Epilepsy & Behavior最新文献

Rationale: Patients who experience seizures, including PNES, are usually advised to discontinue driving, or have their driving privileges revoked until a determined period of seizure-freedom is achieved. In this retrospective study, patients with PNES who requested driving privileges or reported having resumed driving were compared to those who did not on measures of depression, anxiety, PTSD, and cognitive flexibility/motor speed.

Methods: DiagnosisofPNESwasconfirmedwithvideo-EEG.Demographicand clinical dataand requests for reinstatement of driving privileges (requiring 6 or more months seizure freedom) and reports of decisions to resume driving were noted. Tests of motor speed and hand eye coordination and self-report questionnaires of depression, anxiety and PTSD administered as part of neuropsychological assessment were analyzed.

Results: A total of 403 patients with PNES evaluated in 2010-2020 were identified. Of those, 365 patients were eligible for inclusion, and of those, 60 applied for driving privileges or reported that they resumed driving. When the two groups were compared, the group that applied for driving privileges or decided to resume driving was significantly less depressed (p = 0.001) when tested than the group that did not. Furthermore, a significant difference was seen in measures of motor performance between those who requested to resume driving and those who did not (DKEFS T1, p = 0.006, DKEFS T2, p = 0.001, DKEFS T3, p = 0.002, DKEFS T4, p = 0.001; GPT dominant, p = 0.05, GPT non-dominant, p = 0.003).

Conclusion: Driving a motor vehicle is a useful measure of improvement for PNES because patients with seizures are required to discontinue driving until seizure-freedom is achieved. This study revealed that lower levels of depression and better fine motor functioning were associated with reported seizure-freedom and driving resumption. Depression is commonly associated with diminished performance (slower motor response times and impaired fine motor movements) on tests of motor functioning, both of which may result in less interest in pursuing permission to resume driving. These findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.

Objective: The neuropsychological adverse effects of antiseizure medications (ASMs) influence the tolerability, and in turn effectiveness of these medications, which can occur in a dose-dependent fashion. In this study, we examine the neuropsychological effects of perampanel (PER) at 4 mg daily as this dose has not been previously assessed with objective cognitive tests.

Methods: The study was originally designed to assess (1) effects of perampanel at 4 mg using different titration rates, and (2) habituation over time. Due to the COVID-19 pandemic, the study was halted, limiting the sample size needed to analyze titration and habituation effects. Therefore, we compared the neuropsychological effects of perampanel 4 mg daily from non-drug baseline to the end of drug titration and end of drug maintenance in this randomized double-blind study of healthy volunteers. Treatment period was 6 weeks total with 2 weeks of variable titration followed by 4-week maintenance. Composite Z-scores were calculated by combining Z-scores from both cognitive (computerized and non-computerized) and behavioral tests. Secondary analyses were conducted on the independent cognitive and behavioral domain Z-scores, and on the raw scores from 19 items in the full battery.

Results: The overall composite Z-scores did not differ across baseline, the end of titration, and the end of maintenance. Similarly, individual cognitive and behavioral domain Z-scores did not differ across the three titration rates. Exploratory analyses of the raw scores were marginally significant on only two of the 19 neuropsychological measures.

Conclusions: Perampanel 4 mg daily was well tolerated with few neuropsychological effects in healthy volunteers.

Objective: The study aimed to investigate the causal relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and epilepsy using Mendelian randomization (MR), thereby addressing confounding and reverse causality issues in observational studies.

Methods: We employed a two-sample bidirectional MR design utilizing summary-level data from the IEU OpenGWAS project. Serum 25(OH)D levels were analyzed using the publicly available dataset ebi-a-GCST90000618, which included 496,946 European samples and 68,960,93 SNPs. Data on epilepsy were obtained from ebi-a-GCST90018840, comprising 458,310 samples, including 4,382 epilepsy patients and 453,928 controls. To identify instrumental variables (IVs), we applied a significance threshold of P < 5e-8 for serum 25(OH)D levels as the exposure and P < 5e-6 for epilepsy as the exposure. IVs were required to demonstrate an r² < 0.001 linkage disequilibrium and an F-statistic greater than 10. The MR analysis utilized five methods: inverse variance weighted (IVW), weighted median, MR-Egger, weighted mode, and simple mode, assessing causal relationships between serum 25(OH)D levels and epilepsy. Robustness checks included heterogeneity tests, leave-one-out sensitivity analyses, and assessments for horizontal pleiotropy.

Results: Both directions of the MR analysis revealed no genetic correlation between serum 25(OH)D levels and epilepsy.

Conclusion: Our findings, supported by robust IV screening and consistent results across multiple MR methods, indicate a lack of causal relationship between serum 25(OH)D levels and epilepsy. These results suggest that while vitamin D plays a role in the nervous system, its relationship to epilepsy may not be direct, thus highlighting the need for further investigation in future studies.

