Uncontrolled Seizures Research Articles

Cognitive profiles in patients with epileptic and nonepileptic seizures evaluated using a brief cognitive assessment tool

BackgroundThere is a need for the development of brief tools to screen for cognitive impairments in epilepsy patients in order to prioritize and direct formal comprehensive cognitive testing. Yet, shorter cognitive screening tools are limited in their breadth of cognitive domains or have not been intensively studied on an epilepsy population. This study used a brief cognitive screening tool in order to compare cognitive profiles between patients with epilepsy and those with nonepileptic seizures. MethodsPatients admitted to the Royal Melbourne Hospital video-EEG monitoring unit between 2005 and 2017 were included. Patients were categorized according to seizure etiology (epileptic, psychogenic or other nonepileptic seizures), epilepsy syndrome (focal or generalized; temporal lobe (TLE) or extra-temporal lobe epilepsy (ETLE)), seizure frequency, and anti-seizure medications (ASMs). Attention, visuoconstructional, memory, executive, and language functioning were assessed with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). General linear mixed models were computed to investigate cognitive profiles according to diagnostic group and other clinicodemographic variables. Results800 patients were included in the analysis (61% female and 39 % male, median age 36 years). Patients with both epileptic seizures and psychogenic seizures (n = 25) had the lowest total scores on NUCOG, followed by patients with epileptic seizures (n = 411), psychogenic seizures (n = 185), and nonepileptic seizures (n = 179, p = 0.002). Specifically, patients with epileptic seizures performed worse than those with nonepileptic seizures in the executive, language, and memory domain, and had lower language domain scores than those with psychogenic seizures. Patients with bilateral TLE had poorer performance than those with unilateral TLE, particularly for memory function. Specific ASMs and polypharmacy but not seizure frequency had a negative effect on cognition (p < 0.001). NUCOG scores did not differ between focal and generalized epilepsies, or between TLE and ETLE. ConclusionThe NUCOG differentiated cognitive profiles in patients with uncontrolled seizures due to different etiologies. Bilateral TLE and medication adversely affected cognitive performance, and overall patients with epilepsy performed worse than those with nonepileptic seizures. These results provide further evidence for sensitivity of the NUCOG for detecting cognitive impairment in patients with seizure disorders.

PP482 Invasive Electroencephalography In The Pre-Surgical Diagnosis Of Pharmacoresistant Epilepsy

IntroductionWorldwide, more than 50 million people suffer from epilepsy, and there are 16–51 new cases per 100,000 population each year. Up to 30 percent of patients with epilepsy are pharmacoresistant, who are candidates for surgical treatment. Invasive electroencephalography (iEEG) is a mandatory method in the arsenal of epileptic centers, and is gradually becoming the gold standard for invasive determination of boundaries between the affected and functional zones of the cortex and subcortical brain. Treatment costs correlate with the severity of the disease, with patients having uncontrolled seizures incurring eight times the costs compared to those with controlled epilepsy.MethodsTo assess the clinical and cost-effectiveness of the iEEG in the pre-surgical diagnosis of pharmacoresistant epilepsy, a systematic search of literature by keywords in the MEDLINE database was conducted. The search resulted in sixty-six articles. The analysis included twenty studies that met the search criteria.ResultsMost studies including meta-analysis show very low rates of complications of iEEG. Literature data demonstrate cost-effectiveness of the method in patients with pharmacoresistant epilepsy in comparison with continued antiepileptic drug therapy. As an integrated method, rather than a simple method, it takes maximum account of clinical, neurophysiological and anatomical-functional data to achieve accurate localization of the epileptogenic zone. Currently, iEEG is a clinically effective method to improve the safety and specificity of resective surgery.ConclusionsWith the use of iEEG, mortality and disability of patients with pharmacoresistant epilepsy will be significantly reduced. It has also been proven that epilepsy surgery leads to significant financial savings in the treatment of pharmacoresistant epilepsy. The results of the clinical and economic evaluation (mini-HTA report) have been submitted to the Ministry of Healthcare for decision-making on including iEEG in government reimbursement system.

