s recommendations, clinical decisions and surgery outcomes were observed.

A STUDY OF CLINICAL AND IMAGING FEATURES OF REFRACTORY EPILEPSY IN PATIENTS ATTENDING A TERTIARY CARE HOSPITAL

Background &amp; objectives Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. It is estimated that 70% of people living with epilepsy could live seizure free if properly diagnosed and treated. The exact magnitude of medically intractable epilepsy in India is unknown. The factors that determine the outcome of epilepsy are age of onset and the type of seizure. The aim of our study was to identify the causes of refractory epilepsy To identify the clinical and imaging features i Objectives: n refractoriness. To determine the importance of early and proper evaluation of seizures in refractory epilepsy. It was an observational study Methods: in patients of refractory epilepsy. After taking informed consent, detailed history was taken and examination was done. 105 Patie Results: nts with refractory epilepsy were included in the study. Majority were between 21-30 years age group. 44% of the patients had the onset of seizures below 10 years. Focal seizure type (68 patients) was the most frequent type. Status epilepticus was found in 41.9% of the patients. Engel's seizure score showed the association of high seizure score with RE. The most common cause for refractoriness was found to be congenital anomalie Interpretation &amp; Conclusions: s in children and calcication in adults.

Use of sulthiame as add-on therapy in children with non-self-limited focal epilepsies of childhood

PurposeThis retrospective study aimed to evaluate the efficacy and tolerability of sulthiame (STM) as an add-on treatment in 49 patients with non-self-limited focal epilepsies of childhood (non-SeLFE) resistant to other antiseizure medications (ASM) and/or non-pharmacological treatment. MethodsPatients with non-SeLFE who had failed to respond to at least five previous ASM, alone or in combination, were included in the study. All patients underwent neurological examination, brain magnetic resonance imaging repeated prolonged electroencephalography (EEG) or video-EEG studies, and neurometabolic studies. School achievements and/or performance on neuropsychological tests were also assessed. Sulthiame was added in doses ranging from 10 to 40 mg/kg/day. Efficacy was measured by comparing seizure frequency before and after initiating STM therapy. ResultsTwenty-nine of 49 patients (59.1%) who received STM as add-on therapy had a greater than 50% decrease in seizures after a mean follow-up of 35 months. One patient (2%) became seizure-free. Fourteen patients (40%) had a 25–50% seizure reduction. The mean time of response was 5 months (range, 3.5 to 6 months). No differences were found either between patients with a response of more or less than 50% or between the response of the focal seizure types (motor or non-motor, with or without consciousness impairment). ConclusionIn our study, STM was found to be effective and well-tolerated in children and adolescents with non-SeLFE. In the patients who responded, improvement in the EEG was seen.

Brain network dynamics codify heterogeneity in seizure evolution.

Dynamic functional brain connectivity facilitates adaptive cognition and behaviour. Abnormal alterations within such connectivity could result in disrupted functions observed across various neurological conditions. As one of the most common neurological disorders, epilepsy is defined by the seemingly random occurrence of spontaneous seizures. A central but unresolved question concerns the mechanisms by which extraordinarily diverse propagation dynamics of seizures emerge. Here, we applied a graph-theoretical approach to assess dynamic reconfigurations in the functional brain connectivity before, during and after seizures that display heterogeneous propagation patterns despite sharing similar cortical onsets. We computed time-varying functional brain connectivity networks from human intracranial recordings of 67 seizures (across 14 patients) that had a focal origin—49 of these focal seizures remained focal and 18 underwent a bilateral spread (focal to bilateral tonic-clonic seizures). We utilized functional connectivity networks estimated from interictal periods across patients as control. Our results characterize network features that quantify the underlying functional dynamics associated with the observed heterogeneity of seizure propagation across these two types of focal seizures. Decoding these network features demonstrate that bilateral propagation of seizure activity is an outcome of the imbalance of global integration and segregation in the brain prior to seizure onset. We show that there exist intrinsic network signatures preceding seizure onset that are associated with the extent to which an impending seizure will propagate throughout the brain (i.e. staying within one hemisphere versus spreading transcallosally). Additionally, these features characterize an increase in segregation and a decrease in excitability within the brain network (i.e. high modularity and low spectral radius). Importantly, seizure-type-specific differences in these features emerge several minutes prior to seizure onset, suggesting the potential utility of such measures in intervention strategies. Finally, our results reveal network characteristics after the onset that are unique to the propagation mechanisms of two most common focal seizure subtypes, indicative of distinct reconfiguration processes that may assist termination of each seizure type. Together, our findings provide insights into the relationship between the temporal evolution of seizure activity and the underlying functional connectivity dynamics. These results offer exciting avenues where graph-theoretical measures could potentially guide personalized clinical interventions for epilepsy and other neurological disorders in which extensive heterogeneity is observed across subtypes as well as across and within individual patients.

