Pub Date : 2024-07-15DOI: 10.1016/j.yebeh.2024.109897
Objective
To compare the effects of levetiracetam(LEV), lamotrigine(LTG), oxcarbazepine(OXC), topiramate(TPM) and valproate (VPA) on postictal state (PIS).
Methods
A total of 187 epilepsy patients undergoing monotherapy were enrolled in a long-term follow-up study at the Affiliated Hospital of Yangzhou College. This included 30 patients on levetiracetam, 41 on valproate, 30 on oxcarbazepine, 28 on topiramate, and 31 on lamotrigine. A control group of 28 newly diagnosed or previously untreated epilepsy patients was also included. The Liverpool Seizure Severity Scale 2.0 (LSSS2.0) and the Seizure Severity Questionnaire (SSQ) were utilized to evaluate the patients’ condition, with comparison based on the results of the postictal status items. EEG during PIS termination was assessed using the Grand Total EEG score (GTE) as an objective tool to measure the impact of Antiseizure medications (ASMs) on the post-seizure state.
Results
The LSSS2.0 score indicated a statistically significant difference in post-seizure status score among the 5 groups (p < 0.05). The difference between the 5 groups and the control group was statistically significant (p < 0.05). Results of the SSQ demonstrated that all 5 drugs significantly reduced the post-seizure status score compared to the control group (p < 0.05). The GTE score revealed that, in the later stage of the seizure, the GTE score of the levetiracetam group, valproate group, oxcarbazepine group, and lamotrigine group significantly decreased compared to the control group (P < 0.05). There was no significant decrease in the GTE score in the topiramate group (P < 0.05).
Conclusion
Levetiracetam, lamotrigine, oxcarbazepine, topiramate, and valproate demonstrate favorable efficacy in ameliorating the severity of post-seizure condition. Further investigations are warranted to assess the potential of other widely employed anti-seizure medications in enhancing post-seizure status.
{"title":"Clinical study of the effect of 5 kinds of antiepileptic drugs on the postictal state","authors":"","doi":"10.1016/j.yebeh.2024.109897","DOIUrl":"10.1016/j.yebeh.2024.109897","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effects of levetiracetam(LEV), lamotrigine(LTG), oxcarbazepine(OXC), topiramate(TPM) and valproate (VPA) on postictal state (PIS).</p></div><div><h3>Methods</h3><p>A total of 187 epilepsy patients undergoing monotherapy were enrolled in a long-term follow-up study at the Affiliated Hospital of Yangzhou College. This included 30 patients on levetiracetam, 41 on valproate, 30 on oxcarbazepine, 28 on topiramate, and 31 on lamotrigine. A control group of 28 newly diagnosed or previously untreated epilepsy patients was also included. The Liverpool Seizure Severity Scale 2.0 (LSSS2.0) and the Seizure Severity Questionnaire (SSQ) were utilized to evaluate the patients’ condition, with comparison based on the results of the postictal status items. EEG during PIS termination was assessed using the Grand Total EEG score (GTE) as an objective tool to measure the impact of Antiseizure medications (ASMs) on the post-seizure state.</p></div><div><h3>Results</h3><p>The LSSS2.0 score indicated a statistically significant difference in post-seizure status score among the 5 groups (p < 0.05). The difference between the 5 groups and the control group was statistically significant (p < 0.05). Results of the SSQ demonstrated that all 5 drugs significantly reduced the post-seizure status score compared to the control group (p < 0.05). The GTE score revealed that, in the later stage of the seizure, the GTE score of the levetiracetam group, valproate group, oxcarbazepine group, and lamotrigine group significantly decreased compared to the control group (P < 0.05). There was no significant decrease in the GTE score in the topiramate group (P < 0.05).</p></div><div><h3>Conclusion</h3><p>Levetiracetam, lamotrigine, oxcarbazepine, topiramate, and valproate demonstrate favorable efficacy in ameliorating the severity of post-seizure condition. Further investigations are warranted to assess the potential of other widely employed anti-seizure medications in enhancing post-seizure status.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141623186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1016/j.yebeh.2024.109946
Necla Kasimoğlu , Nazan Gürarslan Baş
Aim
The aim of this study is to evaluate the relationship between parental attitudes toward childhood epilepsy and spiritual orientations.
