Pub Date : 2024-10-17DOI: 10.1016/j.yebeh.2024.110100
Pietro Mattioli , Maria Margherita Mancardi , Alessandra Ferrari , Elisa Micalizzi , Dario Arnaldi , Irene Pappalardo , Francesca Bisulli , Chiara Pastori , Paola Mandich , Lino Nobili , Francesca Darra , Flavio Villani , Commission on Transition of the Lega Italiana Contro l'Epilessia (LICE)
Transition from the paediatric holistic approach to the adult more individual care of epilepsy is a process that carries a high level of complexity and involves many actors. It is a mandatory step so to provide a gold-standard quality of care in young people with epilepsy. Its failure is strongly associated with a poor epilepsy, cognitive, and behavioural outcome.
Although the interest of the scientific community on transition has increased, in the clinical practice it is still considered a sensitive issue, in particular for adult neurologists. In this study we aimed at exploring pitfalls and unmet needs of transition from the adult neurologists’ perspective. A short survey, aimed to adult neurologists, was designed to explore i) whether transition is considered a problematic issue for the adult neurologist, ii) how transition impact his/her clinical practice, iii) which are the major problems related to the process, and iv) how transition may be improved. The results of the survey showed that transition is felt as a complex process that needs a shared action plan between child and adult neurologists, possibly with multidisciplinary team meetings as well as a higher training on childhood epilepsies for the adult neurologist.
{"title":"Pitfalls and unmet needs of transition in epilepsy: Understanding the adult neurologist perspective","authors":"Pietro Mattioli , Maria Margherita Mancardi , Alessandra Ferrari , Elisa Micalizzi , Dario Arnaldi , Irene Pappalardo , Francesca Bisulli , Chiara Pastori , Paola Mandich , Lino Nobili , Francesca Darra , Flavio Villani , Commission on Transition of the Lega Italiana Contro l'Epilessia (LICE)","doi":"10.1016/j.yebeh.2024.110100","DOIUrl":"10.1016/j.yebeh.2024.110100","url":null,"abstract":"<div><div>Transition from the paediatric holistic approach to the adult more individual care of epilepsy is a process that carries a high level of complexity and involves many actors. It is a mandatory step so to provide a gold-standard quality of care in young people with epilepsy. Its failure is strongly associated with a poor epilepsy, cognitive, and behavioural outcome.</div><div>Although the interest of the scientific community on transition has increased, in the clinical practice it is still considered a sensitive issue, in particular for adult neurologists. In this study we aimed at exploring pitfalls and unmet needs of transition from the adult neurologists’ perspective. A short survey, aimed to adult neurologists, was designed to explore i) whether transition is considered a problematic issue for the adult neurologist, ii) how transition impact his/her clinical practice, iii) which are the major problems related to the process, and iv) how transition may be improved. The results of the survey showed that transition is felt as a complex process that needs a shared action plan between child and adult neurologists, possibly with multidisciplinary team meetings as well as a higher training on childhood epilepsies for the adult neurologist.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110100"},"PeriodicalIF":2.3,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445194","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 : 2024-10-15DOI: 10.1016/j.yebeh.2024.110084
Susanna Stjerna , Yfke Huber-Mollema , Torbjörn Tomson , Emilio Perucca , Dina Battino , John Craig , Anne Sabers , Sanjeev Thomas , Frank Vajda , Eija Gaily
{"title":"Response to Letter on “Cognitive outcomes after fetal exposure to carbamazepine, lamotrigine, valproate or levetiracetam monotherapy: Data from the EURAP neurocognitive extension protocol”","authors":"Susanna Stjerna , Yfke Huber-Mollema , Torbjörn Tomson , Emilio Perucca , Dina Battino , John Craig , Anne Sabers , Sanjeev Thomas , Frank Vajda , Eija Gaily","doi":"10.1016/j.yebeh.2024.110084","DOIUrl":"10.1016/j.yebeh.2024.110084","url":null,"abstract":"","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110084"},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437823","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 : 2024-10-15DOI: 10.1016/j.yebeh.2024.110092
Catrin Mann , Nico Melzer , Dorothea Münch
Of all patients with brain tumors, about 30–50% suffer from epileptic seizures. The probability of developing epilepsy is particularly high in low-grade, epilepsy-associated brain tumors (LEAT). LEATs often show a pronounced network dysfunction with extensive EEG pathologies and cognitive deficits, and the epilepsies are often difficult to treat. In high-grade brain tumors, epileptic seizures determine morbidity and quality of life. The underlying mechanisms of epileptogenesis of brain tumors are increasingly understood and raise hope for personalized therapeutic approaches. This short, focused review provides an overview of the current understanding of brain tumor-related epilepsies.