Efficacy of cenobamate by focal seizure subtypes: Post-hoc analysis of a phase 3, multicenter, open-label study

PurposeTo report post-hoc efficacy data by focal seizure subtypes from 10 US study sites from a large, global, open-label, phase 3 study of adjunctive cenobamate. MethodsPatients 18–70 years old with uncontrolled focal seizures taking stable doses of 1–3 antiseizure medications were administered increasing daily doses of cenobamate (12.5, 25, 50, 100, 150, 200 mg/day) at 2-week intervals (target dose 200 mg/day). Further increases to 400 mg/day by 50-mg/day increments every other week were allowed. Results240 patients were evaluated; 27 (11.3%), 224 (93.3%), and 56 (23.3%) patients had focal aware motor (FAM), focal impaired awareness (FIA), and focal to bilateral tonic-clonic (FBTC) seizures, respectively (patients may have had ≥ 1 seizure subtype). Median baseline seizure frequencies/28 days were 10.5, 2.3, and 0.9 for FAM, FIA, and FBTC seizure subtypes. Reductions in median percent seizure frequency/28 days from baseline were observed during Months 1–3 (55.0%, 52.4%, and 94.1% for FAM, FIA, and FBTC). Greater reductions were observed during Months 4–5 (88.2%, 81.0%, and 100%) and during Months 25–27 (98.1%, 100%, and 100%). The percentage of patients achieving 100% seizure reduction in the FAM, FIA, and FBTC seizure subtypes was 22.2% (6/27), 21.5% (48/223), and 50% (28/56) during Months 1–3 and increased to 47.8% (11/23), 54.3% (88/162), and 90.5% (38/42) during Months 25–27, respectively. The most common treatment-emergent adverse events (≥ 20%) were fatigue, dizziness, and somnolence. No cases of DRESS were reported. ConclusionsSeizure reductions occurred in all focal seizure subtypes with cenobamate over time through Months 25–27, with the earliest onset in the FBTC group. Results from this subset analysis of the phase 3 study support the long-term efficacy of cenobamate across focal seizure types.

Bcl-2 and caspase-9 serum levels in children and adolescents with idiopathic epilepsy and active seizures.

In the present study we investigated the levels of proapoptotic caspase-9 and antiapoptotic Bcl-2 proteins in the sera of children and adolescents with idiopathic epilepsy and tried to relate the findings to the patients' clinical parameters. This retrospective study consisted of 118 children and adolescents with idiopathic epilepsy, categorized according to type and number of seizures, duration of the disease and the control of seizures and 30 age- and sex-matched controls. The relapse of seizures was taken into consideration. Mean serum level between Bcl-2 and caspase-9 was significantly higher only in Bcl-2 patients, compared to controls (P≤0.0001) and (P=0.987) respectively. Significant difference in Bcl-2 level was found among the different types of focal seizures. Caspase-9 level was statistically different in patients with two or more seizures per month compared to those with one seizure per month (P=0.048). No correlation was found between Bcl-2 and caspase-9 levels and age, gender, seizure frequency, total number of seizures and the duration of epilepsy. No significant difference was found in patients with and without drug treatment. Bcl-2 displays an association with apoptosis and highlights the potential of being a surrogate biomarker for active seizures and epilepsy. There is a significant difference in Bcl-2 serum level among the different types of focal seizures. Proapoptotic caspase-9 cannot act as a marker of active seizures and epilepsy. Caspase-9 serum level is increased acutely in controlled cases after a single relapse.

