Epilepsia Open最新文献

Objective

This study evaluated the long-term risk of major cardiovascular diseases (CVDs) in patients with epilepsy using a nationwide cohort, aiming to address critical gaps in population-based evidence on brain–heart interactions.

Methods

Data from the Korean National Health Insurance Service (2002–2013) were analyzed. For each cardiovascular outcome, an independent matched cohort was constructed, comprising 1740 to 3164 patients with newly diagnosed epilepsy and corresponding 10-fold matched controls. The primary outcomes included six CVDs: hypertension (HTN), ischemic heart disease (IHD), cardiac arrhythmia (CA), heart failure (HF), atherosclerosis (AS), and peripheral artery disease (PAD). Incidence rate ratios (IRRs) and adjusted hazard ratios (aHRs) were calculated using multivariable Cox regression models.

Results

Epilepsy was significantly associated with increased risk of all six CVDs. The highest aHRs were observed for CA (2.02 [95% CI, 1.70–2.39]), IHD (1.71 [95% CI, 1.50–1.95]), and HF (1.64 [95% CI, 1.28–2.10]). Risk was higher in patients aged <60 years and in men. Notably, younger patients showed substantially elevated risks for CA (2.61 [95% CI, 1.99–3.42]) and AS (2.06 [95% CI, 1.47–2.89]). The sex-specific difference was most prominent for HF, with higher aHRs in men (1.86 [95% CI, 1.29–2.67]) than in women (1.49 [95% CI, 1.07–2.09]).

Significance

Patients with epilepsy have a significantly increased long-term risk of CVD, especially CA, IHD, and HF. Risk is disproportionately elevated in younger individuals and men, suggesting the need for targeted cardiovascular surveillance and prevention in these subgroups.

Plain Language Summary

People with epilepsy may face a higher risk of heart and blood vessel diseases such as heart attack, irregular heartbeat, and heart failure. This study analyzed national health data from Korea and found that epilepsy patients had more cardiovascular problems than those without epilepsy, especially younger men. These results suggest that doctors should monitor heart health more closely in people living with epilepsy.

The management of drug-resistant epilepsy (DRE) in the pediatric population using neurostimulation of the centromedian (CM) nucleus of the thalamus (CMN) has been reported to be effective and safe. We present a case series of pediatric patients treated with responsive neurostimulation (RNS) and report on contact localization in relation to preliminary outcomes, specifically seizure reduction rates. Thirteen pediatric patients treated with RNS underwent direct targeting of the CMN based on Magnetization-Prepared 2 Rapid Gradient-Echo (MP2RAGE) scans, using ClearPoint neuronavigation. The implanted electrodes were co-registered to a probabilistic anatomical model of the thalamic nuclei (Freesurfer) for secondary confirmation of contact localization. Ten out of the 12 patients with extra-temporal multifocal or generalized DRE (83.3%) had over 50% reduction in seizures, benefiting from an 80.4% seizure reduction rate. The average follow-up interval was 25.2 months, with no patients experiencing stimulation-related side effects. The analysis of post-operative images revealed that out of the 24 CM-processed electrodes, 23 (95.8%) had at least two contacts in the nucleus, based on patient-specific segmentation of the thalamus. The preliminary outcomes suggest a robust response to central neurostimulation and no stimulation-related side effects in pediatric patients suffering from multifocal or generalized DRE when implementing high-accuracy direct targeting.

Plain Language Summary

We are reporting our experience in the management of the most challenging types of pediatric epilepsy, involving seizures originating from multiple and/or poorly defined brain areas. We surgically implanted a responsive neurostimulation device (RNS) in central areas of the brain that function as connection hubs between different brain regions. These devices are designed to detect early signs of abnormal brain activity, and respond with electrical pulses to prevent progression to clinical seizures. Using our approach, we reduced the seizure rates by an average of 80% in 83% of the pediatric patients who received this treatment.

Epilepsy affects 65 million people worldwide, and is a World Health Organization priority disease as highlighted in their 2022–2031 Intersectoral Global Action Plan (IGAP) on Epilepsy and other Neurological Disorders. IGAP's objectives include improving epilepsy treatment and care. Patient-reported outcomes measures (PROMs) may assist with this. PROMs are self-report instruments that assess the lived experience of disease, for example, quality of life, mood, and treatment adverse effects. Regulatory agencies recommend including PROMs in clinical trials, and incorporating PROMs into routine clinical practice may improve patient outcomes. We conducted a narrative review of PubMed and health regulatory agencies' guidelines to identify PROMs used in clinical epilepsy research and practice. We identified 390 unique PROMs used in epilepsy settings. We summarize the practical considerations for PROMs selection, including the various psychometric properties that can be used to measure how “good” a PROM is; the role for generic, neurology-specific, and epilepsy-specific PROMs; and ways to optimize the collection of PROMs in clinical settings. This review discusses the strengths and limitations of 22 PROMs, covering four domains (health-related quality of life, disability and seizure severity, mood, and antiseizure medication adverse effects), that are commonly used in clinical epilepsy research and practice. This article may serve as a useful reference for researchers and clinicians when selecting PROMs for use in clinical epilepsy trials and routine clinical practice, and complements the recently published report from the International Consortium for Health Outcomes Measurement that recommends five specific PROMs assessing quality of life, depression, anxiety, cognition, and sleep. The judicious selection and application of PROMs may lead to better understanding of patient experiences, inform clinical decision-making, and ultimately improve outcomes.

Plain Language Summary

Patient-reported outcome measures (PROMs) are questionnaires completed by patients, assisting with communication of their lived experience of disease with clinicians. PROMs cover topics such as quality of life, disability, mood, and treatment side effects. PROMs may improve patient satisfaction and communication with healthcare providers, detect hitherto undisclosed issues, and can be used to monitor treatment response. This current review summarizes the strengths and limitations of 22 PROMs that are commonly used in clinical epilepsy research and practice.