Methods
This descriptive study was conducted online between May and July 2022 with 417 parents residing in the eastern part of Turkey. Data were collected using a descriptive information form, the Social Attitudes Scale toward Childhood Epilepsies, and the Spiritual Orientation Scale. The obtained data were analyzed using the SPSS software package, employing descriptive statistics such as frequency, percentage, mean, standard deviation, as well as inferential statistics including independent samples t-test, ANOVA, multiple linear regression and correlation tests.
Results
The Total Social Attitudes Scale Score toward Childhood Epilepsies was calculated as 45.10 ± 7.81, and the Spiritual Orientation Scale Score was 89.88 ± 30.30 for parents with an average age of 36.64 ± 8.26. It was found statistically significant and high (p > 0.05) for parents who are female, have a higher level of education, and have previously received education about epilepsy regarding both the Total Social Attitudes Scale Score toward Childhood Epilepsies and the Spiritual Orientation Scale Score. A statistically significant positive correlation was found between the Total Social Attitudes Scale Score toward Childhood Epilepsies and the Spiritual Orientation Scale Score.
Conclusion
According to the findings of the research, parents' attitudes towards childhood epilepsy are positive, and their spiritual orientation levels are high. As parents' spiritual orientation levels increase, their positive attitudes towards childhood epilepsy also increase.
{"title":"The relationship between parental attitude toward childhood epilepsy and spiritual orientation","authors":"Necla Kasimoğlu , Nazan Gürarslan Baş","doi":"10.1016/j.yebeh.2024.109946","DOIUrl":"10.1016/j.yebeh.2024.109946","url":null,"abstract":"<div><h3>Aim</h3><p>The aim of this study is to evaluate the relationship between parental attitudes toward childhood epilepsy and spiritual orientations.</p></div><div><h3>Methods</h3><p>This descriptive study was conducted online between May and July 2022 with 417 parents residing in the eastern part of Turkey. Data were collected using a descriptive information form, the Social Attitudes Scale toward Childhood Epilepsies, and the Spiritual Orientation Scale. The obtained data were analyzed using the SPSS software package, employing descriptive statistics such as frequency, percentage, mean, standard deviation, as well as inferential statistics including independent samples <em>t</em>-test, ANOVA, multiple linear regression and correlation tests.</p></div><div><h3>Results</h3><p>The Total Social Attitudes Scale Score toward Childhood Epilepsies was calculated as 45.10 ± 7.81, and the Spiritual Orientation Scale Score was 89.88 ± 30.30 for parents with an average age of 36.64 ± 8.26. It was found statistically significant and high (p > 0.05) for parents who are female, have a higher level of education, and have previously received education about epilepsy regarding both the Total Social Attitudes Scale Score toward Childhood Epilepsies and the Spiritual Orientation Scale Score. A statistically significant positive correlation was found between the Total Social Attitudes Scale Score toward Childhood Epilepsies and the Spiritual Orientation Scale Score.</p></div><div><h3>Conclusion</h3><p>According to the findings of the research, parents' attitudes towards childhood epilepsy are positive, and their spiritual orientation levels are high. As parents' spiritual orientation levels increase, their positive attitudes towards childhood epilepsy also increase.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1016/j.yebeh.2024.109943
Anna Mammì , Valentina Bova , Iolanda Martino , Ilaria Sammarra , Edoardo Ferlazzo , Angelo Pascarella , Domenico Abelardo , Oreste Marsico , Claudia Torino , Vittoria Cianci , Giulia Viola , Valeria Pecoraro , Massimiliano Beghi , Antonio Gambardella , Arturo Pujia , Umberto Aguglia , Sara Gasparini
Objective
Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation’s link to binge eating, and to explore psychological characteristics of FS individuals.
Method
Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders.
Results
We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet ’Perseveration’ predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people.
Discussion
This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.