Spectral and network characterization of focal seizure types and phases

Background and objectiveCurrently, epileptic seizure characterization relies on several clinical features that allow their classification into different types. The present work aims to characterize both seizure types and phases based exclusively on electrophysiological characteristics. MethodsBased on the analysis of intracranial EEG recordings of 129 seizures from 22 patients obtained from the European Epilepsy Database, network and spectral measures were calculated in five-second temporal windows. Statistically significant differences between each window of the seizure phases (preictal, ictal, and postictal) and the interictal phase were used to identify/classify seizure types and their phases. A support vector machine (SVM) working on a multidimensional feature space of network and spectral measures was implemented for the classification of each seizure type; a traditional statistical approach was also conducted to highlight the underlying patterns to each seizure type or phase. ResultsThe percentage of correct classification of seizure types, corrected by chance, provided by the SVM exceeded 70%, considering all measures and the entire seizure (preictal + ictal + postictal). This percentage increased to more than 80% when all the measures during the ictal period for the depth electrodes or during the postictal for subdural electrodes were considered. Regarding the statistical approach, several measures presented a monotonic ascending and descending behavior with respect to seizure severity; these changes were observed during the ictal and postictal periods. Some measures were specific of each seizure type. ConclusionsOur results provide a new framework to seizure characterization and reveal the possibility of an exclusively intracranial EEG-based classification. This could be used to build an automatic seizure classification system and provides new evidence of the network-related physiopathology of epilepsies. Thus, the novelty of this work is the possibility of differentiating seizure types based exclusively on the EEG recordings, providing evidence of the underlying patterns or characteristics to each seizure type and/or phase that would allow their optimal classification.

An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa.

BackgroundGlobally, adults presenting with seizures account for 1% – 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients.ObjectivesTo review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting.MethodA retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures.ResultsThe mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes.ConclusionA high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24–48 h in a resource restricted setting.

Seizure in children: How important is EEG &amp; Neuroimaging?

Seizure in children are generally indicating a potentially serious underlying systemic or CNS disorders that require thorough clinical examination, investigation and management. It is therefore important to establish accurate diagnosis of seizure and its etiology to manage such patients appropriately. We carried out this study to evaluate different etiology of seizures and its correlation with abnormal EEG &amp; abnormal neuroimaging in the age group of 2mo to 14 years. 200 children presented with seizure to our department from January 2019 to November 2020 were enrolled in this prospective hospital-based study. Detailed history, clinical examination, investigation with special emphasis to EEG &amp; neuroimaging was done and different correlation was drawn by using SSPS 18.0 statistical analysis. Among 200 cases, 6 to 10yr. age group constituted maximum (49%) number of cases. Male to female ratio is 1.5:1. GTCS is the predominant pattern of seizure (60%) in all age groups. EEG abnormality is found in 45%, mostly in focal seizure type. Neuroimaging abnormality found in 29%. Maximum cases (30%) had infectious etiology. Childhood seizure needs detailed history taking and careful examination. Vedio recording shown by parents / caregivers really help towards differentiating seizure from seizure mimics. EEG has a role in specific seizure type; Neuroimaging at times helps in diagnosis. There are few studies that describe neuroimaging [Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)] and Electroencephalogram (EEG) data in children who present with new-onset seizures. The EEG is recommended as a part of the neurodiagnostic evaluation of the child with an apparent first unprovoked seizure.

