Epilepsy & Behavior最新文献

{"title":"Impact of interaction among antiseizure medication polytherapy, clinical, sociodemographic and psychological factors on quality of life in patients with epilepsy: A systematic review","authors":"Alejandro Lozano-García ,&nbsp;Esperanza González-Bono ,&nbsp;Irene Cano-López","doi":"10.1016/j.yebeh.2024.110170","DOIUrl":"10.1016/j.yebeh.2024.110170","url":null,"abstract":"<div><h3>Introduction</h3><div>Drug-resistant epilepsy usually requires the use of polytherapy with antiseizure medications (ASMs) for management, which could involve side and adverse effects that may impact quality of life (QOL). This systematic review summarizes the evidence about the relationship between ASM polytherapy and QOL in epilepsy patients, considering clinical, sociodemographic, and psychological variables.</div></div><div><h3>Method</h3><div>This review followed the PRISMA guidelines and was registered in PROSPERO. The studies examined were collected from PubMed/MEDLINE, Scopus, Web of Science, and Embase. The data extracted were categorized into three categories: the<!--> <!-->relationship between the number of ASMs and QOL, differences in QOL between patients taking polytherapy and patients taking monotherapy, and the<!--> <!-->role of other variables on QOL.</div></div><div><h3>Results</h3><div>The review included 34 studies. Thirty examined the relationship between the number of ASMs and QOL, 93.3% of them identifying a significant association between a higher number of ASMs and poorer QOL. Fifteen studies analyzed differences in QOL between patients receiving polytherapy and those on monotherapy, all of them showing poorer QOL in those on polytherapy. Thirty-two studies considered other factors beyond polytherapy as determinants of QOL, including clinical, sociodemographic, and psychological variables, and higher seizure frequency and mood comorbidities (depression and anxiety) emerged as the strongest predictors of poor QOL.</div></div><div><h3>Conclusions</h3><div>Polytherapy, despite being necessary for managing drug-resistant epilepsy, significantly contributes to impairing QOL. Effective seizure control remains critical, but a multifactorial approach addressing mental health and social determinants is essential for improving QOL in epilepsy patients. Future research should focus on optimizing treatment strategies that balance seizure control by minimizing the negative impact of polytherapy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110170"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744383","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}

{"title":"Central expression and peripheral levels of MMP-9 and TIMP-1 in patients with temporal lobe epilepsy","authors":"Andrea Toledo ,&nbsp;Sandra Orozco-Suarez ,&nbsp;Yamile Paredes Chiquini ,&nbsp;Daniel Sanchez ,&nbsp;Lorenzo Maldonado ,&nbsp;Jorge Flores ,&nbsp;Sara I. Bautista ,&nbsp;Alfonso Arellano ,&nbsp;Sergio Moreno ,&nbsp;Iris E. Martínez Juárez ,&nbsp;Agnès Fleury","doi":"10.1016/j.yebeh.2024.110163","DOIUrl":"10.1016/j.yebeh.2024.110163","url":null,"abstract":"<div><h3>Purpose</h3><div>Thirty percent of epilepsy patients are drug-resistant (DR) and, in adults, temporal lobe epilepsy (TLE) is the most common form of DR- epilepsy. Patients with TLE exhibit a neuroinflammatory response associated with blood–brain barrier dysfunction. In this context, the main aim of our study was to evaluate peripheral levels and central expression of MMP-9 and TIMP-1 in TLE patients and assess their association with drug resistance and inflammatory markers.</div></div><div><h3>Methods</h3><div>Three groups of patients were included, 41 DR-TLE patients, 10 non-DR-TLE patients, and 20 healthy controls (HC). MMP-9 and TIMP-1 were assessed by ELISA in sera in all patients, and by immunohistochemistry and immunofluorescence in the cerebral cortex and hippocampus in a subgroup of DR-TLE patients and 3 controls. Peripheral and central cells phenotypes were determined by flow cytometry and immunohistochemistry, respectively, while cytokines were determined in the two compartments by ELISA.</div></div><div><h3>Results</h3><div>Central expression of MMP-9 and TIMP-1, and peripheral expression of TIMP-1, were higher in DR-TLE patients than in controls, while peripheral levels of MMP-9 and TIMP-1 were higher in DR-TLE patients compared with non-DRE-TLE patients. MMP-9 levels in serum increased with seizure severity and decreased after successful epilepsy surgery. MMP-9 levels in the serum of DR-TLE patients were positively correlated with several markers of peripheral inflammation, which was not the case in the groups of non-DR-TLE patients and healthy controls. MMP-9 and TIMP-1 expression in the hippocampus of DR-TLE patients correlated positively with various markers of central inflammation. Negative correlations between their peripheral levels and central expression were observed.