This paper was presented at 16th International Epilepsy Course and Colloquium held in Frankfurt a.M., Germany, September 2024.
{"title":"Epilepsy in LEAT and other brain tumors: A focused review","authors":"Catrin Mann , Nico Melzer , Dorothea Münch","doi":"10.1016/j.yebeh.2024.110092","DOIUrl":"10.1016/j.yebeh.2024.110092","url":null,"abstract":"<div><div>Of all patients with brain tumors, about 30–50% suffer from epileptic seizures. The probability of developing epilepsy is particularly high in low-grade, epilepsy-associated brain tumors (LEAT). LEATs often show a pronounced network dysfunction with extensive EEG pathologies and cognitive deficits, and the epilepsies are often difficult to treat. In high-grade brain tumors, epileptic seizures determine morbidity and quality of life. The underlying mechanisms of epileptogenesis of brain tumors are increasingly understood and raise hope for personalized therapeutic approaches. This short, focused review provides an overview of the current understanding of brain tumor-related epilepsies.</div><div>This paper was presented at 16th International Epilepsy Course and Colloquium held in Frankfurt a.M., Germany, September 2024.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110092"},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432449","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 : 2024-10-11DOI: 10.1016/j.yebeh.2024.110066
Camilo Garcia-Gracia , Samer Riaz , Claudia Vallin , Andreas Alexopoulos , Badih Adada , William Bingaman , Imad Najm , Juan C. Bulacio
Objective
Our study aimed to investigate the management of patients with medically refractory epilepsy related to temporal encephaloceles, focusing on the use of ancillary testing in the pre-surgical evaluation to optimize surgical outcomes.
Methods
We conducted a retrospective analysis of electronic medical records from the Cleveland Clinic, covering the period from January 2000 to May 2020. Patients with drug-resistant temporal lobe epilepsy were included if they had temporal lobe encephaloceles and required surgical intervention. We reviewed the results of ancillary studies, including invasive EEG.
Results
A total of 19 patients with temporal lobe encephaloceles underwent resection for drug-resistant epilepsy treatment. Among them, 63 % reported experiencing auras commonly associated with mesial temporal lobe epilepsy, such as autonomic, psychic, and abdominal symptoms, followed by dialeptic seizures. Ictal patterns were consistently ipsilateral, with high amplitude delta or medium amplitude theta activity at onset, predominantly localized to the frontotemporal region in more than half of the cases. In 35 % of these patients, encephaloceles were only diagnosed during surgery. Stereo-EEG evaluation revealed two distinct ictal patterns: one characterized by localized low voltage fast activity in the temporal pole evolving into a 3–4 Hz high amplitude diffuse spiky activity, and the other exhibiting low amplitude rhythmic theta activity in the temporal pole with late involvement of the amygdala/hippocampus. Surgical resection strategy was based on clinical history and ancillary data analysis. At one-year follow-up after resection, 63 % of the patients attained Engel I seizure control over an average duration of 44 months (ranging from 6 months to 7.3 years). Additionally, 18 % of the patients achieved an Engel II outcome.
Significance
Tailored resection of the encephalocele and the surrounding temporal pole, while preserving the mesial temporal structures, can effectively control seizures in patients with temporal encephaloceles identified through MRI. Patients presenting with temporal lobe symptoms and scalp ictal patterns characterized by polymorphic high delta theta activity with frontotemporal evolution should be evaluated for temporal encephaloceles as a potential underlying cause of their seizures, especially when the MRI is otherwise unrevealing.