Perampanel in the additional therapy of focal and primary generalized tonic-clonic seizures in children 4–12 years old: clinical data, experience of use and practical recommendations

On March 18, 2021, an online council of experts in the field of epilepsy treatment was held, dedicated to the use of perampanel in the additional therapy of focal seizures (FS) and primary generalized tonic-clonic seizures (PGTCS) in children 4–12 years old. During the event, the features of the use of perampanel in this group of patients were discussed, considering the specifics of everyday clinical practice, current possibilities of PGTCS and FS therapy in children, its goals, as well as unsolved problems in the treatment of pediatric patients with PGTCS and FS. Particular attention was paid to the role of perampanel in the treatment of PGTCS and FS in children and its effectiveness in specific types of focal seizures.

Genetics and clinical correlation of Dravet syndrome and its mimics – experience of a tertiary center in Taiwan

Dravet syndrome is a severe developmental and epileptic encephalopathy characterized by the onset of prolonged febrile and afebrile seizures in infancy and SCN1A gene mutations. In some cases, non-SCN1A gene mutations can present with a phenotype very similar to that of Dravet syndrome. The aim of this study was to compare phenotypes of patients with SCN1A and non-SCN1A gene mutation-related Dravet syndrome. Thirty-six patients with Dravet syndrome-like phenotypes were followed from July 2017 to December 2019. We retrospectively analyzed their clinical profiles and genetic surveys. Of the 36 enrolled patients, 15 (41.7%) had SCN1A mutations, one (2.8%) had an SCN8A mutation, one (2.8%) had an STX1B mutation, and five females (13.9%) had PCDH 19 mutations. The median age at first seizure onset was 7 months in those with SCN1A mutations, 1.3 years in those with PCDH19 mutations, and 10 months for the remaining patients. The majority of the patients with SCN1A mutations had status epilepticus (80% vs. 20%) and fever-sensitive seizures (76% vs. 31%) compared to those with PCDH19 mutations. The patients with SCN1A-related seizures had a higher rate of focal seizures as first seizure type than those without SCN1A mutations. Three of five (60%) patients with PCDH19 mutations had brain magnetic resonance imaging abnormalities. The three most commonly used antiseizure medications were sodium valproate, levetiracetam, and clobazam. Seven of the 15 patients with SCN1A mutations used stiripentol. The median time from seizure onset to genetic diagnosis was 6.6 years (range 4 months-22.3 years). The patients with SCN1A mutations in this study had high rates of fever-sensitive seizures, status epilepticus, seizure onset with focal seizure type, and relatively young age at seizure onset. The patients with PCDH19 mutations had a relatively high rate of abnormal brain magnetic resonance imaging findings.

Forecasting Seizure Storms Using Epilepsy Wristband Sensors.

Machine Learning From Wristband Sensor Data for Wearable, Noninvasive Seizure Forecasting Meisel C, El Atrache R, Jackson M, Schubach S, Ufongene C, Loddenkemper T. Epilepsia. 2020;61(12):2653-2666. doi:10.1111/epi.16719Objective:Seizure forecasting may provide patients with timely warnings to adapt their daily activities and help clinicians deliver more objective, personalized treatments. Although recent work has convincingly demonstrated that seizure risk assessment is in principle possible, these early approaches relied largely on complex, often invasive setups including intracranial electrocorticography, implanted devices, and multichannel electroencephalography and required patient-specific adaptation or learning to perform optimally, all of which limit translation to broad clinical application. To facilitate broader adaptation of seizure forecasting in clinical practice, noninvasive, easily applicable techniques that reliably assess seizure risk without much prior tuning are crucial. Wristbands that continuously record physiological parameters, including electrodermal activity, body temperature, blood volume pulse, and actigraphy, may afford monitoring of autonomous nervous system function and movement relevant for such a task, hence minimizing potential complications associated with invasive monitoring and avoiding stigma associated with bulky external monitoring devices on the head.Methods:Here, we applied deep learning on multimodal wristband sensor data from 69 patients with epilepsy (total duration >2311 hours, 452 seizures) to assess its capability to forecast seizures in a statistically significant way.Results:Using a leave-one-subject-out cross-validation approach, we identified better-than-chance predictability in 43% of the patients. Time-matched seizure surrogate data analyses indicated forecasting not to be driven simply by time of day or vigilance state. Prediction performance peaked when all sensor modalities were used and did not differ between generalized and focal seizure types but generally increased with the size of the training data set, indicating potential further improvement with larger data sets in the future.Significance:Collectively, these results show that statistically significant seizure risk assessments are feasible from easy-to-use, noninvasive wearable devices without the need of patient-specific training or parameter optimization.