</div></div><div><h3>Conclusion</h3><div>MMP-9 and TIMP-1 are markers that seem to be associated to the central and peripheral inflammatory reaction occurring in DR-TLE patients. The significant negative correlations between central and peripheral markers are interesting to note, and further studies need to be carried out to fully understand the complex regulation of these proteins during DR epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110163"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744481","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}

{"title":"Predicting medication adherence among children with epilepsy: Application of the protection motivation theory","authors":"Chunsong Yang ,&nbsp;Weiqi Deng ,&nbsp;Linan Zeng ,&nbsp;Qiuji Tao ,&nbsp;Lingli Zhang","doi":"10.1016/j.yebeh.2024.110153","DOIUrl":"10.1016/j.yebeh.2024.110153","url":null,"abstract":"<div><h3>Purpose</h3><div>Based on the protection motivation theory (PMT), which is an extension of the health belief model that takes the “reward” brought by behavior in the long-term process as a consideration factor and considering the influence of environmental and social factors on behavior patterns, this cross-sectional study evaluated medication adherence among children with epilepsy using structural equation modeling.</div></div><div><h3>Methods</h3><div>Children with epilepsy from pediatric neurology clinics were consecutively sampled at West China Second Hospital of Sichuan University from July 2021 to January 2024. According to PMT, we designed the 23-item questionnaire, which included seven factors, namely severity, susceptibility, external return, internal returns, self-efficacy, reaction efficiency, and reaction cost. Medication adherence was assessed using the Morisky Medication Adherence Scale. The reliability and validity of the scale were tested by confirmatory factor analysis, and path analysis was used to conduct hypothesis testing and calculate standardized path coefficients.</div></div><div><h3>Results</h3><div>We enrolled 1357 children with epilepsy (mean age, 8.36 ± 4.04 years). Younger age, being an only child, caregivers’ unemployment, and comorbidities were associated with high medication adherence scores. The designed scale of PMT displayed good reliability and validity. Through path analysis of the structural equation model, self-efficacy, susceptibility, and severity exerted significant positive effects on adherence, and external return, internal returns, and reaction cost had significant negative effects on adherence.</div></div><div><h3>Conclusions</h3><div>Medication adherence in children with epilepsy is relatively poor. PMT can explain and predict the medication adherence behavior and behavior intention of patients with epilepsy. It is recommended to increase the health education, personalize medication guidance, and provide telephone interventions to caregivers of children with epilepsy to enhance medication adherence and further improve therapeutic efficacy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110153"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744490","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}

{"title":"Trends in antiseizure medication prescription in Idiopathic generalized epilepsy over the last 10 years","authors":"Iker Elosua-Bayes ,&nbsp;Laura Abraira ,&nbsp;Elena Fonseca ,&nbsp;Sofía Lallana ,&nbsp;Daniel Campos-Fernández ,&nbsp;Samuel López-Maza ,&nbsp;Manuel Quintana ,&nbsp;Estevo Santamarina ,&nbsp;Javier Salas-Puig ,&nbsp;Manuel Toledo","doi":"10.1016/j.yebeh.2024.110158","DOIUrl":"10.1016/j.yebeh.2024.110158","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic Generalized Epilepsies (IGE) are a subset of syndromes defined by the International League against Epilepsy (ILAE) with the particularity to respond to a narrow number of ASMs and particularly to valproic acid (VPA). Recommendations have changed in the last decade. We aimed to describe changes in antiseizure medication (ASM) in adult IGE over the last 10 years.</div></div><div><h3>Methods</h3><div>Cross-sectional study comparing two cohorts of patients ≥ 16 years receiving ASM for IGE in a tertiary center (year 2013 and 2023). We collected clinical-demographic variables and ASM, analysing diagnosis and ASM prescription.</div></div><div><h3>Results</h3><div>249 patients were included in 2013 (53.8 % women; mean age 35.6 years ±14.6 standard deviation [SD]) and 278 in 2023 (61.2 % women, mean age 38.1 years ±16.1 SD).