{"title":"Temporal lobe encephaloceles: Electro-clinical characteristics and seizure outcome after tailored lesionectomy","authors":"Camilo Garcia-Gracia , Samer Riaz , Claudia Vallin , Andreas Alexopoulos , Badih Adada , William Bingaman , Imad Najm , Juan C. Bulacio","doi":"10.1016/j.yebeh.2024.110066","DOIUrl":"10.1016/j.yebeh.2024.110066","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aimed to investigate the management of patients with medically refractory epilepsy related to temporal encephaloceles, focusing on the use of ancillary testing in the pre-surgical evaluation to optimize surgical outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of electronic medical records from the Cleveland Clinic, covering the period from January 2000 to May 2020. Patients with drug-resistant temporal lobe epilepsy were included if they had temporal lobe encephaloceles and required surgical intervention. We reviewed the results of ancillary studies, including invasive EEG.</div></div><div><h3>Results</h3><div>A total of 19 patients with temporal lobe encephaloceles underwent resection for drug-resistant epilepsy treatment. Among them, 63 % reported experiencing auras commonly associated with mesial temporal lobe epilepsy, such as autonomic, psychic, and abdominal symptoms, followed by dialeptic seizures. Ictal patterns were consistently ipsilateral, with high amplitude delta or medium amplitude theta activity at onset, predominantly localized to the frontotemporal region in more than half of the cases. In 35 % of these patients, encephaloceles were only diagnosed during surgery. Stereo-EEG evaluation revealed two distinct ictal patterns: one characterized by localized low voltage fast activity in the temporal pole evolving into a 3–4 Hz high amplitude diffuse spiky activity, and the other exhibiting low amplitude rhythmic theta activity in the temporal pole with late involvement of the amygdala/hippocampus. Surgical resection strategy was based on clinical history and ancillary data analysis. At one-year follow-up after resection, 63 % of the patients attained Engel I seizure control over an average duration of 44 months (ranging from 6 months to 7.3 years). Additionally, 18 % of the patients achieved an Engel II outcome.</div></div><div><h3>Significance</h3><div>Tailored resection of the encephalocele and the surrounding temporal pole, while preserving the mesial temporal structures, can effectively control seizures in patients with temporal encephaloceles identified through MRI. Patients presenting with temporal lobe symptoms and scalp ictal patterns characterized by polymorphic high delta theta activity with frontotemporal evolution should be evaluated for temporal encephaloceles as a potential underlying cause of their seizures, especially when the MRI is otherwise unrevealing.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110066"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406258","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 : 2024-10-11DOI: 10.1016/j.yebeh.2024.110077
Qi Wang , Hao Sun , Jie Huang , Yanjie Chen , Jiameng Ni , Zaixiang Tang , Jingfang Liu
Background
The prescription of levetiracetam during pregnancy has become more common due to its lower teratogenic risk profile. However, due to a lack of data about its association with stillbirth and spontaneous abortion, worries remain.
Objective
To investigate information on any possible association of spontaneous abortion and stillbirth adverse events with levetiracetam in women with epilepsy.
Methods
This retrospective pharmacovigilance study used disproportionality analysis to detect signals of adverse reaction of interest reported with Levetiracetam in FAERS, the FDA Adverse Event Reporting System. The ratio of reporting odds (ROR) and information component (IC) indices were used to undertake disproportionality analyses, and change point analyses were carried out to identify variations in the frequency of reporting of relevant adverse events. Sensitivity analyses included subgroup analyses by indication, treatment regimen, and reporting region.
Results
Overall, 2870 cases of spontaneous abortion and stillbirth with commonly used antiseizure medications were analyzed. A total of 65.5 % of these cases had epilepsy as the indication. In the entire dataset, we observed disproportionality signals of spontaneous abortion for 6 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine, topiramate, valproic acid) and disproportionality signals of stillbirth for 4 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine). In the epileptic population, disproportionality signals for stillbirth (ROR0.25 = 4.60; IC0.25 = 1.30) and spontaneous abortion (ROR0.25 = 3.98; IC0.25 = 1.20) in levetiracetam was identified. These disproportionality signals have been consistently robust over the past years, according to a temporal assessment of them. Sensitivity studies proved how reliable the findings were.
Conclusion
Using validated pharmacovigilance methods, we found significant disproportional signals for spontaneous abortion and stillbirth associated with levetiracetam. Of these, the signals for spontaneous abortion were observed after 2011 and for stillbirth after 2014, which may be related to the rise in levetiracetam prescriptions during pregnancy in recent years. The association of spontaneous abortion and stillbirth adverse events with levetiracetam and potential biases confounding this association merit further investigation.
