Epilepsy Research最新文献

Objectives

Monitoring seizure control metrics is key to clinical care of patients with epilepsy. Manually abstracting these metrics from unstructured text in electronic health records (EHR) is laborious. We aimed to abstract the date of last seizure and seizure frequency from clinical notes of patients with epilepsy using natural language processing (NLP).

Methods

We extracted seizure control metrics from notes of patients seen in epilepsy clinics from two hospitals in Boston. Extraction was performed with the pretrained model RoBERTa_for_seizureFrequency_QA, for both date of last seizure and seizure frequency, combined with regular expressions. We designed the algorithm to categorize the timing of last seizure (“today”, “1–6 days ago”, “1–4 weeks ago”, “more than 1–3 months ago”, “more than 3–6 months ago”, “more than 6–12 months ago”, “more than 1–2 years ago”, “more than 2 years ago”) and seizure frequency (“innumerable”, “multiple”, “daily”, “weekly”, “monthly”, “once per year”, “less than once per year”). Our ground truth consisted of structured questionnaires filled out by physicians. Model performance was measured using the areas under the receiving operating characteristic curve (AUROC) and precision recall curve (AUPRC) for categorical labels, and median absolute error (MAE) for ordinal labels, with 95 % confidence intervals (CI) estimated via bootstrapping.

Results

Our cohort included 1773 adult patients with a total of 5658 visits with reported seizure control metrics, seen in epilepsy clinics between December 2018 and May 2022. The cohort average age was 42 years old, the majority were female (57 %), White (81 %) and non-Hispanic (85 %). The models achieved an MAE (95 % CI) for date of last seizure of 4 (4.00–4.86) weeks, and for seizure frequency of 0.02 (0.02–0.02) seizures per day.

Conclusions

Our NLP approach demonstrates that the extraction of seizure control metrics from EHR is feasible allowing for large-scale EHR research.

Aim

The present study was performed to investigate the associations among perceived stress, spiritual well-being, and alexithymia in people with epilepsy.

Method

The study was performed with 140 patients diagnosed with epilepsy in the neurology clinic of a training and research hospital between May and December 2022. Personal Information Form, Perceived Stress Scale (PSS-14), Spiritual Well-Being Scale (FACIT Sp-12), and Toronto Alexithymia Scale (TAS-20) were used to collect the data. Descriptive statistical methods, simple and multiple regression analyses, and path analysis were used to analyze the data.

Results

The mean scores of the patients were 25.51±9.42 for PSS-14, 29.77±8.33 for FACIT Sp-12, and 56.55±16.87 for TAS-20. Concerning direct effects, a negative association was found between perceived stress and spiritual well-being, a positive association between perceived stress and alexithymia, and a negative association between spiritual well-being and alexithymia. The confirmed mediating effect was the role of spiritual well-being in the association between perceived stress and alexithymia. Perceived stress explained 28 % of spiritual well-being. In addition, the model explained 34 % of alexithymia in total.

Conclusion

Perceived stress levels of people with epilepsy were low, while alexithymia and spiritual well-being levels were found to be moderate. It was found that as the stress levels perceived by people with epilepsy increased, alexithymia levels also increased. It was also found that the negative impact of perceived stress on alexithymia was reduced through spiritual well-being. The study shows how important spiritual well-being is in decreasing the negative impacts of perceived stress on alexithymia in people with epilepsy.

Introduction

Seizures and epilepsy are well-documented in association with autoimmune encephalitis. Despite this, a notable gap exists in understanding the persistence of seizures beyond the acute phase, particularly within the context of low- and low-middle-income settings.

Objective

To evaluate the frequency, clinical characteristics, diagnosis, and potential factors associated with the occurrence and persistence of seizures in autoimmune encephalitis patients.

Methods

This was a retrospective, cross-sectional study. Patients diagnosed with possible, probable or confirmed autoimmune encephalitis according to the Graus criteria at the “Instituto Nacional de Ciencias Neurológicas” in Lima, Peru, were included between January 2018 and April 2023. Demographic, clinical, diagnosis, and management information was recorded. A bivariate analysis was performed considering the persistence of seizures at one-year follow-up and a second analysis was performed to compare the groups according to the anti N-methyl-D-aspartate receptor (NMDAR) antibody results.

Results

Sixty patients predominantly male (40; 66.7 %) were included. Only 36 (60 %) patients were tested for antibodies, 16 (44.4 %) were NMDAR positive. 46 (76.7 %) patients had at least one seizure and 13 (37.1 %) had seizures after 1 year of follow-up. Patients with seizure relapse were younger, 20 (IQR: 18–28) versus 29.5 years (IQR: 21–48), p=0.049. Four (44.4 %) patients with persistent seizures had positive NMDAR results. Similar sex distributions, no differences in seizure characteristics, and higher CSF cell count in the NMDAR-positive group were observed. Neuroimaging, EEG findings, and follow-up times were comparable between the groups.