</div><div>In 2023, the most frequent IGE subtype syndrome was juvenile myoclonic epilepsy (JME) (39.6 % vs 33.3 % in 2013), followed by epilepsy with generalized tonic-clonic seizures alone (28.4 % vs 42.6 %).</div><div>Valproic acid (VPA) was the most used ASM in both periods, although it was prescribed less frequently in 2023 compared to 2013 (49.3 % vs. 69.1 %; p &lt; 0.001). Lamotrigine (LTG) was the second most used ASM in 2013 (14.1 %), followed by levetiracetam (LEV) (12.4 %). By contrast, in 2023 LEV was the second most used ASM (29.5 %), followed by LTG (21.6 %) (LEV p &lt; 0.001; LTG p = 0.025).</div><div>VPA use decreased in women under 45 years (57.9 % vs 20.3 %, p &lt; 0.001), with a subsequent increase of LEV (19.6 % vs 45.8 %, p &lt; 0.001). In men we observed no significant differences in the use of VPA (80.0 % vs 75.9 %, p = 0.463).</div></div><div><h3>Conclusions</h3><div>The use of VPA has decreased during the last decade for all IGEs and particularly in women of childbearing potential, along with an increase in the use of LEV and LTG.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"163 ","pages":"Article 110158"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747627","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}

{"title":"Epilepsy and nicotine use: Exploring disparities in ENDS and cigarette use among US adults with epilepsy","authors":"Miranda Gehris ,&nbsp;Ateeqa Ijaz ,&nbsp;Aditya Chakraborty ,&nbsp;Rime Jebai ,&nbsp;Wei Li ,&nbsp;Olatokunbo Osibogun ,&nbsp;Zeinab Mortazavizadeh ,&nbsp;Seyedeh Yasaman Alemohammad ,&nbsp;Erinoso Olufemi ,&nbsp;Zoran Bursac ,&nbsp;Ziyad Ben Taleb ,&nbsp;Mohammad Ebrahimi Kalan (Ebbie)","doi":"10.1016/j.yebeh.2024.110177","DOIUrl":"10.1016/j.yebeh.2024.110177","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals with epilepsy are at greater risk for tobacco use, which may exacerbate their health challenges. This study examines the prevalence and sociodemographic correlates of electronic nicotine delivery systems (ENDS), cigarette, and dual use among US adults with and without epilepsy.</div></div><div><h3>Methods</h3><div>Data from the 2021–2023 National Health Interview Surveys were analyzed (N = 86,655 adults aged ≥ 18 years), including 1,579 (1.89 %, estimated 14.5 million US adults) with self-reported epilepsy (outcome variable). Participants were categorized into mutually exclusive groups: never-use of either product [reference group], current (used on some days or daily) cigarette-only use, ENDS-only, dual-use, former cigarette-only, former ENDS-only, and former dual-use. Weighted logistic regression models assessed the relationship between epilepsy and tobacco use, adjusting for sociodemographic characteristics.</div></div><div><h3>Results</h3><div>Adults with epilepsy had higher rates of cigarette-only (16.51 % vs. 9.27 %), ENDS-only (5.56 % vs. 3.95 %), and dual use (3.53 % vs. 1.50 %) compared to those without epilepsy. Relative to never use, current cigarette-only use (AOR = 1.66, 95 %CI: 1.36–2.01), current ENDS-only use (AOR = 1.51, 95 %CI: 1.08–2.13), and current dual use (AOR = 2.29, 95 % CI: 1.56–3.48) were associated with higher odds of epilepsy after adjusting for demographic and health factors. Among adults with epilepsy, identifying as gay, lesbian, or bisexual was linked to higher odds of cigarette, ENDS, or dual use compared to straight individuals. Lower levels of education were associated with higher odds of cigarette smoking, while having health insurance was associated with lower odds among adults with epilepsy. Adults ≥ 35 were more likely to smoke cigarettes and less likely to use ENDS compared to younger age groups.</div></div><div><h3>Conclusion</h3><div>Cigarette, ENDS, and dual use rates were higher in adults with epilepsy than in those without epilepsy. Social factors like sexual orientation, education, and insurance status further influence tobacco use within this population. Tailored cessation interventions are warranted for this vulnerable population to reduce disease burden.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110177"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744389","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}