{"title":"Investigation of spontaneous abortion and stillbirth adverse events in epilepsy patients treated with levetiracetam: A pharmacovigilance study","authors":"Qi Wang , Hao Sun , Jie Huang , Yanjie Chen , Jiameng Ni , Zaixiang Tang , Jingfang Liu","doi":"10.1016/j.yebeh.2024.110077","DOIUrl":"10.1016/j.yebeh.2024.110077","url":null,"abstract":"<div><h3>Background</h3><div>The prescription of levetiracetam during pregnancy has become more common due to its lower teratogenic risk profile. However, due to a lack of data about its association with stillbirth and spontaneous abortion, worries remain.</div></div><div><h3>Objective</h3><div>To investigate information on any possible association of spontaneous abortion and stillbirth adverse events with levetiracetam in women with epilepsy.</div></div><div><h3>Methods</h3><div>This retrospective pharmacovigilance study used disproportionality analysis to detect signals of adverse reaction of interest reported with Levetiracetam in FAERS, the FDA Adverse Event Reporting System. The ratio of reporting odds (ROR) and information component (IC) indices were used to undertake disproportionality analyses, and change point analyses were carried out to identify variations in the frequency of reporting of relevant adverse events. Sensitivity analyses included subgroup analyses by indication, treatment regimen, and reporting region.</div></div><div><h3>Results</h3><div>Overall, 2870 cases of spontaneous abortion and stillbirth with commonly used antiseizure medications were analyzed. A total of 65.5 % of these cases had epilepsy as the indication. In the entire dataset, we observed disproportionality signals of spontaneous abortion for 6 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine, topiramate, valproic acid) and disproportionality signals of stillbirth for 4 ASMs (levetiracetam, carbamazepine, lamotrigine, oxcarbazepine). In the epileptic population, disproportionality signals for stillbirth (ROR<sub>0.25</sub> = 4.60; IC<sub>0.25</sub> = 1.30) and spontaneous abortion (ROR<sub>0.25</sub> = 3.98; IC<sub>0.25</sub> = 1.20) in levetiracetam was identified. These disproportionality signals have been consistently robust over the past years, according to a temporal assessment of them. Sensitivity studies proved how reliable the findings were.</div></div><div><h3>Conclusion</h3><div>Using validated pharmacovigilance methods, we found significant disproportional signals for spontaneous abortion and stillbirth associated with levetiracetam. Of these, the signals for spontaneous abortion were observed after 2011 and for stillbirth after 2014, which may be related to the rise in levetiracetam prescriptions during pregnancy in recent years. The association of spontaneous abortion and stillbirth adverse events with levetiracetam and potential biases confounding this association merit further investigation.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110077"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417043","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 : 2024-10-11DOI: 10.1016/j.yebeh.2024.110074
Behnaz Esmaeili , Andrew L. Ko , John W. Miller
We aimed to identify factors predicting additional surgical interventions in patients with drug-resistant epilepsy who continue experiencing seizures after mesial temporal laser interstitial thermal therapy (LITT). In a retrospective observational study, we analyzed consecutive patients with drug-resistant temporal epilepsy treated with mesial temporal LITT at the University of Washington between 2013–2022. The primary outcome was subsequent epilepsy surgery to improve seizure control after LITT. Logistic regression was used to assess how clinical factors and travel distance within tertiary center referral regions predict subsequent surgery occurrence. We identified 145 patients treated with mesial temporal LITT. Among the patients, 25 underwent subsequent surgeries, including 17 temporal lobectomies, 5 repeat LITT, 2 responsive neurostimulation, and 1 with deep brain stimulation. Further surgery was associated with higher Engel scores and shorter travel distance to our tertiary epilepsy center. Factors like age, sex, epilepsy duration, surgery on dominant hemisphere, and frequency of convulsive seizures were not significant. Patients who continue to have seizures after LITT are potential candidates for more surgery. Patients who must travel farther are less likely to receive follow-up surgery. Healthcare inequity presents a significant barrier in accessing epilepsy surgery, limiting the potential to achieve improved outcomes for individuals with epilepsy.
