Acta Epileptologica最新文献

Background: Epilepsy is one of the common clinical disorders with comorbid anxiety and depression that severely affects their quality of life and increases their suicidality, while screening for anxiety and depression currently lacks objective identifiers. This study aimed to analyze the characteristics of the electroencephalogram (EEG) power spectrum in patients with epilepsy with comorbid anxiety and depression, utilizing resting EEG data.

Methods: Resting EEG data were collected under standard conditions from two groups: patients with epilepsy comorbid with anxiety and depression (n = 42) and patients without comorbidities (n = 45). EEG power was calculated using data processing with EEGLAB and MATLAB. This study compared the absolute and relative powers of the δ, θ, α, β, and γ frequency bands, as well as the values of (δ + θ)/(α + β), between the two groups. Additionally, the correlation between the EEG power of each frequency band and anxiety and depression scores was analyzed.

Results: 1) Among individuals with epilepsy comorbid with anxiety and depression, lower absolute power of δ, α, and θ at specific sites was observed (P < 0.05), along with lower relative power of θ at certain sites (P < 0.05). Conversely, higher relative power of β and γ at specific sites was noted in those with comorbidities (P < 0.05). 2) There was no statistically significant difference in the values of (δ + θ)/(α + β) between the two groups (P > 0.05). 3) Depression scores exhibited a negative correlation with θ absolute power at the T3 and T4 sites (P < 0.05), while showing a positive correlation with β relative power at the C4 and T6 sites (P < 0.05). Anxiety scores displayed a positive correlation with β relative power at the F4, C3, C4 and T6 sites and γ relative power at F8 site (P < 0.05).

Conclusions: The findings suggest that comorbid anxiety and depression may impact resting EEG power spectra in individuals with epilepsy, particularly in regions exhibiting altered network connectivity. Furthermore, a positive correlation was observed between anxiety and depression scores and β relative power in the right central and right posterior temporal regions, indicating potential screening utility.

Background: Regional variations in the prevalence of epilepsy in Nigeria have been validated. We determined the prevalence of active convulsive epilepsy in six towns of Dunukofia County and compared the findings with existing regional prevalence data.

Methods: Patients with active convulsive epilepsy were identified in a two-phase cross-sectional descriptive community-based door-to-door study using a validated questionnaire in the first phase and a modified epilepsy questionnaire developed for tropical countries in the second phase after clinical assessment and electroencephalogram.

Results: A total of 9000 persons were surveyed in the first stage, of which 56 had active convulsive epilepsy. The highest point prevalence was found in Nawgu, 7.3 per 1000 (95% confidence interval [CI]: 2.7-15.8) while the lowest point prevalence of 5.0 per 1000 (95% CI: 2.0-10.3) was obtained in Ukpo. The observed rates after age adjustment to the Nigeria standard population of 4.9-5.7 per 1000 in this study, which was comparable to 4.6-5.7 per 1000 reported in previous studies, besides two isolated reports of rates as low as 2.7 per 1000 and as high as 20.0 per 1000 reported in the past from two sites in the northern section of the region.

Conclusions: The burden of epilepsy is high in this region, and intra-regional differences in prevalence rates exist. The implications of this finding do not only border on the care of people living with epilepsy but also highlight the need to identify local risk factors as well as appropriate and locally acceptable approaches to reduce the epilepsy burden.

Background: Epilepsy is a neurological syndrome caused by excessive neuronal discharges, with a part of the patients being pharmacoresistant to the traditional treatment. Cannabidiol, a non-psychoactive component of Cannabis Sativa, shows promise as an alternative, but further research is needed to quantify its efficacy.

Methods: This literature systematic review was made following the PRISMA protocol guidelines. The Google Scholar, Scielo, and PubMed/MEDLINE databases were included using the descriptors "Cannabidiol", "Epilepsy", and "Drug Resistant Epilepsy". This research was registered in the Prospero platform with the identification (CRD42024479643).

Results: A total of 1448 results were identified from the PubMed, Virtual Health Library, and Google Scholar databases. After applying exclusion criteria, six studies met the criteria for full-text evaluation and eligibility. The compiled analysis showed that the patients who received cannabidiol experienced a 41.0875% reduction in the total number of seizures, compared to an average reduction of 18.1% in placebo groups. This represents a 127% higher response rate for patients who received the intervention.

Conclusions: Given these results, it is possible to conclude that the therapeutic response of cannabidiol is worthy of consideration in new protocols and of being added to public healthcare systems for its antiepileptic potential. However, the high efficacy rate observed in the placebo group suggests that other methods of data collection analysis may be employed.