{"title":"Role for a video tool in educating youth with epilepsy about anticonvulsant and contraceptive drug interactions","authors":"Natalia I. Lopez ,&nbsp;Camille A. Dang ,&nbsp;Rovingaile Kriska M. Ponce ,&nbsp;Sara Jacobellis ,&nbsp;Madeline Niemann ,&nbsp;Rinat Jonas ,&nbsp;Laurie M. Douglass","doi":"10.1016/j.yebeh.2024.110154","DOIUrl":"10.1016/j.yebeh.2024.110154","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Anti-seizure medications (ASM) can lower the efficacy of hormonal birth control (BC), while estrogen-containing BC can increase ASM metabolism, altering seizure frequency. Despite these adverse interactions, many youth with epilepsy demonstrate inadequate knowledge about this topic. Thus, there is a need to develop tools that empower youth with epilepsy to make more informed contraceptive decisions. This study assesses the use of a video-based educational tool to raise awareness of BC and ASM interactions in this population.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We created a video that gives an overview of possible interactions between certain BC methods and ASMs, mainly increased risk of pregnancy and change in seizure frequency. The video was shown to female patients aged 12 and older with epilepsy in a child neurology clinic and followed by a discussion with their treating neurologist. Fifteen patients completed two surveys that collected demographics, ASM regimen, BC history, and assessed exposure to and understanding of the subject matter before and after viewing the educational tool using 11-point Likert scales. We received seven responses from provider opinion surveys that were administered after the visit to assess the practicality of the video tool in teaching patients about their medication interactions. Data was analyzed with descriptive statistics and one-tailed paired t-tests (α = 0.05).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Patients ranged from ages 16 to 24, with 46.7 % being in the 16 to 18 year-old range, 26.7 % in the 19 to 21 year-old range, and 26.7 % in the 22 to 24 year-old range. The median age was 19. 33 % of the patients reported having used BC, with 27 % reporting current interest in using BC. 33 % of patients were taking ASM that could reduce BC efficacy, and 27 % were on ASM with efficacy that can be reduced by BC. While 80 % of patients endorsed having previously discussed BC and ASM interactions with a doctor, patients rated their knowledge of the subject pre-video as moderately low with high interest in learning more about the topic. Patients’ understanding of how BC and ASM interactions can increase risk of pregnancy showed a significant increase post-video. Patients also indicated a high likelihood that they would think of the video when choosing a BC method and that they are more likely to start a discussion with their doctor about BC and ASM interactions because of the video. Treating neurologists showed high agreement that the video is useful in teaching their patients about BC and ASM interactions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Youth with epilepsy deserve engaging resources that empower them to make informed decisions about BC. Despite most of our patients having had prior education about BC and ASM interactions, our results support the need for educational tools beyond patient-provider discussion and the efficacy of video as a tool to enhance understanding of this topic. The ","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"163 ","pages":"Article 110154"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142747625","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}

{"title":"Combining three-phase EEG pattern and ipsilateral isolated eye deviation to predict seizure focus in the frontal interhemispheric fissure","authors":"Mitsuyo Nishimura ,&nbsp;Ayataka Fujimoto ,&nbsp;Tohru Okanishi ,&nbsp;Yosuke Masuda ,&nbsp;Kota Araki ,&nbsp;Hideo Enoki ,&nbsp;Eiichi Ishikawa","doi":"10.1016/j.yebeh.2024.110175","DOIUrl":"10.1016/j.yebeh.2024.110175","url":null,"abstract":"<div><h3>Objective</h3><div>Identification of seizure focus on the interhemispheric fissure (IHF) is often challenging at the step of scalp video-EEG monitoring on preoperative evaluations. We previously reported ictal three-phase EEG patterns (3Ph-EEG) and isolated eye deviation (isolated ED) to side of the seizure focus during seizures, each of which is available for identifying the seizure focus for frontal IHF (F-IHF). This study aimed to evaluate the accuracy of predicting the F-IHF focus using a combination of 3Ph-EEG and isolated ED in patients with frontal lobe epilepsy and the accuracy of predicting lateralization of the F-IHF focus using the predominance of findings.</div></div><div><h3>Methods</h3><div>We collected 15 patients diagnosed with frontal lobe epilepsy showing clinical seizures arising only from the frontal lobe, from 131 patients with intracranial video-EEG performed between January 2012 and December 2019. All 15 patients were classified into the IHF group (n = 7) and the extra-IHF group (n = 8) based on intracranial video-EEG. We statistically evaluated the accuracies of predicting F-IHF onset using combinations of 3Ph-EEG and isolated ED on scalp-EEG: 1) 3Ph-EEG (+); 2) isolated ED (+); 3) 3Ph-EEG (+) and/or isolated ED (+); and 4) 3Ph-EEG (+) and isolated ED (+). We also evaluated the accuracy of predicting focus lateralization using 3Ph-EEG and isolated ED.