Seizure free status as a good predictor for quality of life of temporal lobe epilepsy patients after amygdalohippocampectomy

Background:  The aim of epilepsy surgery is to improve the quality of life of people with epilepsy. Temporal lobe epilepsy (TLE) is the most common form of intractable epilepsy with a risk of low quality of life due to uncontrolled seizures. In this study, we evaluated the quality of life among TLE patients who underwent amygdalohippocampectomy between those who were free from seizure and those who were not.Methods: This was a cross-sectional observational study. The postoperative quality of life was measured by QOLIE-31 questionnaire followed-up at least 12 months since the surgery. Results: Among 31 patients, 21 patients (67.7%) were free from seizures after 12 months of follow-up. We observed significantly higher quality of life of those seizure-free patients either as overall quality of life (p=0.001) or among domains such as seizure anxiety (p=0.003), emotional well-being (p&lt;0.001), fatigue (p&lt;0.001), cognition (p=0.002), medication effects (p=0.01) and social function (p&lt;0.001).Conclusion:  TLE patients who were seizure-free had better quality of life compared to those who were not after amygdalohippocampectomy.

Factors associated with alexithymia in adults with epilepsy

PurposeThe relationship between epilepsy and alexithymia, characterized by the inability to feel or express emotion, remains incompletely understood. We investigated alexithymia and its association with epilepsy-related factors in patients with epilepsy (PWE). MethodsIn this cross-sectional study, PWE and healthy control subjects were recruited. Alexithymia was assessed using the Toronto Alexithymia Scale-20 (TAS-20). The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) were also administered to assess depression and anxiety, respectively. Mediation analysis was conducted using a two-stage regression method. ResultsNinety adult PWE and 161 healthy control subjects were included in the study. PWE had significantly higher TAS-20 scores (B = 2.445, p = 0.014) than controls, but the prevalence of alexithymia, defined as TAS-20≥61, did not differ between PWE and control subjects after controlling for confounders (15.6% vs. 6.2%, respectively; p = 0.873). Uncontrolled seizures significantly increased alexithymia through depression (B = 3.536, p = 0.006), and this effect was responsible for 61.2% of the total effect on alexithymia. The direct effects of uncontrolled seizures on alexithymia were not significant. In contrast, AED polytherapy had significant direct effects on alexithymia (B = 4.489, p = 0.037) independent of depression. The indirect effects of AED polytherapy via depression did not reach statistical significance (B = 2.371, p = 0.066). ConclusionsAlexithymia was more severe, but not more prevalent, in PWE than in healthy controls. AED polytherapy was directly associated with alexithymia, while uncontrolled seizures were indirectly related to alexithymia through depressive symptoms.

Prevalence, severity, and associations of depression in people with epilepsy in Guinea: A single-center study

Background and objectiveDepression has long been recognized as a comorbidity of epilepsy in high-income countries, ranging from 17 to 49% of people with epilepsy (PWE). Of the limited studies from sub-Saharan Africa (SSA), where most people have uncontrolled seizures, an even higher prevalence of depression is reported among PWE at times exceeding 80%. We sought to assess the prevalence and severity of depression and its associated factors among PWE in Guinea, a sub-Saharan West African country where most PWE have poorly controlled seizures. MethodsPeople with epilepsy from the community, age 16 years old and above, were consecutively recruited into a convenience cohort at the Ignace Deen Hospital in the capital city, Conakry, in summer 2018 as part of a larger study characterizing PWE in Guinea. Each participant was evaluated by a team of Guinean physicians and a U.S.-based neurologist to confirm the diagnosis of epilepsy. Inperson interviews were performed to measure demographic, clinical, socioeconomic, and related variables. Depression was measured via the Patient Health Questionniare-9 in the language of the participant's preference with a cutoff of 5 or more points being categorized as depressed. Regression analyses were performed to measure the associations between explanatory variables with the outcome of depression. ResultOf 140 PWE (age range: 16–66 years old; 64 female; 64% taking an antiseizure medication including 28% carbamazepine, 16% phenobarbital, and 14% valproic acid; duration of epilepsy: 11 years; 71% with one or more seizures in the past month; 17% never treated with an antiseizure medication; 90% with loss of consciousness during seizures; 10% without formal education; 31% with university level education; 62% using tap water; 48% with a serious seizure-related injury), the point prevalence of depression was 66% (95% confidence interval [CI]: 58%–74%): 43% of PWE had mild depression, 19% moderate, 4% moderate to severe, and 0.1% severe. In a multivariate analysis, the occurrence of a seizure in the past month (odds ratio: 3.03, 95% CI: 2.63–3.48, p = 0.01) was associated with depression, while gender, self-perceived stigma score, serious injuries, and the number of antiseizure medications taken were not statistically significantly associated (p > 0.05). Twenty-five percent of all participants endorsed thoughts of self-harm or suicidality. ConclusionTwo-thirds of PWE in Guinea had depression in this single-institution convenience cohort. The presence of a seizure in the last month was the factor most associated with depression and is modifiable in many PWE. The high prevalance of depression suggests that screening and addressing depressive symptoms should be incorporated into routine epilepsy care in Guinea.