目的:功能性癫痫发作(FS)是一种短暂的、不自主的行为或意识变化,有别于癫痫发作,可能与心理分离有关。暴食症(BED)也与心理和躯体解离有关。然而,FS 和 BED 之间的任何联系都没有得到充分探讨。我们旨在评估FS、焦虑/抑郁(AD)和健康受试者(HS)的暴食症患病率,研究解离与暴食的关系,并探索FS患者的心理特征:参与者根据 ILAE 指南和 DSM-5 标准接受评估,包括评估暴食、解离、焦虑、抑郁和人格特质的问卷。纳入标准为年龄大于 18 岁、无药物滥用史、无癫痫病史、未使用诱发饮食失调的药物:结果:我们发现,与 HS 相比,FS 和 AD 患者的暴食症状更为频繁和严重。在 AD 和 FS 组中,抑郁和分离与暴食症状相关。PID-5的 "毅力 "面仅对FS患者的暴饮暴食态度有预测作用;与AD患者相比,FS患者报告了更多的童年情感忽视和更多的抑制:本研究强调了FS患者暴饮暴食症状的普遍性,并强调了其与解离症状的关联。这一发现支持了解离症状与进食障碍之间存在联系的假设。研究发现了FS患者的独特临床特征,即与暴饮暴食症状相关的强迫性维度,从而为全面了解FS患者的心理特征提供了依据,并为有针对性的治疗干预提供了指导。
{"title":"Functional seizures and binge eating disorder: A cross-sectional study","authors":"Anna Mammì , Valentina Bova , Iolanda Martino , Ilaria Sammarra , Edoardo Ferlazzo , Angelo Pascarella , Domenico Abelardo , Oreste Marsico , Claudia Torino , Vittoria Cianci , Giulia Viola , Valeria Pecoraro , Massimiliano Beghi , Antonio Gambardella , Arturo Pujia , Umberto Aguglia , Sara Gasparini","doi":"10.1016/j.yebeh.2024.109943","DOIUrl":"10.1016/j.yebeh.2024.109943","url":null,"abstract":"<div><h3>Objective</h3><p>Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation’s link to binge eating, and to explore psychological characteristics of FS individuals.</p></div><div><h3>Method</h3><p>Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders.</p></div><div><h3>Results</h3><p>We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet ’Perseveration’ predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people.</p></div><div><h3>Discussion</h3><p>This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152550502400324X/pdfft?md5=84bc684d2b94b269af63bc3813e7cb04&pid=1-s2.0-S152550502400324X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epilepsy is a disease that affects a significant proportion of the female population worldwide. The management of anti-seizure medications during pregnancy and the potential adverse outcomes to both the mother and fetus represent a significant challenge. This retrospective study aimed to evaluate the impact of anti-seizure medications during pregnancy by comparing maternal and fetal outcomes between pregnant women with and without epilepsy.
Methods
A total of 242 participants were analysed, including 112 with epilepsy and 130 healthy pregnant controls. Maternal age, medical history, seizure characteristics, use of anti-seizure medications, and pregnancy history were recorded. Maternal and fetal complications, delivery modes, and perinatal outcomes were evaluated.
Results
A total of 242 patients, including 112 (46.3 %) pregnant women with epilepsy and 130 (53.7 %) healthy pregnant women, were included in the study. Among pregnant patients with epilepsy, 4 (3.5 %) did not use anti-seizure medications, 79 (70.5 %) received monotherapy, and 29 (25.8 %) received polytherapy. The rates of pregnancy termination, spontaneous abortion, and maternal and fetal complications were significantly higher in pregnant women with epilepsy (p = 0.045, p = 0.045, p < 0.001, and p = 0.016, respectively). Folic acid use, planned pregnancy rate and postpartum breastfeeding rate were all statistically lower in pregnant women with epilepsy (p < 0.001, p < 0.001, p < 0.001, respectively). The rates of intensive care unit stay, infants with birth weight less than 2500 g, congenital malformations, and preterm births were significantly higher in babies born to pregnant women with epilepsy (p < 0.001, p = 0.047, p = 0.003, and p = 0.051, respectively). Gestational diabetes mellitus was observed in 4 (13.8 %) and congenital malformations in 4 (14.3 %) of the pregnant women with epilepsy who received polytherapy, and in both cases these rates were statistically higher than those of pregnant women with epilepsy who received monotherapy (p = 0.048 and p = 0.004, respectively).
Discussion
This study demonstrated that pregnancies among women affected by epilepsy have significantly higher rates of maternal and fetal complications, spontaneous abortions, and premature births. Polytherapy with anti-seizure medications is associated with an increased risk of gestational diabetes and congenital anomalies. Notably, folic acid use, planned pregnancy, and postpartum breastfeeding were less common in patients with epilepsy. The most commonly prescribed anti-seizure medications were levetiracetam and lamotrigine. Caesarean section is a common mode of delivery in pregnancies of mothers with epilepsy.