我们的目的是找出耐药性癫痫患者在接受颞中叶激光间质热疗（LITT）后继续出现癫痫发作的额外手术干预的预测因素。在一项回顾性观察研究中，我们分析了 2013-2022 年间在华盛顿大学接受颞中叶激光间质热疗的连续耐药颞叶癫痫患者。主要结果是 LITT 后为改善癫痫发作控制而进行的后续癫痫手术。逻辑回归用于评估三级中心转诊区域内的临床因素和旅行距离如何预测后续手术的发生。我们确定了 145 名接受颞中叶 LITT 治疗的患者。其中 25 人接受了后续手术，包括 17 例颞叶切除术、5 例重复 LITT、2 例反应性神经刺激和 1 例脑深部刺激。进一步手术与较高的恩格尔评分和较短的前往三级癫痫中心的路程有关。年龄、性别、癫痫持续时间、优势半球手术和惊厥发作频率等因素均无显著影响。LITT后仍有癫痫发作的患者有可能接受更多手术。必须长途跋涉的患者接受后续手术的可能性较低。医疗不公平是接受癫痫手术的一大障碍，限制了癫痫患者获得更好治疗效果的可能性。
{"title":"Predictive factors for additional surgeries in drug-resistant epilepsy after mesial temporal laser interstitial thermal therapy","authors":"Behnaz Esmaeili , Andrew L. Ko , John W. Miller","doi":"10.1016/j.yebeh.2024.110074","DOIUrl":"10.1016/j.yebeh.2024.110074","url":null,"abstract":"<div><div>We aimed to identify factors predicting additional surgical interventions in patients with drug-resistant epilepsy who continue experiencing seizures after mesial temporal laser interstitial thermal therapy (LITT). In a retrospective observational study, we analyzed consecutive patients with drug-resistant temporal epilepsy treated with mesial temporal LITT at the University of Washington between 2013–2022. The primary outcome was subsequent epilepsy surgery to improve seizure control after LITT. Logistic regression was used to assess how clinical factors and travel distance within tertiary center referral regions predict subsequent surgery occurrence. We identified 145 patients treated with mesial temporal LITT. Among the patients, 25 underwent subsequent surgeries, including 17 temporal lobectomies, 5 repeat LITT, 2 responsive neurostimulation, and 1 with deep brain stimulation. Further surgery was associated with higher Engel scores and shorter travel distance to our tertiary epilepsy center. Factors like age, sex, epilepsy duration, surgery on dominant hemisphere, and frequency of convulsive seizures were not significant. Patients who continue to have seizures after LITT are potential candidates for more surgery. Patients who must travel farther are less likely to receive follow-up surgery. Healthcare inequity presents a significant barrier in accessing epilepsy surgery, limiting the potential to achieve improved outcomes for individuals with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110074"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406257","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 : 2024-10-11DOI: 10.1016/j.yebeh.2024.110058
Meha Joshi , Laura D. Fonseca , Gogi Kumar
Objective
We aimed to determine the demographics and clinical presentation of young persons with epilepsy (YPE) 18-years and older who have not transitioned to adult health care systems (AHCS) and to investigate the number of neurology-related hospital encounters in this population before and after attaining adulthood.
Methods
We conducted a single-site retrospective cohort study at Dayton Children’s Hospital (DCH) between 12/01/2021 and 5/31/2022. We included epilepsy patients 18-years and older. Patient demographics, insurance, number of hospitalizations and Emergency Department (ED) visits before and after 18 years of age, clinical presentation, and comorbidities were collected.
Results
251 patient charts were reviewed. The median age was 20.9 years. The most common comorbidities were intellectual disability (36 %) and psychiatric illnesses (59 %). The majority had generalized epilepsy (52 %) and tonic-clonic seizures (56 %). 58 % of the patients had infrequent seizures in the past year. Documentation of transition to AHCS discussion occurred in only 3 % of patients before age 18 compared to 35 % of patients after age 18. There was a decrease in 30 % for ED visits and 15 % for neurology related hospitalizations after the age of 18.
Conclusion
YPE 18-years of age and older who were managed by a pediatric neurologist at DCH had significant co-morbidities. However, they were clinically stable and rarely required admission to the hospital. Most of them did not have documentation about transition discussions. At DCH, YPE who have not transitioned to AHCS are clinically stable and well managed.
{"title":"Clinical presentation of young persons with epilepsy who have not transitioned to adult health care systems: A single-site retrospective cohort","authors":"Meha Joshi , Laura D. Fonseca , Gogi Kumar","doi":"10.1016/j.yebeh.2024.110058","DOIUrl":"10.1016/j.yebeh.2024.110058","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to determine the demographics and clinical presentation of young persons with epilepsy (YPE) 18-years and older who have not transitioned to adult health care systems (AHCS) and to investigate the number of neurology-related hospital encounters in this population before and after attaining adulthood.</div></div><div><h3>Methods</h3><div>We conducted a single-site retrospective cohort study at Dayton Children’s Hospital (DCH) between 12/01/2021 and 5/31/2022. We included epilepsy patients 18-years and older. Patient demographics, insurance, number of hospitalizations and Emergency Department (ED) visits before and after 18 years of age, clinical presentation, and comorbidities were collected.</div></div><div><h3>Results</h3><div>251 patient charts were reviewed. The median age was 20.9 years. The most common comorbidities were intellectual disability (36 %) and psychiatric illnesses (59 %). The majority had generalized epilepsy (52 %) and tonic-clonic seizures (56 %). 58 % of the patients had infrequent seizures in the past year. Documentation of transition to AHCS discussion occurred in only 3 % of patients before age 18 compared to 35 % of patients after age 18. There was a decrease in 30 % for ED visits and 15 % for neurology related hospitalizations after the age of 18.</div></div><div><h3>Conclusion</h3><div>YPE 18-years of age and older who were managed by a pediatric neurologist at DCH had significant co-morbidities. However, they were clinically stable and rarely required admission to the hospital. Most of them did not have documentation about transition discussions. At DCH, YPE who have not transitioned to AHCS are clinically stable and well managed.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110058"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406249","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}
Utilizing interictal manifestations for the diagnosis of epilepsy is challenging. We investigated whether an interictal “head-turning sign,” typically indicative of dependence on others observed in Alzheimer’s disease, can act as a behavioral marker of idiopathic generalized epilepsy.