NCOG-45. FIRST-LINE ANTIEPILEPTIC DRUG TREATMENT IN GLIOMA PATIENTS WITH EPILEPSY: LEVETIRACETAM VERSUS VALPROIC ACID

Abstract BACKGROUND Levetiracetam and valproic acid are two of the most commonly prescribed antiepileptic drugs (AEDs) in patients with a glioma and epilepsy. This study aimed at estimating the cumulative incidence of treatment failure of first-line monotherapy levetiracetam versus valproic acid in glioma patients with epilepsy. METHODS In this retrospective observational study, a competing risk model was used to estimate the cumulative incidence of treatment failure, from AED treatment initiation, for the two AEDs with death as competing event. Patients were matched on baseline covariates potentially related to treatment assignment and/or outcomes of interest according to the nearest neighbour propensity score matching technique. Secondary outcomes were the cumulative incidence of recurrent seizure, from AED treatment initiation (estimated with a competing risk model), and severity of adverse effects. Maximum duration of follow-up was 36 months. RESULTS In total, 776 patients using levetiracetam and 659 using valproic were identified. Matching resulted in two equal groups of 429 patients, with similar covariate distribution. The cumulative incidence of treatment failure (any reason) at 12 months for levetiracetam and valproic acid was equal to 33% (95%CI=29-38%) versus 50% (95%CI=45-55%), respectively (p&amp;lt; 0.001). The cumulative incidence of treatment failure due to uncontrolled seizures was significantly lower for levetiracetam compared to valproic acid (12 months: 16% [95%CI=12-19%] versus 28% [95%CI=23-32%]; p&amp;lt; 0.001), but no differences were found for treatment failure due to adverse effects (12 months: 14% [95%CI=11-18%] versus 15% [95%CI=11-18%]; p=0.636). The cumulative incidence of recurrent seizure of levetiracetam was significantly lower compared to valproic acid (12 months: 54% [95%CI=49-59%] versus 67% [95%CI=62-71%]; p&amp;lt; 0.001). No significant differences were found for level of toxicity. CONCLUSION Our results suggest that levetiracetam has superior efficacy compared to valproic acid, while showing a similar level of toxicity. Therefore, levetiracetam seems the preferred choice for first-line AED treatment in glioma patients.

Rufinamide add-on therapy for drug-resistant epilepsy.

Rufinamide add-on therapy for drug-resistant epilepsy.