</div></div><div><h3>Results</h3><div>Both 3Ph-EEG (+) and isolated ED (+) demonstrated good accuracy for identifying F-IHF foci. They showed identical sensitivities of 71.4 %, with odds ratios of 7.5 for 3Ph-EEG (+) and 17.5 for isolated ED (+), respectively. Only the combination of 3Ph-EEG (+) and/or isolated ED (+) showed significant associations (<em>p</em> = 0.007). This combination demonstrated the highest sensitivity (100 %) and modified odds ratio (39.0), indicating that all patients in the IHF group exhibited at least one of the following: 3Ph-EEG or isolated ED. The combination of 3Ph-EEG (+) and isolated ED (+) offered one of the highest specificities, at 87.5 %. To predict lateralization with the F-IHF focus, both the predominant side for the third phase of 3Ph-EEG (n = 5) and the direction of isolated ED (n = 5) were perfectly concordant with the F-IHF focus side (100 % for both).</div></div><div><h3>Conclusion</h3><div>The combination of 3Ph-EEG and isolated ED can detect the IHF seizure focus with higher sensitivity in patients with frontal lobe epilepsy compared with using each method individually. Moreover, the absence of these two features eliminated the possibility of an F-IHF focus. Based on 3Ph-EEG and the direction of isolated ED, the focus side could presume lateralization of the F-IHF focus. Combining 3Ph-EEG and ipsilateral isolated ED at presurgical evaluation may help in designating locations for intracranial EEG electrodes.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110175"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744381","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}

{"title":"Combining MRI radiomics and clinical features for early identification of drug-resistant epilepsy in people with newly diagnosed epilepsy","authors":"Shijun Yang ,&nbsp;Siying Chen ,&nbsp;Yaling Huang ,&nbsp;Yang Lu ,&nbsp;Yi Chen ,&nbsp;Liyun Ye ,&nbsp;Qunhui Liu","doi":"10.1016/j.yebeh.2024.110165","DOIUrl":"10.1016/j.yebeh.2024.110165","url":null,"abstract":"<div><h3>Objective</h3><div>To identify newly diagnosed patients with drug-resistant epilepsy (DRE) based on radiomics and clinical features.</div></div><div><h3>Methods</h3><div>A radiomics approach was used to combine clinical features with magnetic resonance imaging (MRI) features extracted by the ResNet-18 deep learning model to predict DRE. Three machine learning classifiers were built, and <em>k</em>-fold cross-validation was used to assess the classifier outcomes, and other evaluation metrics of accuracy, sensitivity, specificity, F1 score, and area under the curve (AUC) were used to evaluate the performance of these models.</div></div><div><h3>Results</h3><div>One hundred and thirty-four newly diagnosed epilepsy patients with 13 available clinical features and 1394 MRI features extracted by the ResNet-18 model were included in our study. Then three machine learning classifiers were built based on5 clinical features and 8 MRI features, including Support Vector Machine (SVM), Gradient-Boosted Decision Tree (GBDT) and Random Forest. After internally validation, the GBDT model performed the best, with an average accuracy of 0.85 [95% confidence interval (CI) 0.77–0.91], sensitivity of 0.97 [95% CI 0.85–1.00], specificity of 0.96 [95% CI 0.83–1.00], F1 score of 0.81 [95% CI 0.77–0.89], AUC of 0.95 [95% CI 0.82–0.99], and ten-fold cross validation avg score of 0.96 [95% CI 0.89–0.99] in test set.</div></div><div><h3>Significance</h3><div>This study offers a novel approach for early diagnosis of DRE. Radiomics can provide potential diagnostic and predictive information to support personalized treatment decisions.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110165"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744401","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}