Purpose: Concurrent electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have been used to assist in the presurgical localization of seizure foci in people with epilepsy. Our study aimed to examine the clinical feasibility of an optimized concurrent EEG-fMRI protocol.

Methods: The optimized protocol employed a fast-fMRI sequence (sampling rate = 10 Hz) with a spare arrangement, which allowed a time window of 1.9 s for EEG recording without radio frequency noise. Patients with a diagnosis of drug-resistant epilepsy who were candidates for surgical intervention were enrolled and underwent concurrent EEG-fMRI studies to map fMRI blood oxygen level-dependent (BOLD) signal changes related to interictal epileptiform discharges. The BOLD signals were compared to those in the epileptogenic zone determined by resective cavities or radiofrequency thermocoagulation lesions. Postoperative seizure outcomes were classified according to the ILAE classification.

Results: The EEG-related BOLD results indicated that 15 of the 19 patients (78.9 %) had concordant findings in the epileptogenic zone determined by surgical intervention. The percentage of patients who achieved good surgical outcomes was significantly greater in the concordant group than in the discordant group (n = 9, 60.0 % vs. n = 0, 0 %, p = 0.033).

Conclusions: Using fast MRI scan, the optimized protocol provides satisfactory accuracy (78.9 %) for detecting epileptogenic zones. A concordant BOLD signal and epileptogenic zone can predict good surgical outcomes.

Background: The underrepresentation of acute psychiatric settings in epilepsy research presents a barrier to delivering equitable healthcare for people with comorbid epilepsy and severe mental illness. We aimed to report the prevalence of epilepsy among people receiving acute psychiatric inpatient care and examine the sociodemographic and clinical characteristics influencing their treatment outcomes.

Methods: We analysed electronic patient records to estimate the lifetime prevalence of epilepsy in a retrospective cohort of 9,237 people admitted to psychiatric inpatient wards in South London between 2015 and 2019. Hospital and national databases were used to examine the characteristics of those with epilepsy, including sociodemographic variables, antiseizure medication prescriptions, and engagement with specialist neurology services. Kaplan-Meier and Cox regression analyses identified predictors of all-cause mortality in individuals with epilepsy and a comparator cohort without epilepsy.

Results: The lifetime prevalence of epilepsy in this population was 3 % (95 % CI: 2.65 to 3.36). Among individuals with epilepsy, 64.1 % were prescribed two or more antiseizure medications, while only 32.6 % received specialist neurology input in the year before and after their latest admission. Additionally, 72.8 % lived in areas with high levels of socioeconomic deprivation. Adjusting for clinical and demographic covariates, the presence of epilepsy was associated with a 43 % increased risk of mortality in this population (HR = 1.43, 95 % CI: 1.08-1.90, p = 0.01).

Conclusions: Epilepsy has an elevated prevalence and is a predictor of increased mortality among people receiving acute psychiatric inpatient care. Improving outcomes in this population will require interdisciplinary collaboration and patient advocacy.

Objective: This study aimed to evaluate the quality of life (QOL) in children with epilepsy and their caregivers, as well as the caregiver burden, through a secondary analysis of a cross-sectional online survey in Japan.

Methods: Eligible participants were caregivers of children (aged < 18 years) diagnosed with epilepsy. Children's QOL was measured using the daily living subset of the Japanese version of the Quality of Life in Children with Epilepsy (QOLCE-Js52). Caregiver QOL and burden were measured using the physical component summary (PCS) and mental component summary (MCS) of the Short Form-8 (SF-8) and the short Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8).

Results: Between March 2023 and May 2023, 1,147 caregivers completed the survey. Most caregivers (n = 1,144, 99.7 %) were parents. The mean (standard deviation [SD]) QOLCE-Js52 score was 68.3 (14.2). The mean (SD) scores of the PCS and MCS of the SF-8 were 46.5 (4.5) and 43.7 (5.1), respectively, which were significantly lower than those of the general Japanese population (p < 0.001 for both means). The mean (SD) J-ZBI_8 score was 4.9 (7.1), with 13.2 % of caregivers scoring at least 13, a predictor of depression. Multivariable regression analysis showed that disability was a significant risk factor for lower QOL and increased caregiver burden (p < 0.001). Frequent seizures, emergency transportation, and longer epilepsy duration were associated with poorer QOL in children and caregivers.

Conclusion: Risk factors, such as emergency transport, may be mitigated by rescue medication in non-hospital settings.

Objective: While guidelines encourage individualized discussions of the risks and benefits of antiseizure medication (ASM) withdrawal after a period of seizure-freedom, no formal methods exist for assessing patient preferences. We report the initial development of a rapid patient preferences screener.