Methods
This multicenter study examined 579 consecutive patients, with a mean age of 36.8 ± 20.4 years, who did not have an intellectual disability and had their first outpatient visit for epilepsy evaluation between 2019 and 2023. Patients were categorized into IGE, non-IGE epilepsy, non-epileptic, and psychiatric conditions based on their ultimate diagnostic outcomes to identify difference of the occurrence of the head-turning sign among them. Additionally, we extracted data from patients under the age of 40, specifically adolescents and young adults (AYA). Then we used propensity score matching to confirm the reproducibility of observed differences and to identify associated factors within the AYA age group.
Results
The occurrence of the head-turning sign was significantly more prevalent in the IGE group compared to the non-IGE group (20.4 % vs. 2.2 %; P<0.0001) and non-epileptic group (20.4 % vs. 8.3 %; P=0.033). Following the matching, the head-turning sign was still evident in IGE relative to non-IGE patients (14.6 % vs. 4.5; P=0.004), yielding a 94 % specificity for IGE. IGE diagnosis (P<0.0001), myoclonic seizure (P<0.0001), being visited by a parent (P=0.017), and comorbidity with headache (P=0.021) were significantly associated with the head-turning sign. Multivariate analysis revealed that IGE (odds ratio: OR=2.80, P=0.028), attending with a parent (OR=2.92, P=0.029), and comorbidity with headache (OR=4.06, P=0.016) were independently associated with the head-turning sign.
Conclusions
We confirmed a substantial association between the interictal “head-turning sign” and IGE. This unique sign may reflect a tendency towards dependence on others in IGE, and may serve as a promising diagnostic auxiliary marker for identifying IGE in the AYA age group.
{"title":"Interictal head-turning sign in patients with idiopathic generalized epilepsy during initial medical interview: A matched multicenter study","authors":"Shuichiro Neshige , Shiro Aoki , Narumi Ohno , Megumi Nonaka , Hidetada Yamada , Yoshiko Takebayashi , Haruka Ishibashi , Takeo Shishido , Dai Agari , Yu Yamazaki , Koji Iida , Hirofumi Maruyama","doi":"10.1016/j.yebeh.2024.110039","DOIUrl":"10.1016/j.yebeh.2024.110039","url":null,"abstract":"<div><h3>Background</h3><div>Utilizing interictal manifestations for the diagnosis of epilepsy is challenging. We investigated whether an interictal “head-turning sign,” typically indicative of dependence on others observed in Alzheimer’s disease, can act as a behavioral marker of idiopathic generalized epilepsy.</div></div><div><h3>Methods</h3><div>This multicenter study examined 579 consecutive patients, with a mean age of 36.8 ± 20.4 years, who did not have an intellectual disability and had their first outpatient visit for epilepsy evaluation between 2019 and 2023. Patients were categorized into IGE, non-IGE epilepsy, non-epileptic, and psychiatric conditions based on their ultimate diagnostic outcomes to identify difference of the occurrence of the head-turning sign among them. Additionally, we extracted data from patients under the age of 40, specifically adolescents and young adults (AYA). Then we used propensity score matching to confirm the reproducibility of observed differences and to identify associated factors within the AYA age group.</div></div><div><h3>Results</h3><div>The occurrence of the head-turning sign was significantly more prevalent in the IGE group compared to the non-IGE group (20.4 % vs. 2.2 %; P<0.0001) and non-epileptic group (20.4 % vs. 8.3 %; P=0.033). Following the matching, the head-turning sign was still evident in IGE relative to non-IGE patients (14.6 % vs. 4.5; P=0.004), yielding a 94 % specificity for IGE. IGE diagnosis (P<0.0001), myoclonic seizure (P<0.0001), being visited by a parent (P=0.017), and comorbidity with headache (P=0.021) were significantly associated with the head-turning sign. Multivariate analysis revealed that IGE (odds ratio: OR=2.80, P=0.028), attending with a parent (OR=2.92, P=0.029), and comorbidity with headache (OR=4.06, P=0.016) were independently associated with the head-turning sign.</div></div><div><h3>Conclusions</h3><div>We confirmed a substantial association between the interictal “head-turning sign” and IGE. This unique sign may reflect a tendency towards dependence on others in IGE, and may serve as a promising diagnostic auxiliary marker for identifying IGE in the AYA age group.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110039"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142417042","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 : 2024-10-11DOI: 10.1016/j.yebeh.2024.110071
Eric H. Kossoff , Zoe Simpson , Julie Fountain