Epilepsy, a chronic neurological disorder, is characterized by dysfunction in neural networks. Gap junctions and hemichannels, which are integral to the astrocyte connection network, play a critical role in epilepsy. Connexins, the components of astrocyte gap junctions and hemichannels, can be activated to transfer glutamate, adenosine triphosphate, and other chemicals, potentially leading to seizures. Connexins therefore hold significant potential for epilepsy treatment. This review focuses on connexin 43 and provides a brief overview of other connexins and pannexin 1. Understanding the relationship between connexins and epilepsy offers theoretical support for developing new antiseizure medications.

Background: Preferential activation of Acid-sensing ion channel 1a (ASIC1a) by acidosis promotes seizure termination. Studies have found that CO₂ can reduce neuronal excitability and inhibit seizure activity. Dravet syndrome (DS) is a severe and catastrophic form of epilepsy primarily caused by monoallelic loss-of-function mutations in the SCN1A gene. Patients with DS suffer from frequent seizures, which can be triggered by fever and are often resistant to anti-seizure medications. Thus, this study aimed to explore the effect of inhaling 5% CO₂ and activating ASIC1a against hyperthermia-induced seizures in a mouse model of DS (Scn1a^+/-).

Methods: Mice aged postnatal day 18-28 were divided into four groups: wild type (WT) + air, Scn1a^+/- + air, WT + CO₂, and Scn1a^+/- + CO₂. Hyperthermia-induced seizures were performed 60 min after gas inhalation. Neuronal damage was assessed using Nissl staining, whereas ASIC1a expression was evaluated through Western blot and immunofluorescence staining.

Results: In the hyperthermia-induced seizure tests, no seizures occurred in WT mice. All mice in the Scn1a^+/- + air groups experienced seizures. In the Scn1a^+/- + CO₂ group, all but one mouse had seizures. CO₂ inhalation shortened the duration of seizures in Scn1a^+/- mice, improved electroencephalogram discharge patterns, and reduced neuronal damage in the hippocampus. The ASIC1a protein was mainly expressed in hippocampal neurons, with minor expression observed in astrocytes. The level of hippocampal ASIC1a increased in the Scn1a^+/- + CO₂ mice.

Conclusions: After CO₂ inhalation, the expression of the ASIC1a protein in the hippocampus increased, the duration of hyperthermia-induced seizures was reduced in Scn1a^+/- mice, and the damage to hippocampal neurons was alleviated.

Background: Stereotactic electroencephalography (SEEG) has emerged as a widely utilized diagnostic approach in epilepsy surgery, demonstrating broad clinical applications and a favorable safety profile. SEEG, when combined with radiofrequency thermocoagulation (RF-TC), facilitates the identification of epileptogenic zones and serves as a therapeutic option that eliminates the need for general anesthesia, thus incuring no additional costs for patients. This study aimed to investigate whether SEEG-guided RF-TC provides early therapeutic benefits.

Methods: A retrospective analysis was performed on 44 patients with drug-resistant epilepsy who underwent RF-TC treatment between April 2019 and December 2022, with complete follow-up data available. RF-TC was administered after the recording three or more habitual epileptic seizures in all patients. Demographic characteristics were retrospectively assessed, and treatment outcomes were evaluated using the Engel classification system.

Results: SEEG-guided RF-TC treatment was successfully performed in all patients without significant neurological complications. An average of 7.7 ± 0.4 electrodes were implanted per patient, with a SEEG monitoring duration of 7.5 days (range: 6.8-11). Follow-up after thermocoagulation ranged from 9 to 63 months. At the three-month follow-up, 56.8% of patients achieved Engel I (11 cases) and II (14 cases) were included. At the six-month follow-up, 40.9% of patients achieved Engel grades I (9 cases) and II (9 cases), with five patients proceeding to surgical treatment. By the 12-month follow-up, 40.9% of patients reached Engel grades I (5 cases) and II (13 cases), with a cumulative total of 12 patients undergoing surgical intervention. At the 24-month follow-up, 20.5% of patients achieved Engel grades I (3 cases) and II (6 cases), resulting in a cumulative total of 16 patients undergoing surgical treatment. A statistically significant reduction in seizure frequency was observed before and after thermocoagulation in all 44 patients (P = 0.007), although the therapeutic effect of thermocoagulation decreased over time.

Conclusions: SEEG-guided RF-TC is a safe and effective treatment modality for drug-resistant epilepsy. However, as follow-up duration increases, both seizure-free rates and response rates following RF-TC progressively decline.