Profile of People with Epilepsy seen at a Tertiary Hospital in North-West Nigeria

Epilepsy is one of the most prevalent chronic non-communicable neurological disorder. Persons with epilepsy (PWE) have unique characteristics that have social impacts on the affected individuals and their family. This study sought to describe the profile of patients with epilepsy attending the out-patient neurology clinic in a tertiary health care centre in North West Nigeria. The study was carried out at Neurology clinic of Ahmadu Bello University Teaching Hospital Kaduna State, Nigeria from August 2013 to October 2014. Consecutively presenting PWE on follow-up were recruited after obtaining ethical approval and informed consent. Those recruited were at least 18 years and have been on routine follow-up for at least 1 year. Patients with clinical and electroencephalography (EEG) features suggestive of non-epileptic seizures, acute metabolic or febrile illness precipitating seizures were excluded. A structured questionnaire was used to obtain all relevant information. The data was analyzed using SPSS version 17 with p-value set at less than 0.05. A total of 103 PWE were recruited with median age of 29 years. More than 50% were in the 21-30 years age group. About 55.3% were single (never married), 58.2% were unemployed and earned &lt; ₦50,000.00 monthly income. The median age of onset of epilepsy was 20 years, while median duration of illness was 7 years. About 50.5% were focal seizures, with traumatic head injury (14.6%) and febrile convulsion (12.6%) as aetiological factors, while 52.5% of them had no identifiable aetiological factor. About 96% were on antiepileptic drug monotherapy, 82% of them on carbamazepine only for a median duration of 7.5 years. Our study shows that epilepsy is predominant among the young population, who are mostly single (never married), unemployed, with poor monthly income occurring more as focal seizure type, with majority of them on carbamazepine monotherapy. There is the need for public enlightenment campaign and effort targeted at mitigating the prevalence of the disease among the young and productive population.

Machine learning from wristband sensor data for wearable, noninvasive seizure forecasting.

Seizure forecasting may provide patients with timely warnings to adapt their daily activities and help clinicians deliver more objective, personalized treatments. Although recent work has convincingly demonstrated that seizure risk assessment is in principle possible, these early approaches relied largely on complex, often invasive setups including intracranial electrocorticography, implanted devices, and multichannel electroencephalography, and required patient-specific adaptation or learning to perform optimally, all of which limit translation to broad clinical application. To facilitate broader adaptation of seizure forecasting in clinical practice, noninvasive, easily applicable techniques that reliably assess seizure risk without much prior tuning are crucial. Wristbands that continuously record physiological parameters, including electrodermal activity, body temperature, blood volume pulse, and actigraphy, may afford monitoring of autonomous nervous system function and movement relevant for such a task, hence minimizing potential complications associated with invasive monitoring and avoiding stigma associated with bulky external monitoring devices on the head. Here, we applied deep learning on multimodal wristband sensor data from 69 patients with epilepsy (total duration>2311hours, 452 seizures) to assess its capability to forecast seizures in a statistically significant way. Using a leave-one-subject-out cross-validation approach, we identified better-than-chance predictability in 43% of the patients. Time-matched seizure surrogate data analyses indicated forecasting not to be driven simply by time of day or vigilance state. Prediction performance peaked when all sensor modalities were used, and did not differ between generalized and focal seizure types, but generally increased with the size of the training dataset, indicating potential further improvement with larger datasets in the future. Collectively, these results show that statistically significant seizure risk assessments are feasible from easy-to-use, noninvasive wearable devices without the need of patient-specific training or parameter optimization.