Introduction
The ketogenic diet is a valuable nonpharmacologic therapy for the treatment of refractory epilepsy in children and adults. It can be time-intensive for ketogenic teams, typically comprised of a physician and dietitian at a minimum. Challenges and barriers to providing ketogenic diet services to patients by members of these teams has not been studied extensively.
Methods
A survey was created and distributed to attendees at a ketogenic diet training conference (KetoCollegeAdvance™) held 21–23 May 2024 in United Kingdom. Questions included Likert scales and fill-in responses. Surveys were provided by 63 attendees (mostly dietitians) from 17 countries.
Results
Respondents were mostly dietitians (45/63, 71 %) and from the United Kingdom. In regards to perceived interest levels in KD in general in their countries, dietitians were perceived as 80 % very or extremely interested, parents (66 %), and neurologists (45 %). The majority of teams included a dietitian (79 %) and physician (78 %). The majority, 43 (68 %) of respondents, assumed care of all aspects of epilepsy care once the KD was started. Common barriers to starting KD services included a long waiting list, lack of adult KD services, funding dietitians, and low referrals. Barriers to continuing KD services included poor patient compliance, a lack of financial resources for some families to afford foods, and a need for more pre-made ketogenic foods including bread, pizza, pasta, potato fries, and chocolates.
Conclusions
These results from a conference of international ketogenic dietitians and physicians highlights common difficulties in providing the ketogenic diet successfully. Addressing these barriers may help expand the usage of this therapy for more patients with epilepsy.
{"title":"What do ketogenic dietitians and physicians need? A survey from the KetoCollegeAdvance™ training in United Kingdom","authors":"Eric H. Kossoff , Zoe Simpson , Julie Fountain","doi":"10.1016/j.yebeh.2024.110071","DOIUrl":"10.1016/j.yebeh.2024.110071","url":null,"abstract":"<div><h3>Introduction</h3><div>The ketogenic diet is a valuable nonpharmacologic therapy for the treatment of refractory epilepsy in children and adults. It can be time-intensive for ketogenic teams, typically comprised of a physician and dietitian at a minimum. Challenges and barriers to providing ketogenic diet services to patients by members of these teams has not been studied extensively.</div></div><div><h3>Methods</h3><div>A survey was created and distributed to attendees at a ketogenic diet training conference (KetoCollegeAdvance™) held 21–23 May 2024 in United Kingdom. Questions included Likert scales and fill-in responses. Surveys were provided by 63 attendees (mostly dietitians) from 17 countries.</div></div><div><h3>Results</h3><div>Respondents were mostly dietitians (45/63, 71 %) and from the United Kingdom. In regards to perceived interest levels in KD in general in their countries, dietitians were perceived as 80 % very or extremely interested, parents (66 %), and neurologists (45 %). The majority of teams included a dietitian (79 %) and physician (78 %). The majority, 43 (68 %) of respondents, assumed care of all aspects of epilepsy care once the KD was started. Common barriers to starting KD services included a long waiting list, lack of adult KD services, funding dietitians, and low referrals. Barriers to continuing KD services included poor patient compliance, a lack of financial resources for some families to afford foods, and a need for more pre-made ketogenic foods including bread, pizza, pasta, potato fries, and chocolates.</div></div><div><h3>Conclusions</h3><div>These results from a conference of international ketogenic dietitians and physicians highlights common difficulties in providing the ketogenic diet successfully. Addressing these barriers may help expand the usage of this therapy for more patients with epilepsy.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110071"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406260","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 : 2024-10-10DOI: 10.1016/j.yebeh.2024.110067
Debopam Samanta , Zulfi Haneef , Gregory W. Albert , Sunil Naik , Puck C. Reeders , Puneet Jain , Taylor J. Abel , Ruba Al-Ramadhani , George M. Ibrahim , Aaron E.L. Warren