Conclusion
These results suggest that epilepsy increases both maternal and fetal complications during pregnancy. Furthermore, the use of anti-seizure medi
{"title":"Maternal and fetal outcomes of antiepileptic treatments during pregnancy: A retrospective study","authors":"Gökçe Zeytin Demiral , Selin Betaş Akın , Özlem Kayacık Günday , Fatma Gülhan Şahbaz , Ülkü Türk Börü","doi":"10.1016/j.yebeh.2024.109937","DOIUrl":"10.1016/j.yebeh.2024.109937","url":null,"abstract":"<div><h3>Introduction</h3><p>Epilepsy is a disease that affects a significant proportion of the female population worldwide. The management of anti-seizure medications during pregnancy and the potential adverse outcomes to both the mother and fetus represent a significant challenge. This retrospective study aimed to evaluate the impact of anti-seizure medications during pregnancy by comparing maternal and fetal outcomes between pregnant women with and without epilepsy.</p></div><div><h3>Methods</h3><p>A total of 242 participants were analysed, including 112 with epilepsy and 130 healthy pregnant controls. Maternal age, medical history, seizure characteristics, use of anti-seizure medications, and pregnancy history were recorded. Maternal and fetal complications, delivery modes, and perinatal outcomes were evaluated.</p></div><div><h3>Results</h3><p>A total of 242 patients, including 112 (46.3 %) pregnant women with epilepsy and 130 (53.7 %) healthy pregnant women, were included in the study. Among pregnant patients with epilepsy, 4 (3.5 %) did not use anti-seizure medications, 79 (70.5 %) received monotherapy, and 29 (25.8 %) received polytherapy. The rates of pregnancy termination, spontaneous abortion, and maternal and fetal complications were significantly higher in pregnant women with epilepsy (p = 0.045, p = 0.045, p < 0.001, and p = 0.016, respectively). Folic acid use, planned pregnancy rate and postpartum breastfeeding rate were all statistically lower in pregnant women with epilepsy (p < 0.001, p < 0.001, p < 0.001, respectively). The rates of intensive care unit stay, infants with birth weight less than 2500 g, congenital malformations, and preterm births were significantly higher in babies born to pregnant women with epilepsy (p < 0.001, p = 0.047, p = 0.003, and p = 0.051, respectively). Gestational diabetes mellitus was observed in 4 (13.8 %) and congenital malformations in 4 (14.3 %) of the pregnant women with epilepsy who received polytherapy, and in both cases these rates were statistically higher than those of pregnant women with epilepsy who received monotherapy (p = 0.048 and p = 0.004, respectively).</p></div><div><h3>Discussion</h3><p>This study demonstrated that pregnancies among women affected by epilepsy have significantly higher rates of maternal and fetal complications, spontaneous abortions, and premature births. Polytherapy with anti-seizure medications is associated with an increased risk of gestational diabetes and congenital anomalies. Notably, folic acid use, planned pregnancy, and postpartum breastfeeding were less common in patients with epilepsy. The most commonly prescribed anti-seizure medications were levetiracetam and lamotrigine. Caesarean section is a common mode of delivery in pregnancies of mothers with epilepsy.</p></div><div><h3>Conclusion</h3><p>These results suggest that epilepsy increases both maternal and fetal complications during pregnancy. Furthermore, the use of anti-seizure medi","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525505024003184/pdfft?md5=8db4b0916ec16f06b4f13d3bc94176d4&pid=1-s2.0-S1525505024003184-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1016/j.yebeh.2024.109918
Leena Kämppi , Antti Kämppi , Adam Strzelczyk
Status epilepticus is associated with high mortality and morbidity, both in the acute phase and over the long term. However, the long-term outcome of SE is not well studied, and there is no consensus on how to measure and predict it. Moreover, the factors that influence the long-term outcome of SE are complex and multifactorial, and may vary depending on the patient's characteristics, the SE etiology and type, and the treatment and complications. The aim of this article is to review the current literature on the mortality and morbidity of SE over the long term and to discuss the challenges and perspectives for future research.
Proceedings of the 9th London-Innsbruck Colloquium on Status Epilepticus and acute seizures.