Accuracy of ICD-10-CM claims-based definitions for epilepsy and seizure type

ObjectiveTo evaluate the accuracy of ICD-10-CM claims-based definitions for epilepsy and classifying seizure types in the outpatient setting. MethodsWe reviewed electronic health records (EHR) for a cohort of adults aged 18+ years seen by six neurologists who had an outpatient visit at a level 4 epilepsy center between 01/2019−09/2019. The neurologists used a standardized documentation template to capture the diagnosis of epilepsy (yes/no/unsure), seizure type (focal/generalized/unknown), and seizure frequency in the EHR. Using linked ICD-10-CM codes assigned by the provider, we assessed the accuracy of claims-based definitions for epilepsy, focal seizure type, and generalized seizure type against the reference-standard EHR documentation by estimating sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). ResultsThere were 673 eligible outpatient encounters. After review of EHRs for standardized documentation, an analytic sample consisted of 520 encounters representing 402 unique patients. In the EHR documentation, 93.5 % (n = 486/520) of encounters were with patients with a diagnosis of epilepsy. Of those, 66.0 % (n = 321/486) had ≥1 focal seizure, 41.6 % (n = 202/486) had ≥1 generalized seizure, and 7% (n = 34/486) had ≥1 unknown seizure. An ICD-10-CM definition for epilepsy (i.e., ICD-10 G40.X) achieved Sn = 84.4 % (95 % CI 80.8−87.5%), Sp = 79.4 % (95 % CI 62.1−91.3%), PPV = 98.3 % (95 % CI 96.6−99.3%), and NPV = 26.2 % (95 % CI 18.0−35.8%). The classification of focal vs generalized/unknown seizures achieved Sn = 69.8 % (95 % CI 64.4−74.8%), Sp = 79.4 % (95 % CI 72.4−85.3%), PPV = 86.8 % (95 % CI 82.1−90.7%), and NPV = 57.5 % (95 % CI 50.8−64.0%). ConclusionsClaims-based definitions using groups of ICD-10-CM codes assigned by neurologists in routine outpatient clinic visits at a level 4 epilepsy center performed well in discriminating between patients with and without a diagnosis of epilepsy and between seizure types.

A Russian retrospective multicenter open-label observational study based on medical documentation on the use of perampanel in everyday clinical practice

Objective : to retrospectively assess the Russian experience with perampanel (PER) in everyday clinical practice as an adjunctive medication for the treatment of patients aged 12 years or older with focal epilepsy (FE). Patients and methods . A multicenter retrospective study was conducted, during which the physicians filled out standard questionnaires assessing the characteristics of the disease and the therapy performed. The maximum follow-up period was 12 months. Each patient was included in the study only once for the duration of the study. A total of 164 cases of pharmacoresistant FE were analyzed. The patients' mean age was 37.7 years; the male to female ratio was 1:1. The disease duration over 10 years was in 68.7% of patients; structural epilepsy was present in 68.2% (temporal and frontal lesions in 53.4 and 39.1%, respectively) Results and discussion . Most (26.6%) patients were prescribed PER after three previous lines of therapy; before PEP administration, there was a maximum of 2 (50.9%) and 3 (29.6%) drugs, respectively, in the combination. The initial frequency of all seizure types reached 9 [3; 34] per month; that of focal-onset bilateral tonic-clonic seizures was 3 [2; 6] per month. Combined therapy including PER could lead to the disappearance of seizures in 22.7% of cases; the responders (by all seizure types) were 52.8%, whereas the remission rate of bilateral tonic-clonic seizures was 60.8% of patients, the responder rate was 27,8%. At 12 months of follow-up, the therapy retention rate reached 80.7% (95% confidence interval, 72.3—89.1). Adverse events (AEs) were noted in 31.3% of patients; the most frequent AEs were drowsiness (10.4%), aggression (9.8%), irritability (6.7%); other AEs were observed in individual cases. The average dose of PER was 8 mg. Conclusion . PER was effective in patients with resistant PEs at a maximum follow-up of 12 months in routine clinical practice. Remission of all seizure types was achieved in 22.7% of cases, the decrease in the number of seizures &gt;50% was seen in 52.8% of cases; the therapy retention rate was 80.7%. The drug had a therapeutic effect in all types of focal seizures and was most effective in focal-onset bilateral tonic-clonic seizures. Along with its good clinical effect, PER demonstrated a predictable safety profile.