{"title":"Shortage of antiseizure medication in Germany: How big is the problem?","authors":"Josephine Steidl ,&nbsp;Sabine Krebs ,&nbsp;Karel Kostev ,&nbsp;Stefan Schwab ,&nbsp;Hajo M. Hamer","doi":"10.1016/j.yebeh.2024.110162","DOIUrl":"10.1016/j.yebeh.2024.110162","url":null,"abstract":"<div><h3>Objectives</h3><div>We determined the frequency of drug shortages of antiseizure medication (ASM) availability in Germany.</div></div><div><h3>Methods</h3><div>Retrospective and descriptive analysis of databases of 2 pharmaceutical wholesalers in Germany with a market share of about 45% of the German market in July 2023 (chosen arbitrarily) focusing on antiseizure drug shortages (i.e. demand could not be met entirely) and disruptions (i.e. demand could not be met at all) on the level of formulations, ASM and of manufacturers.</div></div><div><h3>Results</h3><div>98/909 (10.8%) of formulations of ASM with Wholesaler A were listed with drug shortages and 131/872 (15%) of formulations were reported with drug shortages at Wholesaler B. 19 of 222 (8.6%) entire ASM at Wholesaler A and 12/213 (5.6%) of ASM with Wholesaler B were reported with drug shortages. 41/62 (66.1%) manufacturers at wholesaler A and 36/57 (63.2%) manufacturers at wholesaler B reported shortages. The three compounds affected most frequently by drug shortages were pregabalin, levetiracetam and carbamazepine. 1.7% (Wholesaler A) and 12.9% (Wholesaler B) of formulations were listed with disruptions.</div><div>16.7% (40/239) of ASM with drug shortages/disruptions were brand-name ASM and 83.3% (199/239) were generic ASM.</div></div><div><h3>Conclusions</h3><div>11% to 15% of ASM formulations had drug shortages in Germany in July 2023. Generic ASM were more frequently affected than brand-name ASM. About 2/3 of manufacturers were reported to have drug shortages.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110162"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744486","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}

{"title":"Integrating alternative and complementary medicine in the management of epilepsy and its comorbidities in low- and middle-income settings","authors":"Symon M. Kariuki ,&nbsp;Charles R.J.C. Newton","doi":"10.1016/j.yebeh.2024.110172","DOIUrl":"10.1016/j.yebeh.2024.110172","url":null,"abstract":"<div><div>Traditional/alternative and complementary medicine (TCM) encompasses products, practices and practitioners that do not form part of conventional treatment and are not an integral part of the main health care systems. They are very common in the management of epilepsy and mental health conditions, particularly in low- and middle-income countries (LMIC). For instance, in a population-based survey in Africa, over 70% of people with epilepsy had visited a traditional health practitioner before the survey, with similarly high estimates reported in Asia and South America. Accessibility, cultural appropriateness/alignment, non-response to conventional (biomedical) medicine, and exercise of control over one’s treatment were some of the reasons TCM was preferred over conventional medicine. There is also emerging evidence that TCM products administered alone or together with anti-seizure medications result in improvement in seizure control, psychiatric comorbidities, and quality of life. Most of the convincing evidence is from biological-based therapies for example, multivitamin supplementation, ketogenic diet and cannabidiol extracts. Mind-based therapies e.g. Yoga and whole-body systems therapies e.g. Ayurdelic and Traditional Chinese Medicine have also generated interest in epilepsy care. There is a paucity of effectiveness studies of these therapies in LMIC such as Africa, where capacity to take these products through clinical trials is limited. There are however serious concerns on reliability of reported findings because of inadequate randomization, and small sample sizes, and concerns on quality and safety owing to lack of standardization of bioactive compounds, accidental or intention botanical substitution of products and unhygienic handling. There is growing interest in TCM worldwide because of its economic potential, concerns on safety and quality and potential for integration into the health care systems. There is urgent need to develop and implement national TCM regulatory policies and programmes aimed at expanding the knowledge base and providing guidance on quality assurance standards. However, LMIC continue to lag in implementation of these policies and guidelines, especially in the areas of research and development and regulation of TCM practice. Working with stakeholders, countries are advised to assess their own national situations in relation to TCM, and then develop practical solutions to accommodate these approaches. For instance, conduct surveys on benefits and risks of TCM in the management of epilepsy in the local context and use this information to promote appreciation of a role for TCM, which will ease integration into the main health systems.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"162 ","pages":"Article 110172"},"PeriodicalIF":2.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744487","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}