癫痫状态与高死亡率和高发病率有关,无论是在急性期还是在长期。然而,对 SE 长期预后的研究并不深入,在如何测量和预测 SE 长期预后方面也没有达成共识。此外,影响 SE 长期预后的因素是复杂的、多因素的,可能会因患者的特征、SE 病因和类型以及治疗和并发症的不同而不同。本文旨在回顾有关 SE 长期死亡率和发病率的现有文献,并讨论未来研究的挑战和前景。
{"title":"Mortality and morbidity of status epilepticus over the long term","authors":"Leena Kämppi , Antti Kämppi , Adam Strzelczyk","doi":"10.1016/j.yebeh.2024.109918","DOIUrl":"https://doi.org/10.1016/j.yebeh.2024.109918","url":null,"abstract":"<div><p>Status epilepticus is associated with high mortality and morbidity, both in the acute phase and over the long term. However, the long-term outcome of SE is not well studied, and there is no consensus on how to measure and predict it. Moreover, the factors that influence the long-term outcome of SE are complex and multifactorial, and may vary depending on the patient's characteristics, the SE etiology and type, and the treatment and complications. The aim of this article is to review the current literature on the mortality and morbidity of SE over the long term and to discuss the challenges and perspectives for future research.</p><p>Proceedings of the 9th London-Innsbruck Colloquium on Status Epilepticus and acute seizures.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1016/j.yebeh.2024.109909
Ronen Spierer
Lewis Carroll’s classic Alice in Wonderland describes Alice’s fantastical experiences so similarly to the actual phenomenology of the eponymous syndrome, that it has been previously suggested that Carroll himself experienced it. The syndrome is mostly associated with migrainous aura, and naturally, Carroll was postmortemly “diagnosed” as a migraineur. However, when considering his unique personality profile, it appears that he might have had temporal lobe epilepsy.
刘易斯-卡罗尔(Lewis Carroll)的经典作品《爱丽丝梦游仙境》(Alice in Wonderland)中描述的爱丽丝的奇幻经历与同名综合征的实际现象非常相似,因此有人认为卡罗尔本人也经历过这种综合征。该综合征主要与偏头痛先兆有关,卡罗尔死后自然被 "诊断 "为偏头痛患者。然而,考虑到他独特的个性特征,他似乎可能患有颞叶癫痫。
{"title":"Lewis Carroll’s personality and the possibility of epilepsy","authors":"Ronen Spierer","doi":"10.1016/j.yebeh.2024.109909","DOIUrl":"https://doi.org/10.1016/j.yebeh.2024.109909","url":null,"abstract":"<div><p>Lewis Carroll’s classic Alice in Wonderland describes Alice’s fantastical experiences so similarly to the actual phenomenology of the eponymous syndrome, that it has been previously suggested that Carroll himself experienced it. The syndrome is mostly associated with migrainous aura, and naturally, Carroll was postmortemly “diagnosed” as a migraineur. However, when considering his unique personality profile, it appears that he might have had temporal lobe epilepsy.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-13DOI: 10.1016/j.yebeh.2024.109944
Rohan Jha , Melissa M.J. Chua , David D. Liu , Garth R. Cosgrove , Steven Tobochnik , John D. Rolston
Objective
Many patients pursue epilepsy surgery with the hope of reducing or stopping anti-seizure medications (ASMs), in addition to reducing their seizure frequency and severity. While ASM decrease is primarily driven by surgical outcomes and patient preferences, preoperative estimates of meaningful ASM reduction or discontinuation are uncertain, especially when accounting for the various forking paths possible following intracranial EEG (iEEG), including resection, neuromodulation, or even the absence of further surgery. Here, we characterize in detail the ASM reduction in a large cohort of patients who underwent iEEG, facilitating proactive, early counseling for a complicated cohort considering surgical treatment.
Methods
We identified a multi-institutional cohort of patients who underwent iEEG between 2001 and 2022, with a minimum of two years follow-up. The total number of ASMs prescribed immediately prior to surgery, choice of investigation modality, and subsequent surgical treatment were extracted for each patient. Primary endpoints included decreases in ASM counts from preoperative baseline to various follow-up intervals.
Results
A total of 284 patients were followed for a median of 6.0 (range 2,22) years after iEEG surgery. Patients undergoing resection saw an average reduction of ∼ 0.5 ASMs. Patients undergoing neuromodulation saw no decrease and trended towards requiring increased ASM usage during long-term follow-up. Only patients undergoing resection were likely to completely discontinue all ASMs, with an increasing probability over time approaching ∼ 10 %. Up to half of resection patients saw ASM decreases, which was largely stable during long-term follow-up, whereas only a quarter of neuromodulation patients saw a reduction, though their ASM reduction decreased over time.
Conclusions
With the increasing use of stereotactic EEG and non-curative neuromodulation procedures, realistic estimates of ASM reduction and discontinuation should be considered preoperatively. Almost half of patients undergoing resective surgery can expect to reduce their ASMs, though only a tenth can expect to discontinue ASMs completely. If reduction is not seen early, it likely does not occur later during long-term follow-up. Less than a third of patients undergoing neuromodulation can expect ASM reduction, and instead most may require increased usage during long-term follow-up.