Conclusions

We found a 37.1 % seizures rate after one year of follow-up, predominantly in younger patients.

Purpose

New onset status epilepticus (NOSE), a subtype of status epilepticus, is a neurological emergency associated with significant morbidity and mortality. This study aimed to analyze the phenotypic spectrum and outcomes of patients presenting with NOSE.

Methods

This prospective and retrospective descriptive study included patients presenting with NOSE over a 10-year period. Data collected included patient demographics, phenotypic characteristics of SE and its etiology, Status Epilepticus Severity Score (STESS), SE classification Axis-II, and Modified Rankin Scale (mRS) scores at admission and discharge. Functional outcomes and seizure status were assessed at least 6 months post-discharge. Prognostic factors for mortality and the development of epilepsy were also analyzed.

Results

A total of 208 patients were included, with a mean age of 41.97 ± 21.66 years, and a male predominance (57.1 %). Focal to bilateral tonic-clonic seizures were observed in 47.5 % of patients. The etiology was acute symptomatic in 35.57 % and remote symptomatic in 24 %. The median hospital stay was 4 days (range: 2.25–10.75 days). The mortality rate was 26.5 %, and 23 % of patients developed epilepsy with a median follow-up of 9 months. Higher age (≥ 50 years), elevated STESS, ICU admission, use of anesthetic agents, refractory status epilepticus (RSE), and new-onset refractory status epilepticus (NORSE) were significant risk factors for mortality (p<0.05). The development of epilepsy was associated with a higher number of antiseizure medications (ASM) at discharge, ICU admission, use of anesthetic agents, RSE, and NORSE (p<0.05).

Conclusion

NOSE is a neurological emergency with a variable etiology and significant long-term consequences. Approximately one-fourth of patients presenting with NOSE died, and another quarter developed epilepsy during a median follow-up of 9 months. Identifying and addressing the predictors of mortality and epilepsy development following NOSE may improve long-term outcomes.

Seizures induce hippocampal subregion dependent enhancements in microglia/macrophage phagocytosis and cytokine release that may contribute to the development of epilepsy. As a model of hyperactive mTOR induced epilepsy, neuronal subset specific phosphatase and tensin homolog (NS-Pten) knockout (KO) mice exhibit hyperactive mTOR signaling in the hippocampus, seizures that progress with age, and enhanced hippocampal microglia/macrophage activation. However, it is unknown where microglia/macrophages are most active within the hippocampus of NS-Pten KO mice. We quantified the density of IBA1 positive microglia/macrophages in the CA1, CA2/3, and dentate gyrus of NS-Pten KO and wildtype (WT) male and female mice at 4, 10, and 15 weeks of age. NS-Pten KO mice exhibited an overall increase in the number of IBA1 positive microglia/macrophages in each subregion and in the entire hippocampus. After accounting for differences in size, the whole hippocampus of NS-Pten KO mice still exhibited an increased density of IBA1 positive microglia/macrophages. Subregion analyses showed that this increase was restricted to the dentate gyrus of both male and female NS-Pten KO mice and to the CA1 of male NS-Pten KO mice. These data suggest enhanced microglia/macrophage activity may occur in the NS-Pten KO mice in a hippocampal subregion and sex-dependent manner. Future work should seek to determine whether these region-specific increases in microgliosis play a role in the progression of epilepsy in this model.

There are many treatment options available for patients with medically refractory epilepsy including antiseizure medications, surgery, devices and ketogenic diet therapy. Ketogenic diet therapy has been shown to be a safe and effective treatment option in adult and pediatric patients. In order to obtain maximal clinical effectiveness and tolerability of any treatment option, adjustments are often necessary. This article outlines the “fine-tuning” options available for antiseizure medications, vagus nerve stimulation and ketogenic diet therapies and demonstrates that ketogenic diet therapies offer a wider array of personalizing and fine-tuning options.

Purpose

Inconsistent access to healthcare for people with epilepsy results in reduced adherence to antiseizure medications, increased seizure frequency, and fewer appropriate referrals for epilepsy surgery. Identifying and addressing factors that impede access to care should consequently improve patient outcomes. We hypothesized that health insurance and transportation affect access to outpatient neurology care for adults living with epilepsy in the United States (US).