Developmental and epileptic encephalopathies (DEEs) are a group of childhood-onset epilepsy syndromes characterized by frequent seizures, severe cognitive and behavioral impairments, and poor long-term outcomes. These conditions are typically refractory to currently available medical therapies, prompting recent exploration of neuromodulation treatments such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), which aim to modulate epileptic networks spanning cortical and subcortical regions. These advances have occurred alongside an improved understanding of syndrome-specific and interictal epileptiform discharge/seizure-specific brain networks. By targeting key nodes within these networks, DBS and RNS hold promise for influencing seizures and associated cognitive and behavioral comorbidities. Initial experiences with centromedian (CM) thalamic DBS for Lennox-Gastaut syndrome (LGS) have shown modest efficacy across multiple seizure types. Reports also indicate the application of DBS and RNS across various genetic and structural etiologies commonly associated with DEEs, with mixed success. Although DBS and RNS are increasingly used in LGS and other DEEs, their mixed efficacy highlights a knowledge gap in understanding why some patients with LGS do not respond and which neuromodulation approach is most effective for other DEEs. To address these issues, this review first discusses recent neuroimaging studies showing similarities and differences in the epileptic brain networks underlying various DEEs, revealing the common involvement of the thalamus and the default-mode network (DMN) across multiple DEEs. We then examine thalamic DBS for LGS to illustrate how such network insights may be used to optimize neuromodulation. Although network-based neuromodulation is still in its infancy, the LGS model may serve as a framework for other DEEs, where optimal treatment necessitates consideration of the underlying epileptic networks. Lastly, the review suggests future research directions, including individualized connectivity assessment and biomarker identification through collaborative efforts, which may enhance the therapeutic potential of neuromodulation for individuals living with DEEs.
{"title":"Neuromodulation strategies in developmental and epileptic encephalopathies","authors":"Debopam Samanta , Zulfi Haneef , Gregory W. Albert , Sunil Naik , Puck C. Reeders , Puneet Jain , Taylor J. Abel , Ruba Al-Ramadhani , George M. Ibrahim , Aaron E.L. Warren","doi":"10.1016/j.yebeh.2024.110067","DOIUrl":"10.1016/j.yebeh.2024.110067","url":null,"abstract":"<div><div>Developmental and epileptic encephalopathies (DEEs) are a group of childhood-onset epilepsy syndromes characterized by frequent seizures, severe cognitive and behavioral impairments, and poor long-term outcomes. These conditions are typically refractory to currently available medical therapies, prompting recent exploration of neuromodulation treatments such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), which aim to modulate epileptic networks spanning cortical and subcortical regions. These advances have occurred alongside an improved understanding of syndrome-specific and interictal epileptiform discharge/seizure-specific brain networks. By targeting key nodes within these networks, DBS and RNS hold promise for influencing seizures and associated cognitive and behavioral comorbidities. Initial experiences with centromedian (CM) thalamic DBS for Lennox-Gastaut syndrome (LGS) have shown modest efficacy across multiple seizure types. Reports also indicate the application of DBS and RNS across various genetic and structural etiologies commonly associated with DEEs, with mixed success. Although DBS and RNS are increasingly used in LGS and other DEEs, their mixed efficacy highlights a knowledge gap in understanding why some patients with LGS do not respond and which neuromodulation approach is most effective for other DEEs. To address these issues, this review first discusses recent neuroimaging studies showing similarities and differences in the epileptic brain networks underlying various DEEs, revealing the common involvement of the thalamus and the default-mode network (DMN) across multiple DEEs. We then examine thalamic DBS for LGS to illustrate how such network insights may be used to optimize neuromodulation. Although network-based neuromodulation is still in its infancy, the LGS model may serve as a framework for other DEEs, where optimal treatment necessitates consideration of the underlying epileptic networks. Lastly, the review suggests future research directions, including individualized connectivity assessment and biomarker identification through collaborative efforts, which may enhance the therapeutic potential of neuromodulation for individuals living with DEEs.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":"160 ","pages":"Article 110067"},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406256","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}
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