{"title":"Characterization of anti-seizure medication reduction and discontinuation rates following epilepsy surgery","authors":"Rohan Jha , Melissa M.J. Chua , David D. Liu , Garth R. Cosgrove , Steven Tobochnik , John D. Rolston","doi":"10.1016/j.yebeh.2024.109944","DOIUrl":"10.1016/j.yebeh.2024.109944","url":null,"abstract":"<div><h3>Objective</h3><p>Many patients pursue epilepsy surgery with the hope of reducing or stopping anti-seizure medications (ASMs), in addition to reducing their seizure frequency and severity. While ASM decrease is primarily driven by surgical outcomes and patient preferences, preoperative estimates of meaningful ASM reduction or discontinuation are uncertain, especially when accounting for the various forking paths possible following intracranial EEG (iEEG), including resection, neuromodulation, or even the absence of further surgery. Here, we characterize in detail the ASM reduction in a large cohort of patients who underwent iEEG, facilitating proactive, early counseling for a complicated cohort considering surgical treatment.</p></div><div><h3>Methods</h3><p>We identified a multi-institutional cohort of patients who underwent iEEG between 2001 and 2022, with a minimum of two years follow-up. The total number of ASMs prescribed immediately prior to surgery, choice of investigation modality, and subsequent surgical treatment were extracted for each patient. Primary endpoints included decreases in ASM counts from preoperative baseline to various follow-up intervals.</p></div><div><h3>Results</h3><p>A total of 284 patients were followed for a median of 6.0 (range 2,22) years after iEEG surgery. Patients undergoing resection saw an average reduction of ∼ 0.5 ASMs. Patients undergoing neuromodulation saw no decrease and trended towards requiring increased ASM usage during long-term follow-up. Only patients undergoing resection were likely to completely discontinue all ASMs, with an increasing probability over time approaching ∼ 10 %. Up to half of resection patients saw ASM decreases, which was largely stable during long-term follow-up, whereas only a quarter of neuromodulation patients saw a reduction, though their ASM reduction decreased over time.</p></div><div><h3>Conclusions</h3><p>With the increasing use of stereotactic EEG and non-curative neuromodulation procedures, realistic estimates of ASM reduction and discontinuation should be considered preoperatively. Almost half of patients undergoing resective surgery can expect to reduce their ASMs, though only a tenth can expect to discontinue ASMs completely. If reduction is not seen early, it likely does not occur later during long-term follow-up. Less than a third of patients undergoing neuromodulation can expect ASM reduction, and instead most may require increased usage during long-term follow-up.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1016/j.yebeh.2024.109898
Eric Witherspoon , Gabrielle Williams , Nicholas Zuczek , Patrick A. Forcelli
GABA modulators such as phenobarbital (PB) and sodium channel blockers such as phenytoin (PHT) have long been the mainstay of pharmacotherapy for the epilepsies. In the context of neonatal seizures, both PB and PHT display incomplete clinical efficacy. Moreover, in animal models, neonatal exposure to these medications result in neurodegeneration raising concerns about safety. Cenobamate, a more recently approved medication, displays unique pharmacology as it is both a positive allosteric modulator of GABA-A receptors, and a voltage-gated sodium channel blocker. While cenobamate is approved for adult use, its efficacy and safety profile against neonatal seizures is poorly understood. To address this gap, we assessed the efficacy and safety of cenobamate in immature rodents. Postnatal day (P)7 rat pups were pretreated with cenobamate and challenged with the chemoconvulsant pentylenetetrazole (PTZ) to screen for anti-seizure effects. In a separate experiment, P7 rats were treated with cenobamate, and brains were processed to assess induction of cell death. Cenobamate displays dose-dependent anti-seizure efficacy in neonatal rats. Unlike PHB and PHT, it does not induce neurotoxicity in P7 rats. Thus, cenobamate may be effective at treating neonatal seizures while avoiding unwanted neurotoxic side effects such as cell death.