Methods: We conducted a mixed-methods study of adults who were ≥1 year seizure-free and seen for epilepsy across three institutions. We reviewed existing questionnaires and adapted three questions measuring core constructs influencing ASM decisions - views about ASMs, driving restrictions, and seizures. We added one additional "global" question, for 4 total questions. Participants rated question clarity and utility from 1 (low) to 7 (high).

Results: Of 32 participants, the median patient age was 46 (interquartile range [IQR] 33-56), with a median 3 years since their last seizure (IQR 2-11). Median responses were: 2 (IQR 1-5) for being bothered by ASMs, 2 (IQR 1-6) for feeling that a driving restriction would be disruptive, and 5 (IQR 4-7) for feeling that another seizure would be serious. Respondents tended to disagree that ASMs are doing more harm than good (median 1, IQR 1-2). Participants rated question clarity (median 6, IQR 6-7) and utility (median 7, IQR 6-7) highly.

Conclusions: We report the initial development of a pre-visit rapid screener of patient preferences pertinent to ASM withdrawal in well-controlled epilepsy. Patients endorsed the utility of such a screener and provided guidance to improve items. We hope that this work will ultimately improve shared decision-making.

Objective: The aim of this qualitative study is to develop a conceptual model for the school life of the children with epilepsy based on grounded theory methodological framework.

Methodology: A total of 20 children with epilepsy participated in the semi-structured interviews. Inclusion criteria were age of 8-15 years, IQ higher than 70, duration of epilepsy of at least of two years and attendance of mainstream schools. 15 children had never seizure in school and 16 of them have not had a seizure in last 12 months. Qualitative research data was processed based on grounded theory with open coding leading consecutively to several main categories, axial coding establishing connections between individual categories, and finally selective coding resulting in one central category which was the core of the developed conceptual model.

Results: Eight main categories were identified during open coding: type of epilepsy and its management, sources of stress at school, adaptive responses to stressors, safe school environment in relation to (a) epilepsy and (b) learning, family support, stability of experience and behavior, and positive self-concept. Axial and selective coding resulted in establishment of Adaptive responses to stressors as the central category which is in the developed conceptual model determined by relevant external and internal factors as well as the sources enabling effective adaptation.

Conclusions: The presented research emphasize the importance of adaptive responses to stressors in the school environment among children with epilepsy which may be useful in counselling focused on how to avoid or successfully manage possible traumatizing experience related with epilepsy in this group.

Improving health literacy can improve health. This essay reviews the resources available to help improve epilepsy health literacy, including websites, drug inserts/labels/information leaflets, patient educators, handouts, plain language, lay summaries, and other efforts to close the gaps between research and epilepsy health literacy.

Purpose: Children with epilepsy are at an increased risk of developing psychiatric comorbidities, which exacerbate the overall disease burden. However, these disorders are often underreported in developing countries. This study, conducted in a developing country, aims to evaluate the frequency of psychiatric disorders and associated factors in a large cohort of children with epilepsy.

Methods: This study is part of a large, ongoing prospective study on a cohort of children with epilepsy in Lebanon. Children were recruited at the onset of their seizures between March 2010 and May 2016 and were followed for periods ranging from 2 to 12 years. The medical records of 598 children with new-onset seizures were analyzed throughout their follow-up period to identify the presence of any psychiatric disorders. Psychiatric disorders were classified as internalizing or externalizing disorders based on DSM-5 criteria and were considered present if the child had been referred and diagnosed by a pediatric psychiatrist, therapist, or neurologist, or if the medical record provided clear evidence of the child taking medication for a psychiatric disorder. Multivariable logistic regression was used to identify factors associated with psychiatric disorders.

Results: Of the 598 children with new onset seizures, 75 (12.5 %) were diagnosed with a psychiatric disorder, with 30 (5.0 %) having an internalizing disorder and 47 (7.9 %) having an externalizing disorder. Externalizing psychiatric disorders were most commonly reported children with developmental epileptic encephalopathies (18.2 %) compared to other epilepsy groups. Intellectual and developmental delay was the most important factor associated with externalizing disorders (OR 3.36, 95 %CI 1.48-7.62, p = 0.004). In contrast, the frequency of internalizing disorders didn't differ across epilepsy groups. The most significant factors associated with the occurrence of internalizing psychiatric comorbidity were the failure of at least two antiseizure medications (OR 3.25, 95 % CI 1.37-7.71, p = 0.007) and an older age at seizure onset (> 10 years vs. < 2 years, OR 6.86, 95 % CI 1.49-31.57, p = 0.013).

Conclusion: The prevalence of diagnosed psychiatric comorbidities in children with epilepsy in this study was lower than previously reported in developed countries. This may indicate potential underreporting of psychiatric disorders in Lebanon, where local practices may prioritize epilepsy management over mental health. This study highlights the need for systematic psychiatric screening during routine clinic visits, particularly for children with intellectual or developmental delays and those with poor seizure control.