Background: Dissociative seizures (DS), also known as psychogenic non-epileptic seizures (PNES), often mimic epileptic seizures (ES), leading to misdiagnosis, unnecessary anti-seizure medications (ASMs)/ suboptimal use of ASMs, and delays in appropriate care in approximately one-third of patients. Rare presentations, such as episodes resembling oculogyric crisis (OGC), further complicate differentiation. This report highlights the diagnostic challenges of DS with atypical features and emphasises the role of video-electroencephalogram (VEEG) in early differentiation.

Case presentation: We present a 16-year-old male with recurrent episodes of upward eye deviation, non-synchronised limb twitching, and bizarre behaviours, initially misdiagnosed as epilepsy and autoimmune encephalitis. Comprehensive investigations, including normal neuroimaging, absence of epileptiform activity on VEEG, and psychological evaluation revealing moderate depression, supported a diagnosis of DS. The patient showed significant improvement with sertraline and cognitive behavioural therapy.

Conclusions: This case underscores the diagnostic challenges posed by atypical DS presentations and highlights the value of/need for VEEG and psychiatric evaluation in differentiation. Early identification of DS can prevent mismanagement and optimize outcomes.

Background: Mesial temporal lobe epilepsy (mTLE) is the most common form of focal epilepsy, often associated with hippocampal sclerosis. Increasing evidence suggests the pivotal role of neuroinflammation in mTLE onset and progression.

Methods: We used morphometric similarity network (MSN) analysis and the Allen Human Brain Atlas (AHBA) database to investigate structural changes between mTLE and healthy controls, as well as correlation with inflammation-related gene expression.

Results: We identified widespread alterations across the frontal and parietal lobes and cingulate cortex linked to neuroinflammatory genes such as PRR5, SMAD3, and IRF3. This correlation was even more pronounced in mTLE patients with hippocampal sclerosis compared to those without. Enrichment analysis highlighted pathways related to neurodevelopment and neurodegeneration, supporting a bidirectional link between mTLE and neurodegenerative diseases.

Conclusions: These findings suggest that brain-wide macroscopic morphometric alternations in mTLE are correlated to the neuroinflammation process. It provides circumstantial evidence from a new perspective to support the bidirectional link between mTLE and neurodegenerative diseases.

Background: The Midasin AAA (ATPase associated with various activities) ATPase 1 (MDN1) gene, a member of the AAA protein family, plays a crucial role in ribosome maturation. MDN1 is expressed in the human brain throughout life, especially during early development and adulthood. However, MDN1 variants have not been previously reported in patients with epilepsy. This study aims to explore the association between MDN1 variants and epilepsy.

Methods: Trios-based whole-exome sequencing was performed in a cohort of patients with epilepsy susceptibility from the China Epilepsy Gene 1.0 Project. The excess, damaging effects, and molecular subregional implications of variants, as well as the spatio-temporal expression of MDN1, were analyzed to validate the gene-disease association.

Results: Compound heterozygous variants in MDN1 were identified in five unrelated patients with febrile seizures or secondary epilepsy. Three patients presented with febrile seizures/epilepsy with febrile seizures plus, while two patients developed epilepsy secondary to brain damage (five or seven years after). These variants were either absent or present at low frequencies in the control group, and exhibited statistically significant higher frequencies in the case group compared to controls. All the missense variants were predicted to be damaging by at least one in silico tool. In each pair of compound heterozygous variants, one allele was located in the AAA2-AAA3 domains, while the other allele was located in the linker domain or its vicinity. In contrast, most of the variants from the asymptomatic control group were located outside the AAA domains, suggesting a molecular subregional implication of the MDN1 variants.

Conclusions: MDN1 is potentially a susceptibility gene for epilepsy.

The unpredictability of seizures underscores the importance of timely recognition and intervention for optimal prognosis. Seizure first aid (SFA) is an essential skill for community members. We reviewed the literature to assess the challenges and explore potential solutions for effective SFA implementation in community settings. The findings reveal that the knowledge of SFA varies significantly among different groups and countries. There are common misunderstandings, such as point therapy, unnecessary ambulance calls, putting objects into the mouth, inappropriate administration of anti-seizure medications, and performing cardiopulmonary resuscitation. Effective SFA training content includes ensuring the safety of patients, avoiding restraint, using lateral position, clearing the respiratory tract, avoiding placing objects into the mouth, recording details, and seeking for professional help. Training methods range from hospital-based courses to community center workshops and online platforms. General practitioners play a pivotal role in epilepsy management and should be actively involved in SFA training initiatives. Therefore, the development of targeted, diverse, and comprehensive training and evaluation strategies, along with collaborative efforts from the whole society, is essential to improve the level and effectiveness of community SFA.