Treatment Outcome and Associated Factors among Adult Epileptic Patients at Hawassa University Specialized Hospital, Southern Ethiopia

Epilepsy, once thought to be a disease of evil spirit, is now believed by many as a common neurologic condition that can be effectively treated by optimal use of anti seizure drugs. Despite the availability of multiple and cost effective medications, people with epilepsy could experience episodes of seizures. Aim of the present study was to assess the treatment outcome and associated factors among adult epileptic patients at Hawassa University Specialized Hospital (HUSH), Ethiopia. A cross sectional study was conducted on randomly selected adult epileptic patients. Univariable and multivariable logistic regression analyses were performed to identify factors associated with treatment outcome. Total of 255 patients were included. of whom, 38% had a poorly controlled seizures. Having no formal education [Adjusted Odds Ratio [(AOR): 2.71, 95% Confidence Interval (CI):1.35 -5.46], spending only a year on Anti Seizure Drugs (ASDs) [Adjusted Odds Ratio [(AOR): 4.90, 95% Confidence Interval (CI):1.37-17.50] and low adherence to ASDs [Adjusted Odds Ratio [(AOR): 2.04, 95% Confidence Interval (CI):1.04-4.04] were associated with uncontrolled seizure. Significantly higher epileptic patients had uncontrolled seizure. Epileptic patients with no formal education, who spent a short time on medication and those who have a low medication adherence, were more likely to have uncontrolled seizure. Therefore, more emphasis should be given to these patients.

Sparganosis due to Spirometra sp. (cestoda; Diphyllobothriidae) in captive meerkats (Suricata suricatta).

We report three cases of sparganosis due to plerocercoids of the tapeworm Spirometra sp. in captive meerkats (Suricata suricatta) from a zoo exhibit in the southeastern United States. Two meerkats were euthanized, one due to an uncontrollable seizure and the other due to trauma, and at necropsy cysts containing cestode larvae were observed. A third meerkat had a subcutaneous nodule surgically removed, which contained similar larvae. The third animal died years later, and had numerous cestode larvae in the pleural and peritoneal cavities. The larvae were morphologically identified as plerocercoids of diphyllobothriidean cestodes. On necropsy, multiple nodules, ranging in size from 2.5 to 3.0 cm, were observed in the subcutaneous tissue and muscles. Multifocally, separating skeletal muscle fibers were longitudinal and transversal sections of cestode larva. Histologically, parasitic cysts contained large numbers of neutrophils and macrophages, admixed with proteinaceous material. Molecular and phylogenetic analyses confirmed that specimens from one of the meerkats belonged to the genus Spirometra and was closely related to Spirometra plerocercoids isolated from a snake from the United States and wild felids from South America. Meerkats likely became infected by ingesting infected second intermediate hosts, such as amphibians and reptiles that may have entered the exhibit. Management practices that minimize access of meerkats and other susceptible hosts to intermediate hosts should be implemented.

Brivaracetam for the treatment of focal-onset seizures: pharmacokinetic and pharmacodynamic evaluations

ABSTRACT Introduction The goal of pharmacologic therapy with antiseizure medications (ASMs) is to achieve a seizure-free state with minimal side effects. About one third of patients treated with available ASMs continue to experience uncontrolled seizures. There is still need for new ASMs with enhanced effectiveness and tolerability. Areas covered The present manuscript is based on an extensive Internet and PubMed search from 1999 to 2020. It is focused on the clinical and pharmacological properties of brivaracetam (BRV) in the treatment of epilepsy. Expert opinion BRV is approved as add-on or monotherapy (in US) for the treatment of focal-onset seizures with or without secondary generalization. BRV is a high affinity synaptic vesicle glycoprotein 2A ligand, with 15–30-fold higher affinity than levetiracetam. The selectivity of BRV may be associated with fewer clinical adverse effects. BRV shares many of the pharmacokinetic characteristics of an ideal ASMs. Additionally, BRV has a low potential for clinically relevant drug–drug interactions. Its pharmacokinetic profile makes BRV a promising agent for the treatment of status epilepticus (SE). Although BRV is not approved for the treatment of SE, it has demonstrated promising preliminary results. Further studies are needed to explore the efficacy and tolerability of BRV in SE.

What is the effect of constraint-induced movement therapy on children with unilateral cerebral palsy? A Cochrane Review summary with commentary.

What is the effect of constraint-induced movement therapy on children with unilateral cerebral palsy? A Cochrane Review summary with commentary.