Methods

We conducted a retrospective cross-sectional study of US adults with active epilepsy surveyed via the National Health Interview Survey (NHIS) in 2015 and 2017. We established whether patients reported seeing a neurologist in the past year and used multiple logistic regression to determine whether health insurance status and transportation access were associated with this outcome.

Results

We identified 735 respondents from 2015 and 2017, representing an estimated 2.98 million US adults with active epilepsy. After adjusting for socioeconomic and seizure-related co-variates, we found that a lack of health insurance coverage was associated with no epilepsy care in the past year (adjusted odds ratio [aOR] 0.22; 95 % confidence interval [CI]: 0.09 – 0.54). Delayed care due to inadequate transportation (aOR 0.42; 95 % CI: 0.19 – 0.93) also resulted in reduced patient access to a neurologist.

Conclusion

Due to the inherent nature of their condition, people with epilepsy are less likely to have employer-sponsored health insurance or consistent driving privileges. Yet, these factors also impact patient access to neurological care. We must address transportation and insurance barriers through long-term investment and partnership between community, healthcare, and government stakeholders.

Children with epilepsy often experience deficits in both executive functioning (EF) and memory. However, how these two domains interact and relate to specific epilepsy types remains unclear. This study compared two groups of children: those with localization-related epilepsy (LRE) and those with genetic generalized epilepsy (GGE). We aimed to understand how performance-based and parent-reported EF differentially contribute to understanding memory function in each group.

We examined neuropsychological measures assessing memory and EF in 75 children with LRE and 91 with GGE. Multiple linear regressions explored the impact of EF on memory performance.

Performance-based EF scores accounted for greater variance in memory scores than parental EF reports. However, performance-based EF measures explained much more variance in visual memory for LRE than GGE and explained much more variance in verbal memory for the GGE group. Parental reports of EF contributed marginally to understanding variance.

These findings suggest differential relationships between EF and memory based on epilepsy type. Performance-based EF measures appear more reliable at understanding memory variance than did parent reports. Our results have potential clinical implications for tailoring neuropsychological assessment and intervention for children with different epilepsy types.

Responsive neurostimulation (RNS) is a treatment option for patients with refractory epilepsy when surgical resection is not possible due to overlap of the irritative zone and eloquent cortex. Presurgical evaluations for RNS placement typically rely on invasive methods. This study investigated the potential of transcranial magnetic stimulation (TMS) and magnetoencephalography (MEG) to provide key presurgical information non-invasively. We hypothesized that these non-invasive methods may assist in optimizing RNS placement by providing useful information for seizure localization by MEG and eloquent cortex mapping by TMS. A retrospective chart review identified nine patients who underwent RNS placement (mean age = 20.4 years [SD = 5.6], two-thirds were female). Characterization of the irritative zone using MEG was successful in eight of nine patients. Non-invasive mapping of relevant eloquent cortex was attempted in all patients. TMS was successful in eight of nine patients, and MEG was successful in two of six patients. Importantly, patients mapped with non-invasive modalities experienced an average seizure reduction of 77 % at their most recent clinic visit, compared to 75 % seizure reduction in those with invasive evaluations, indicating appropriate RNS placement. These data demonstrate that TMS and MEG can provide key information for RNS and may be feasible alternatives to invasive methods for assisting in decision making regarding RNS placement. Non-invasive methods for determining RNS placement have a high rate of success when data from multiple non-invasive modalities converge and can inform more accurate placement of intracranial electrodes prior to RNS placement or mitigate their need.

Ninety percent of tuberous sclerosis complex (TSC) patients have seizures, with ∼50 % developing drug refractory epilepsy. Surgical intervention aims to remove the seizure onset zone (SOZ). This retrospective study investigated the relationship of SOZ size, ictal pattern, and extent of resection with surgical outcomes. TSC patients undergoing resective/ablative surgery with >1-year follow-up and adequate imaging were included. Preoperative iEEG data were reviewed to determine ictal pattern and SOZ location. For outcomes, an ILAE score of 1–3 was defined as good and 4–6 as poor. Forty-four patients were included (age 117.4 ± 110.8 months). Of these, 59.1 % achieved a good outcome, while 40.9 % had a poor outcome. Size of SOZ was a significant factor (p = 0.009), with the poor outcome group having a larger SOZ (11.9 ± 6.7 electrode contacts) than the good outcome group (7.3 ± 7.2). SOZ number was significant (p = 0.020); >1 SOZ was associated with poor outcome. These results demonstrate extent of SOZ as a predictor of seizure freedom following epilepsy surgery in a mostly pediatric TSC cohort. We hypothesize that these features represent biomarkers of focality of the epileptogenic zone and can be used to sharpen prognosis for epilepsy surgery outcomes in this cohort.