{"title":"Cenobamate suppresses seizures without inducing cell death in neonatal rats","authors":"Eric Witherspoon , Gabrielle Williams , Nicholas Zuczek , Patrick A. Forcelli","doi":"10.1016/j.yebeh.2024.109898","DOIUrl":"10.1016/j.yebeh.2024.109898","url":null,"abstract":"<div><p>GABA modulators such as phenobarbital (PB) and sodium channel blockers such as phenytoin (PHT) have long been the mainstay of pharmacotherapy for the epilepsies. In the context of neonatal seizures, both PB and PHT display incomplete clinical efficacy. Moreover, in animal models, neonatal exposure to these medications result in neurodegeneration raising concerns about safety. Cenobamate, a more recently approved medication, displays unique pharmacology as it is both a positive allosteric modulator of GABA-A receptors, and a voltage-gated sodium channel blocker. While cenobamate is approved for adult use, its efficacy and safety profile against neonatal seizures is poorly understood. To address this gap, we assessed the efficacy and safety of cenobamate in immature rodents. Postnatal day (P)7 rat pups were pretreated with cenobamate and challenged with the chemoconvulsant pentylenetetrazole (PTZ) to screen for anti-seizure effects. In a separate experiment, P7 rats were treated with cenobamate, and brains were processed to assess induction of cell death. Cenobamate displays dose-dependent anti-seizure efficacy in neonatal rats. Unlike PHB and PHT, it does not induce neurotoxicity in P7 rats. Thus, cenobamate may be effective at treating neonatal seizures while avoiding unwanted neurotoxic side effects such as cell death.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1016/j.yebeh.2024.109939
KC Neha , Prateek Kumar Panda , Anissa Atif Mirza , Puneet Dhamija , Indar Kumar Sharawat
Introduction
Hyponatremia is a well-documented adverse effect of oxcarbazepine treatment, but no clinical trial has yet been conducted to explore any intervention for reducing the incidence of hyponatremia.
Materials and Methods
This open-label trial evaluated the efficacy of add-on daily oral sodium chloride supplementation of 1–2 g/day for 12 weeks in reducing the incidence of hyponatremia in children receiving oxcarbazepine monotherapy aged 1–18 years. Apart from comparing the incidence of symptomatic and severe hyponatremia, serum and urine sodium levels, serum and urine osmolality, changes in behavior and cognition, and the number of participants with recurrence of seizures and requiring additional antiseizure medication (ASM) were also compared.
Results
A total of 120 children (60 in each group) were enrolled. The serum sodium level at 12 weeks in the intervention group was higher than that of the control group (136.5 ± 2.6 vs 135.4 ± 2.5 mEq/L, p = 0.01). The number of patients with hyponatremia was significantly lower in the intervention group (4/60vs14/60, p = 0.01). However, the incidence of symptomatic and severe hyponatremia (0/60vs1/60, p = 0.67 for both), changes in social quotient and child behavior checklist total score (0.6 ± 0.8 vs 0.7 ± 0.5, p = 0.41 and 0.9 ± 1.2 vs 1.1 ± 0.9, p = 0.30 respectively), the number of patients with breakthrough seizures (9/60vs10/60, p = 0.89), and the number of patients requiring additional ASMs (8/60vs10/60, p = 0.79) were comparable in both groups.
Conclusions
Daily oral sodium chloride supplementation is safe and efficacious in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy. However, sodium chloride supplementation does not significantly reduce more clinically meaningful outcome measures like symptomatic and severe hyponatremia.
{"title":"Efficacy of oral sodium chloride in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy: A randomized controlled trial (SCHO Trial)","authors":"KC Neha , Prateek Kumar Panda , Anissa Atif Mirza , Puneet Dhamija , Indar Kumar Sharawat","doi":"10.1016/j.yebeh.2024.109939","DOIUrl":"10.1016/j.yebeh.2024.109939","url":null,"abstract":"<div><h3>Introduction</h3><p>Hyponatremia is a well-documented adverse effect of oxcarbazepine treatment, but no clinical trial has yet been conducted to explore any intervention for reducing the incidence of hyponatremia.</p></div><div><h3>Materials and Methods</h3><p>This open-label trial evaluated the efficacy of add-on daily oral sodium chloride supplementation of 1–2 g/day for 12 weeks in reducing the incidence of hyponatremia in children receiving oxcarbazepine monotherapy aged 1–18 years. Apart from comparing the incidence of symptomatic and severe hyponatremia, serum and urine sodium levels, serum and urine osmolality, changes in behavior and cognition, and the number of participants with recurrence of seizures and requiring additional antiseizure medication (ASM) were also compared.