Correlates of Seizure Control Among Patients with Epilepsy at Two Referral Hospitals in Zambia

Background: Epilepsy is a neurological condition that has proven to be a major public health challenge worldwide, including Zambia. Despite the availability of many treatment alternatives, people with epilepsy still experience seizures. There is paucity of information on the control of seizures and associated factors in Zambia.&#x0D; Methods: A cross sectional study was conducted among epileptic patients at Kitwe and Ndola Teaching Hospitals, two referral hospitals in Northern Zambia, from September 2 to September 23, 2019. We performed a multivariate logistic regression analysis to identify independent predictors of seizure control. Adjusted odds ratios and their 95% confidence intervals are reported.&#x0D; Results: A total of 220 epileptic patients were enrolled in the study. Of these, 23.6% had controlled seizures while 76.4% had uncontrolled seizures. Occupation (p value=0.018), level of education (p value&lt;0.001), clinic attendance (p value&lt;0.001), drug adherence (p value&lt;0.001), belief about drugs (p value=0.006) and having friends (p value=0.025) were significantly associated with seizure control. A higher level of education (AOR:0.243, CI:0.080-0.738), regular clinic attendance (AOR:8.578, CI:3.327-22.112) and age at first seizure of 7-12 years (AOR: 1.035, CI:0.240-4.454) were predictors of controlled seizures.&#x0D; Conclusions and Implications for Translation: Our study showed that there was a low prevalence of controlled seizures among the study population.&#x0D; Key words: • Seizure • Control • Epilepsy • Zambia • Healthcare&#x0D; &#x0D; Copyright © 2020 Mwansa et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Biotin–Thiamine Responsive Basal Ganglia Disease Presented as Intractable Seizure in a 1-Month-Old Infant

AbstractBiotin–thiamine responsive basal ganglia disease is a neurometabolic disorder, seen in children presenting with encephalopathy, seizures, and positive family history. The disease is diagnosed based on typical magnetic resonance imaging (MRI) findings and whole exome sequencing but may be initially misdiagnosed as a mitochondrial encephalopathy or an inborn error of metabolism (IEM). We describe the case of an infant who presented with uncontrolled seizures and encephalopathy, responding to high doses of thiamine and biotin. Life-long supplementation of biotin (2–10 mg/kg/day) and thiamine (200–300 mg/day) improves the symptomatology and prevents relapse. Outcomes of the disease are heterogeneous, ranging in scope from complete remission to severe neurological sequelae.

Letter: Using Continuous Intracranial Electroencephalography Monitoring to Manage Epilepsy Patients During COVID-19.

Letter: Using Continuous Intracranial Electroencephalography Monitoring to Manage Epilepsy Patients During COVID-19.

Magnitude, Symptom Presentation and Correlates of Psychological Distress Among People with Epilepsy in Southern Ethiopia: A Cross-Sectional Study.

BackgroundPsychological distress is a common co-morbid condition among people with epilepsy. Untreated comorbid psychosocial problems are associated with increased morbidity and health-care costs, and negatively affects treatment outcome of people with epilepsy. Therefore, the aim of this study was to describe the prevalence of psychological distress and to identify its associated factors among people with epilepsy attending outpatient treatment in Gedeo zone public hospitals, Southern Ethiopia.Patients and MethodsThis was an institution-based cross-sectional study conducted at Gedeo zone public hospitals from July 1st to October 1st, 2019. Self-reporting questionnaire was used to screen individuals with epilepsy for the presence of co-morbid psychological distress. A face to face interview was conducted among 321 anti-epileptic medication followers. The collected data were entered into Epi-Data version 3.1 and then exported to SPSS version 20 for further analysis. Binary logistic regression was computed to identify factors associated with psychological distress. Statistically, significant association was set at p-values of <0.05 in the final model with a corresponding 95% confidence interval.ResultsThe prevalence of psychological distress was found to be 38.3% with 95% CI (34.1, 42.7) among people with epilepsy attending outpatient follow-up in Gedeo zone public hospitals. Being female [OR=1.57 (95% CI: 1.01–4.80)], uncontrolled seizures [OR=1.96 (95% CI: 1.21–3.18)], and longer duration of illness [OR= 3.16 (95% CI: 1.75–5.73)] were variables found to have statistically significant association with psychological distress.ConclusionThe findings of this study revealed that more than one-third of people with epilepsy screened positive for psychological distress. Therefore, this demonstrates a need to design and implement programs focusing on the prevention, early screening, and providing appropriate interventions for psychological distress among people with epilepsy.