Time course of 75%-100% efficacy response of adjunctive brivaracetam.

BackgroundTime to sustained seizure frequency reduction can provide clinically meaningful epilepsy outcomes.Aims of the StudyTo examine the time course of brivaracetam (BRV) efficacy in adults with focal seizures and focal to bilateral tonic‐clonic seizures (FBTCS).MethodsPost hoc analysis of data pooled from three randomized controlled trials of oral adjunctive BRV in adults with epilepsy. Patients with focal epilepsy and a subpopulation with FBTCS receiving BRV 50, 100, or 200 mg/d (initiated without up‐titration) or placebo for 12 weeks were analyzed for time to sustained ≥75%, ≥90%, and 100% seizure reduction without interruption from first day until trial ends.ResultsEvaluation included 1160 patients with focal seizures, including 352 patients with FBTCS. Sustained ≥75%, ≥90%, and 100% response in focal seizures was higher from day 1 for BRV 100 and 200 mg/d vs placebo (P < .01). Sustained ≥75% and 100% FBTCS reduction from day 1 was higher for BRV 100 and 200‐mg/d groups vs placebo (P < .01).ConclusionsThe majority of patients achieving 75%‐100% sustained seizure frequency reduction (all focal seizure types and the subpopulation with FBTCS) with oral BRV (100 or 200 mg/d) achieved this response on the first‐treatment day.

Stress Hyperglycemia as Predictive Factor of Recurrence in Children with Febrile Seizures.

Stress hyperglycemia and hyperlactatemia are commonly referred to as markers of stress severity and poor outcome in children with severe acute illness or febrile seizures. Our prospective study aimed to explore the risk factors for stress hyperglycemia and the predictive value of stress hyperglycemia for febrile seizure recurrence. We evaluated as risk factors for blood glucose level, serum lactate, acid–base status, and the clinical parameters relevant to the severity of the infectious context or to febrile seizure event: fever degree, fever duration, seizure type and aspect, seizure duration, and recurrence. Among 166 febrile seizures events in 128 children, the prevalence of stress hyperglycemia (blood glucose >140 mg/dl) was 16.9%. The comparison of the stress versus non-stress hyperglycemia groups revealed lower pH (median (interquartile range): 7.46 (7.37, 7.53) vs. 7.48 (7.42, 7.53), p = 0.049), higher lactate levels (30.50 mg/dl (15, 36) vs. 19.50 mg/dl (15, 27), p = 0.000), slightly lower HCO3 (20.15 (20.20, 21.45) vs. 21.35 (20, 22.40), p = 0.020) in the stress hyperglycemia group. Multiple logistic regression analysis showed that prolonged febrile seizures (>15 min), recurrent febrile seizure (>1 seizure), focal seizure type, body temperature ≥39.5 °C and higher lactate values were significantly associated with stress hyperglycemia. These findings suggest a particular acute stress reaction in febrile seizures, with stress hyperglycemia playing an important role, particularly in patients with a recurrent seizure pattern. A more complex future approach linking pathogenic mechanisms and genetic traits would be advised and could provide further clues regarding recurrence pattern and individualized treatment.

Overview of Post-Stroke Epilepsy

Stroke is the most common cause of seizures, symptomatic epilepsy, and status epilepticus in elderly. Symptomatic stroke-related seizures symptoms are dependent on lesions topography. All types of focal seizures can be observed. Many clinical studies make a distinction between early (within 7 to 14 days of stroke onset) and late (beyond 14 days of stroke onset) seizures based on presumed physiopathological differences. The diagnosis of a seizure during the acute phase of a stroke can be difficult in the absence of a witness when there are disorders of vigilance and speech. The use of antiepileptic drugs is discussed in all cases. New antiepileptic drugs appear to be most appropriate. The aim of this study is to present an overview of the epidemiological, clinical and therapeutic features of vascular epilepsy based on meta-analyses and the more recently published expert recommendations.