</p></div><div><h3>Results</h3><p>A total of 120 children (60 in each group) were enrolled. The serum sodium level at 12 weeks in the intervention group was higher than that of the control group (136.5 ± 2.6 vs 135.4 ± 2.5 mEq/L, p = 0.01). The number of patients with hyponatremia was significantly lower in the intervention group (4/60vs14/60, p = 0.01). However, the incidence of symptomatic and severe hyponatremia (0/60vs1/60, p = 0.67 for both), changes in social quotient and child behavior checklist total score (0.6 ± 0.8 vs 0.7 ± 0.5, p = 0.41 and 0.9 ± 1.2 vs 1.1 ± 0.9, p = 0.30 respectively), the number of patients with breakthrough seizures (9/60vs10/60, p = 0.89), and the number of patients requiring additional ASMs (8/60vs10/60, p = 0.79) were comparable in both groups.</p></div><div><h3>Conclusions</h3><p>Daily oral sodium chloride supplementation is safe and efficacious in reducing the incidence of hyponatremia in children with epilepsy receiving oxcarbazepine monotherapy. However, sodium chloride supplementation does not significantly reduce more clinically meaningful outcome measures like symptomatic and severe hyponatremia.</p><p><strong>Trial registry No.</strong> CTRI/2021/12/038388.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1016/j.yebeh.2024.109916
Chao Zhang , Lu Li , Wenping Li , Jia Fu , Lei Wu , Linlin Sun , Lifen Yao
Background
Branched-chain amino acids (BCAAs) have been affected epilepsy, yet conclusions remain inconclusive, lacking causal evidence regarding whether BCAAs affect epilepsy. Systematic exploration of the causal relationship between BCAAs and epilepsy could hand out new ideas for the treatment of epilepsy.
Methods
Utilizing bidirectional Mendelian randomization (MR) study, we investigated the causal relationship between BCAA levels and epilepsy. BCAA levels from genome-wide association studies (GWAS), including total BCAAs, leucine levels, isoleucine levels, and valine levels, were employed. Causal relationships were explored applying the method of inverse variance-weighted (IVW) and MR-Egger, followed by sensitivity analyses of the results to evaluate heterogeneity and pleiotropy.
Results
Through strict genetic variant selection, we find some related SNPs, total BCAA levels (9), leucine levels (11), isoleucine levels (7), and valine levels (6) as instrumental variables for our MR analysis. Following IVW and sensitivity analysis, total BCAAs levels (OR = 1.14, 95 % CI = 1.019 ∼ 1.285, P = 0.022) and leucine levels (OR = 1.15, 95 % CI = 1.018 ∼ 1.304, P = 0.025) had significant correlation with epilepsy.
Conclusions
There exists a causal relationship between the levels of total BCAAs and leucine with epilepsy, offering the new ideas into epilepsy potential mechanisms, holding significant implications for its prevention and treatment.
{"title":"Association between Branched-Chain amino acids and Epilepsy: A Mendelian randomized study","authors":"Chao Zhang , Lu Li , Wenping Li , Jia Fu , Lei Wu , Linlin Sun , Lifen Yao","doi":"10.1016/j.yebeh.2024.109916","DOIUrl":"10.1016/j.yebeh.2024.109916","url":null,"abstract":"<div><h3>Background</h3><p>Branched-chain amino acids (BCAAs) have been affected epilepsy, yet conclusions remain inconclusive, lacking causal evidence regarding whether BCAAs affect epilepsy. Systematic exploration of the causal relationship between BCAAs and epilepsy could hand out new ideas for the treatment of epilepsy.</p></div><div><h3>Methods</h3><p>Utilizing bidirectional Mendelian randomization (MR) study, we investigated the causal relationship between BCAA levels and epilepsy. BCAA levels from genome-wide association studies (GWAS), including total BCAAs, leucine levels, isoleucine levels, and valine levels, were employed. Causal relationships were explored applying the method of inverse variance-weighted (IVW) and MR-Egger, followed by sensitivity analyses of the results to evaluate heterogeneity and pleiotropy.</p></div><div><h3>Results</h3><p>Through strict genetic variant selection, we find some related SNPs, total BCAA levels (9), leucine levels (11), isoleucine levels (7), and valine levels (6) as instrumental variables for our MR analysis. Following IVW and sensitivity analysis, total BCAAs levels (OR = 1.14, 95 % CI = 1.019 ∼ 1.285, P = 0.022) and leucine levels (OR = 1.15, 95 % CI = 1.018 ∼ 1.304, P = 0.025) had significant correlation with epilepsy.</p></div><div><h3>Conclusions</h3><p>There exists a causal relationship between the levels of total BCAAs and leucine with epilepsy, offering the new ideas into epilepsy potential mechanisms, holding significant implications for its prevention and treatment.</p></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}