Adjunctive Cenobamate for Focal-Onset Seizures in Adults: A Systematic Review and Meta-Analysis.

BackgroundCenobamate is a novel tetrazole-derived carbamate compound with a dual mechanism of action. This drug can enhance the inactivated state of voltage-gated sodium channels, preferentially inhibiting the persistent component of the sodium channel current, and acts as a positive allosteric modulator of GABAA receptors, binding at a non-benzodiazepine site.ObjectiveWe assessed the efficacy and safety of adjunctive cenobamate for the treatment of focal-onset seizures in adult patients with epilepsy using meta-analytical techniques.MethodsWe systematically searched (May, week 4, 2020) MEDLINE (accessed by PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and the US National Institutes of Health Clinical Trials Registry (http://www.clinicaltrials.gov). There were no date limitations or language restrictions. Randomized, placebo-controlled, single or double-blinded, add-on trials of cenobamate in adult patients with uncontrolled focal-onset seizures were identified. Main outcomes included the proportion of patients with ≥ 50 and 100% reduction in seizure frequency during the maintenance treatment period compared with baseline and the incidence of treatment withdrawal and adverse events (AEs). Risk ratio (RR) with 95% confidence interval (CI) was estimated for each outcome.ResultsTwo trials were included, overall enrolling 659 patients (442 for the add-on cenobamate group and 217 for the add-on placebo group). Seizure frequency reduction by at least 50% occurred during the maintenance phase in 50.1% of the patients randomized to cenobamate and 23.5% of the placebo-treated participants (RR 2.18, 95% CI 1.67–2.85; p < 0.001). The pooled estimated RR to achieve seizure freedom for the cenobamate group in comparison with placebo was 3.71 (95% CI 1.93–7.14; p < 0.001). Withdrawal from randomized treatment occurred in 16.7 and 11.1% of participants receiving cenobamate and placebo, respectively (RR 1.34, 95% CI 0.85–2.09; p = 0.205). Treatment was discontinued due to AEs in 12.2 and 4.1% of the patients in the active and control arms (RR 2.27, 95% CI 1.08–4.79; p = 0.031). AEs were reported in 76.9 and 66.8% of the patients during treatment with cenobamate and placebo (RR 1.14, 95% CI 1.02–1.26; p = 0.021). The cenobamate-associated AEs included somnolence, dizziness, fatigue, balance disorder, and diplopia.ConclusionsAdjunctive cenobamate in adult patients with uncontrolled focal-onset seizures is associated with a greater reduction in seizure frequency and a higher rate of AEs than placebo.Electronic supplementary materialThe online version of this article (10.1007/s40263-020-00759-9) contains supplementary material, which is available to authorized users.

Education, Marriage, and Employment in People with Epilepsy: The Barriers that Patients Perceive

Abstract Objectives We surveyed people with epilepsy (PWE) and uncontrolled seizures on the challenges which they have had in their lives with respect to educational achievement, employment, and marriage. We tried to scrutinize their reasons and perceptions for their social underachievement and difficulties. Materials and Methods Adult patients above 25 years of age, with epileptic seizures for more than 5 years, who were investigated at Shiraz Comprehensive Epilepsy Center, from January until March 2019, were studied. We prepared a questionnaire for our study and asked whether they have any college education? If they have ever married? And, if they are employed? Results Seventy patients enrolled in our study. Age of the patients was 33 ± 6 years (range: 26–59 years) and their age at onset of epilepsy was 14 ± 9 years (range: 0–35 years). Forty-four patients (63%) never received any college education; 30 patients (43%) were single; and finally, 37 patients (53%) were unemployed. The most common reasons perceived by the patients for these life challenges were functional disability (e.g., inability to study or to work), social discrimination and stigmatization, and uncontrolled seizures and the associated consequences (i.e., fear of having seizures). Conclusion Many PWE (both men and women) and uncontrolled seizures suffer from social underachievement and challenges in their daily lives. Various strategies may help PWE to overcome these challenges.

Effect of Brivaracetam on Efficacy and Tolerability in Patients With Brain Tumor-Related Epilepsy: A Retrospective Multicenter Study.

Background: Epilepsy is a common symptom of brain tumors and is often pharmacoresistent. Among new antiseizure medications (ASMs) Brivaracetam (BRV) has been approved as adjunctive treatment for focal seizures and it was tested in non-oncological patient populations. This is the first study that retrospectively explored efficacy and tolerability of BRV as add-on therapy in brain tumor-related epilepsy (BTRE) patients.Materials and Methods: We reviewed the medical records of 33 BTRE patients from six Italian epilepsy centers; charts included tumor history, diagnosis of BTRE, BRV added as first or second add-on for uncontrolled seizures and/or adverse events (AEs) of the previous ASMs, at least 1-month follow-up, seizure frequency, and AEs assessment.Results: Thirty-three patients (19 males, mean age: 57.6 years; 14 females, mean age: 42.4 years): 11 low grade gliomas, five high grade gliomas, six meningiomas, 10 glioblastomas, one primary cerebral lymphoma. Fourteen patients had focal aware seizures, nine focal unaware, seven focal to bilateral tonic-clonic seizures, three patients presented more than one seizure type: focal unaware with focal to bilateral tonic clonic seizures (two patients) and focal aware and unaware seizures (one patient). Mean seizure frequency in the month preceding BRV introduction: 7.0; at last follow-up: 2.0 (p = 0.001). Seven patients (21.2%) reported AEs (anxiety, agitation, fatigue, vertigo) and three of them (9.0%) required drug withdrawal due to psychiatric adverse events (PAEs). Three other patients withdrew BRV: one for scarce compliance (3.0%), two for uncontrolled seizures (6.0%).Conclusion: Our results showed that BRV could be a new therapeutic option effective in reducing seizures in BTRE patients, taking into account the incidence of PAEs in this particular population. Future and larger prospective studies are needed.

COVID-19 outbreak: The impact of stress on seizures in patients with epilepsy.

ObjectiveStress is a known trigger for seizures in patients with epilepsy (PWE). However, the association between stress and seizures has not been thoroughly investigated. In December 2019, an outbreak of coronavirus disease (COVID‐19) occurred in Wuhan, Hubei province, China, causing tremendous collateral stress. This study was designed to evaluate the influence of the COVID‐19 outbreak on seizures in PWE in the most severely affected area, Wuhan, and its surrounding cities.MethodsIn this single‐center, cross‐sectional study, PWE were surveyed via online questionnaires between February 23 and March 5, 2020. Collected data included demographic information, epilepsy‐related characteristics (seizure type, frequency, antiepileptic drugs [AEDs], and medication management), direct and perceived threat of COVID‐19, and changes in seizures during the outbreak. Psychological comorbidities were evaluated by the Patient Health Questionnaire–9, Generalized Anxiety Disorder–7 items, and Insomnia Severity Index (ISI). Multivariate logistic regression was used to identify precipitants for seizure exacerbation.ResultsWe received 362 completed questionnaires after excluding 12 duplicates (response rate = 63.51%). A total of 31 (8.56%) patients had increased seizures during the outbreak. Exposure history to COVID‐19 (P = .001), uncontrolled seizure after AED therapy (P = .020), seizure frequency of two or more times per month before the outbreak (P = .005), change of AED regimen during the outbreak (AED reduction, withdrawal, replacement, skipping altogether; P = .002), and worry about the adverse effect of the outbreak on overall seizure‐related issues (severity = moderate to critical; P = .038) were risk factors for increased seizures.SignificanceA minority of PWE experienced seizure exacerbation during the outbreak of COVID‐19. Stress, uncontrolled seizures, and inappropriate change in AED regimen were associated with increased seizures. Based on these findings, stress might be an independent precipitant for triggering seizures in some PWE.

Different modalities of invasive neurostimulation for epilepsy.

Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient.