Pub Date : 2024-11-14DOI: 10.1016/j.seizure.2024.11.004
Colin Reilly , Björn Bjurulf , Tove Hallböök
Purpose
To assess parent-reported mental health in nearest age siblings of children with Dravet Syndrome (DS).
Methods
In this observational study parents of 31 children (age 3–16 years; 18 males and 13 females) of nearest age siblings of children with DS completed the SDQ (Strength and Difficulties Questionnaire). Mental health level was determined using validated norms; abnormal ≥ 90 percentile/borderline ≥80 percentile. At risk status was considered borderline/abnormal. Data were analysed using descriptives and linear regression. Significance level was p < 0.05.
Results
Only five siblings (16 %) had elevated scores on the SDQ total score. However, 32 % of siblings had difficulties on the Emotional subscale and 26 % on the Peer subscale. Only one child (3 %) had an elevated score on the Prosocial subscale which indicates strengths. Regression analysis did not find any significant associations with the SDQ total score.
Conclusions
Siblings of children with DS would not appear to have a higher risk of mental health problems but specific supports may be needed regarding emotional problems. More research is needed to better understand the sibling experience in children with DS and other Developmental and Epileptic Encephalopathies.
{"title":"Parent-Reported mental health in nearest age siblings of children with Dravet Syndrome in Sweden","authors":"Colin Reilly , Björn Bjurulf , Tove Hallböök","doi":"10.1016/j.seizure.2024.11.004","DOIUrl":"10.1016/j.seizure.2024.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess parent-reported mental health in nearest age siblings of children with Dravet Syndrome (DS).</div></div><div><h3>Methods</h3><div>In this observational study parents of 31 children (age 3–16 years; 18 males and 13 females) of nearest age siblings of children with DS completed the SDQ (Strength and Difficulties Questionnaire). Mental health level was determined using validated norms; abnormal ≥ 90 percentile/borderline ≥80 percentile. At risk status was considered borderline/abnormal. Data were analysed using descriptives and linear regression. Significance level was <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Only five siblings (16 %) had elevated scores on the SDQ total score. However, 32 % of siblings had difficulties on the Emotional subscale and 26 % on the Peer subscale. Only one child (3 %) had an elevated score on the Prosocial subscale which indicates strengths. Regression analysis did not find any significant associations with the SDQ total score.</div></div><div><h3>Conclusions</h3><div>Siblings of children with DS would not appear to have a higher risk of mental health problems but specific supports may be needed regarding emotional problems. More research is needed to better understand the sibling experience in children with DS and other Developmental and Epileptic Encephalopathies.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 113-115"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631280","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 : 2024-11-14DOI: 10.1016/j.seizure.2024.10.019
Luisa Delazer , Joachim Havla , Soheyl Noachtar , Elisabeth Kaufmann
Objective
Recent studies reported a significant retinal neuroaxonal loss in people with epilepsy (PWE). However, the impact of these structural alterations on visual function, i.e., visual acuity is yet unknown.
Methods
In this prospective cohort study, 70 PWE and 76 healthy controls (HC), all aged 18–55 years, underwent an assessment of visual acuity with 100 % high contrast (HCVA) and 2.5 % low contrast (LCVA) Sloan letter charts. Thickness of the global peripapillary retinal nerve fiber layer (G-pRNFL) and volume of the ganglion cell inner plexiform layer (GCIP) were assessed with spectral-domain optical coherence tomography (OCT). For the statistical analyses, the epilepsy group was subdivided into PWE with sodium channel blocking (SCB)-drug intake (n = 52) and PWE without SCB-drug intake (n = 18), since an effect of SCB-drugs on visual perception has been reported previously.
Results
The overall PWE cohort presented significantly lower structural retinal measures, i.e., G-pRNFL thickness (97.57 ± 9.06 µm) and GCIP volume (1.99 ± 0.13 mm3) than HC (101.31 ± 8.28 µm, p = .01; 2.10 ± 0.15 mm3, p < .001). Subgroup analyses revealed that PWE who were treated with SCB-drugs had a significantly reduced G-pRNFL thickness (96.61 ± 9.70 µm, p = .01) and GCIP volume (1.98 ± 0.14mm3, p < .001) compared to HC, while PWE without SCB-drugs (100.36 ± 6.32 µm, 2.01 ± 0.13 mm3) did not differ from HC or PWE with SCB-drugs. In visual acuity tests (HCVA and LCVA), the overall PWE cohort (52.28 ± 8.56; 31.71 ± 8.49) scored significantly lower than HC (56.57 ± 4.74, p = .001; 35.13 ± 5.50, p = .04). In subgroup analyses only PWE with SCB-drugs presented significantly lower HCVA (51.25 ± 9.35, p = .003) and LCVA (30.04 ± 8.93, p = .03) scores compared to HC, while visual acuity scores did not differ between PWE without SCB-drugs (55.25 ± 4.75, 36.53 ± 4.50) and HC. PWE with SCB-drugs had significantly lower LCVA scores than PWE without SCB-drugs (p = .03). Importantly, no association was found between visual acuity scores and structural parameters, neither in the overall sample, nor in any of the subgroups.
Significance
Retinal neuroaxonal loss in PWE was not associated with reduced visual acuity under high and low contrast. Instead, our findings reinforce SCB-drug intake as an important factor for reduced visual acuity under high and low contrast.
{"title":"Visual acuity in the context of retinal neuroaxonal loss in people with epilepsy","authors":"Luisa Delazer , Joachim Havla , Soheyl Noachtar , Elisabeth Kaufmann","doi":"10.1016/j.seizure.2024.10.019","DOIUrl":"10.1016/j.seizure.2024.10.019","url":null,"abstract":"<div><h3>Objective</h3><div>Recent studies reported a significant retinal neuroaxonal loss in people with epilepsy (PWE). However, the impact of these structural alterations on visual function, i.e., visual acuity is yet unknown.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, 70 PWE and 76 healthy controls (HC), all aged 18–55 years, underwent an assessment of visual acuity with 100 % high contrast (HCVA) and 2.5 % low contrast (LCVA) Sloan letter charts. Thickness of the global peripapillary retinal nerve fiber layer (G-pRNFL) and volume of the ganglion cell inner plexiform layer (GCIP) were assessed with spectral-domain optical coherence tomography (OCT). For the statistical analyses, the epilepsy group was subdivided into PWE with sodium channel blocking (SCB)-drug intake (<em>n</em> = 52) and PWE without SCB-drug intake (<em>n</em> = 18), since an effect of SCB-drugs on visual perception has been reported previously.</div></div><div><h3>Results</h3><div>The overall PWE cohort presented significantly lower structural retinal measures, i.e., G-pRNFL thickness (97.57 ± 9.06 µm) and GCIP volume (1.99 ± 0.13 mm<sup>3</sup>) than HC (101.31 ± 8.28 µm, <em>p</em> = .01; 2.10 ± 0.15 mm<sup>3</sup>, <em>p</em> < .001). Subgroup analyses revealed that PWE who were treated with SCB-drugs had a significantly reduced G-pRNFL thickness (96.61 ± 9.70 µm, <em>p</em> = .01) and GCIP volume (1.98 ± 0.14mm<sup>3</sup>, <em>p</em> < .001) compared to HC, while PWE without SCB-drugs (100.36 ± 6.32 µm, 2.01 ± 0.13 mm<sup>3</sup>) did not differ from HC or PWE with SCB-drugs. In visual acuity tests (HCVA and LCVA), the overall PWE cohort (52.28 ± 8.56; 31.71 ± 8.49) scored significantly lower than HC (56.57 ± 4.74, <em>p</em> = .001; 35.13 ± 5.50, <em>p</em> = .04). In subgroup analyses only PWE with SCB-drugs presented significantly lower HCVA (51.25 ± 9.35, <em>p</em> = .003) and LCVA (30.04 ± 8.93, <em>p</em> = .03) scores compared to HC, while visual acuity scores did not differ between PWE without SCB-drugs (55.25 ± 4.75, 36.53 ± 4.50) and HC. PWE with SCB-drugs had significantly lower LCVA scores than PWE without SCB-drugs (<em>p</em> = .03). Importantly, no association was found between visual acuity scores and structural parameters, neither in the overall sample, nor in any of the subgroups.</div></div><div><h3>Significance</h3><div>Retinal neuroaxonal loss in PWE was not associated with reduced visual acuity under high and low contrast. Instead, our findings reinforce SCB-drug intake as an important factor for reduced visual acuity under high and low contrast.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 116-122"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631288","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 : 2024-11-13DOI: 10.1016/j.seizure.2024.11.007
Victoria San Antonio-Arce , Anne-Kathrin König , Kerstin Alexandra Klotz , Jan Schönberger , Andreas Schulze-Bonhage , Julia Jacobs-Le Van
Background
Changes in heart rate (HR) may provide an extracerebral indicator of seizure onset. The purpose of this study is to assess the frequency and timing of presentation of ictal tachycardia in a larger series of children with epilepsy grouped in different age groups as well as the influence of seizure characteristics.
Methods
We retrospectively reviewed 732 seizures of 195 patients aged 0 to 14 (median 6.91) years with epilepsy of any cause. Patients were grouped according to the age in groups (1) <1 year (n = 18); (2) 1–2 years (n = 26); (3) 2–6 years (n = 43); (4) 6–10 years (n = 44); and (5) 10–14 years (n = 64). HR was assessed visually during the seizures and compared with HR 1 min before seizure onset. The time from seizure onset to ictal tachycardia, defined as an increase in HR by at least 33 %, was described. Ictal tachycardia was considered early if occurring in the first 10 s.
Results
Ictal tachycardia occurred in at least one seizure in 70.3 % of patients and in 51.1 % of seizures. It was more frequent and earlier in focal seizures and in seizures occurring in sleep. >30 % of patients had ictal tachycardia in all of their seizures, this being more frequent in the age groups 6–10 and 10–14 years.
Conclusions
Children older than 6 years especially with focal seizures during sleep could be ideal candidates for warning devices or stimulation therapies triggered by tachycardia detection. Future studies should aim to assess the implications in relation to the risk of SUDEP.
{"title":"Ictal tachycardia in children with epilepsy","authors":"Victoria San Antonio-Arce , Anne-Kathrin König , Kerstin Alexandra Klotz , Jan Schönberger , Andreas Schulze-Bonhage , Julia Jacobs-Le Van","doi":"10.1016/j.seizure.2024.11.007","DOIUrl":"10.1016/j.seizure.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Changes in heart rate (HR) may provide an extracerebral indicator of seizure onset. The purpose of this study is to assess the frequency and timing of presentation of ictal tachycardia in a larger series of children with epilepsy grouped in different age groups as well as the influence of seizure characteristics.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 732 seizures of 195 patients aged 0 to 14 (median 6.91) years with epilepsy of any cause. Patients were grouped according to the age in groups (1) <1 year (<em>n</em> = 18); (2) 1–2 years (<em>n</em> = 26); (3) 2–6 years (<em>n</em> = 43); (4) 6–10 years (<em>n</em> = 44); and (5) 10–14 years (<em>n</em> = 64). HR was assessed visually during the seizures and compared with HR 1 min before seizure onset. The time from seizure onset to ictal tachycardia, defined as an increase in HR by at least 33 %, was described. Ictal tachycardia was considered early if occurring in the first 10 s.</div></div><div><h3>Results</h3><div>Ictal tachycardia occurred in at least one seizure in 70.3 % of patients and in 51.1 % of seizures. It was more frequent and earlier in focal seizures and in seizures occurring in sleep. >30 % of patients had ictal tachycardia in all of their seizures, this being more frequent in the age groups 6–10 and 10–14 years.</div></div><div><h3>Conclusions</h3><div>Children older than 6 years especially with focal seizures during sleep could be ideal candidates for warning devices or stimulation therapies triggered by tachycardia detection. Future studies should aim to assess the implications in relation to the risk of SUDEP.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 128-132"},"PeriodicalIF":2.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649497","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 : 2024-11-06DOI: 10.1016/j.seizure.2024.11.002
Jakob Bie Granild-Jensen , Kian Yousefi Kousha , Ayako Ochi , Hiroshi Otsubo , Rajesh RamchandranNair , Karen Choong , Burke Baird , Emma Cory , Shelly Weiss , Cecil Hahn , Elizabeth J Donner , Robyn Whitney , Kevin C Jones , Puneet Jain
Objectives
Abusive Head Trauma (AHT) remains an important cause of acute seizures, morbidity, and mortality in children. We aimed to assess the clinical and electrographic seizure burden in children with AHT and to explore predictors of morbidity and mortality.
Methods
We conducted a retrospective chart review of all children admitted with AHT who underwent continuous electroencephalographic monitoring (cEEG) between January 1st, 2015, and April 15th, 2021. Their clinical, EEG and imaging variables were extracted and summarized.
Results
A total of 31 children (17 female) were included. The median age was 3 months (IQR 1.75–5). Forty-five percent of cases presented in the winter season (p = 0.024). In 25 cases out of 31, cEEG detected electrographic seizures, with 6 of these children not manifesting clinical seizures. A shorter time to first recorded seizure during cEEG was a significant predictor of in-hospital mortality (p = 0.012) and the maximum 1-hour seizure count was higher in children with worse cerebral outcomes (p = 0.008). A normal EEG background activity during cEEG was associated with favorable neurological outcomes (p = 0.008). The hospital mortality rate was 23 %.
Conclusion
Almost 20 % of children with AHT had seizures recognized exclusively by cEEG. Normal cEEG background activity predicted a better outcome, while a shorter time to the first recorded seizure was associated with a higher in-hospital mortality. Corroborating prior reports, we found a significant clustering of cases during the winter. These results could enhance AHT prevention strategies and case prognostication.
{"title":"Critical care EEG monitoring in children with abusive head trauma: A retrospective study of seizure burden and predictors of neurological outcomes","authors":"Jakob Bie Granild-Jensen , Kian Yousefi Kousha , Ayako Ochi , Hiroshi Otsubo , Rajesh RamchandranNair , Karen Choong , Burke Baird , Emma Cory , Shelly Weiss , Cecil Hahn , Elizabeth J Donner , Robyn Whitney , Kevin C Jones , Puneet Jain","doi":"10.1016/j.seizure.2024.11.002","DOIUrl":"10.1016/j.seizure.2024.11.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Abusive Head Trauma (AHT) remains an important cause of acute seizures, morbidity, and mortality in children. We aimed to assess the clinical and electrographic seizure burden in children with AHT and to explore predictors of morbidity and mortality.</div></div><div><h3>Methods</h3><div>We conducted a retrospective chart review of all children admitted with AHT who underwent continuous electroencephalographic monitoring (cEEG) between January 1st, 2015, and April 15th, 2021. Their clinical, EEG and imaging variables were extracted and summarized.</div></div><div><h3>Results</h3><div>A total of 31 children (17 female) were included. The median age was 3 months (IQR 1.75–5). Forty-five percent of cases presented in the winter season (<em>p</em> = 0.024). In 25 cases out of 31, cEEG detected electrographic seizures, with 6 of these children not manifesting clinical seizures. A shorter time to first recorded seizure during cEEG was a significant predictor of in-hospital mortality (<em>p</em> = 0.012) and the maximum 1-hour seizure count was higher in children with worse cerebral outcomes (<em>p</em> = 0.008). A normal EEG background activity during cEEG was associated with favorable neurological outcomes (<em>p</em> = 0.008). The hospital mortality rate was 23 %.</div></div><div><h3>Conclusion</h3><div>Almost 20 % of children with AHT had seizures recognized exclusively by cEEG. Normal cEEG background activity predicted a better outcome, while a shorter time to the first recorded seizure was associated with a higher in-hospital mortality. Corroborating prior reports, we found a significant clustering of cases during the winter. These results could enhance AHT prevention strategies and case prognostication.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 142-147"},"PeriodicalIF":2.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142662360","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 : 2024-11-02DOI: 10.1016/j.seizure.2024.11.003
Alexander Grote , Daniel Delev , Hendrik Hoffmann , Christian Elger , Marec von Lehe
Background
In this study, we isolated a cohort of patients who have refractory epilepsy who underwent surgery with frontobasal focus. This work aimed to develop prognostic factors associated with a better seizure outcome and identify risk factors determining postoperative morbidity.
Methods
We identified all patients with frontobasal epilepsy who underwent surgery due to refractory epilepsy at the University Hospital Bonn over 22 years. Although this is a retrospective study, all data sets were collected prospectively. We evaluated both surgical and functional outcomes.
Results
In total, 32 patients were identified for inclusion in this study. With a long and stable postoperative seizure outcome averaging 109 months, we were able to show that patients with frontobasal epilepsy can achieve a better outcome (53 % seizure-free, ILAE1) than patients with frontal epilepsy. In contrast to other brain regions, the resection size (isolated or extended) did not influence the outcome. Low-grade tumors, on the other hand, were associated with a better seizure outcome, and gliosis or non-specific histological findings with a worse seizure outcome. Stereo-EEG with depth electrodes is more suitable for invasive diagnostics at the frontal base than strip or grid electrodes. Patients who did not become seizure-free after surgery and underwent a second surgery did not profit significantly concerning seizure outcome.
Conclusion
Patients with frontobasal epilepsy who are operated on early in the course of the disease, are MRI-positive, and have a tumor as an epileptogenic pathology have the best chance of seizure freedom.
{"title":"Epilepsy-surgery for fronto-basal lesions: Management, outcome, and review of literature","authors":"Alexander Grote , Daniel Delev , Hendrik Hoffmann , Christian Elger , Marec von Lehe","doi":"10.1016/j.seizure.2024.11.003","DOIUrl":"10.1016/j.seizure.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we isolated a cohort of patients who have refractory epilepsy who underwent surgery with frontobasal focus. This work aimed to develop prognostic factors associated with a better seizure outcome and identify risk factors determining postoperative morbidity.</div></div><div><h3>Methods</h3><div>We identified all patients with frontobasal epilepsy who underwent surgery due to refractory epilepsy at the University Hospital Bonn over 22 years. Although this is a retrospective study, all data sets were collected prospectively. We evaluated both surgical and functional outcomes.</div></div><div><h3>Results</h3><div>In total, 32 patients were identified for inclusion in this study. With a long and stable postoperative seizure outcome averaging 109 months, we were able to show that patients with frontobasal epilepsy can achieve a better outcome (53 % seizure-free, ILAE1) than patients with frontal epilepsy. In contrast to other brain regions, the resection size (isolated or extended) did not influence the outcome. Low-grade tumors, on the other hand, were associated with a better seizure outcome, and gliosis or non-specific histological findings with a worse seizure outcome. Stereo-EEG with depth electrodes is more suitable for invasive diagnostics at the frontal base than strip or grid electrodes. Patients who did not become seizure-free after surgery and underwent a second surgery did not profit significantly concerning seizure outcome.</div></div><div><h3>Conclusion</h3><div>Patients with frontobasal epilepsy who are operated on early in the course of the disease, are MRI-positive, and have a tumor as an epileptogenic pathology have the best chance of seizure freedom.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 104-112"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631272","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}
Brain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice?
Methods
A prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed.
Results
Two hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for >3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, p = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient.
Conclusion
When imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.
{"title":"Computed tomography of the head with and without contrast in imaging focal and unknown epilepsy – A prospective observational study","authors":"Jasmine Parihar , Mamta Bhushan Singh , Ajay Garg , Leve Joseph Devarajan , Rohit Bhatia , Anuj Prabhakar , Shailesh Gaikwad , MV Padma Srivastava , Vinay Goyal , Garima Shukla , Vishnu VY , Maroof Ahmad Khan","doi":"10.1016/j.seizure.2024.10.020","DOIUrl":"10.1016/j.seizure.2024.10.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Brain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice?</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed.</div></div><div><h3>Results</h3><div>Two hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for >3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, <em>p</em> = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient.</div></div><div><h3>Conclusion</h3><div>When imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 123-127"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639925","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 : 2024-11-01DOI: 10.1016/j.seizure.2024.07.021
Josef Finsterer
{"title":"Before the variant c.541A>G in UGT1A6 can be held responsible for valproate-induced tremor, alternative causes must be ruled out","authors":"Josef Finsterer","doi":"10.1016/j.seizure.2024.07.021","DOIUrl":"10.1016/j.seizure.2024.07.021","url":null,"abstract":"","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 179-180"},"PeriodicalIF":2.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578169","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 : 2024-10-31DOI: 10.1016/j.seizure.2024.10.018
Matilde Velasco-Mérida , Marian Lázaro , John S Duncan , Gonzalo Alarcon , Ioannis Stavropoulos , Antonio Valentín
Introduction
Epilepsia Partialis Continua (EPC) is a challenging condition in which repetitive transcranial magnetic stimulation (rTMS) can induce a neuromodulation effect of potential diagnostic and therapeutic value.
Methods
A comprehensive literature search was conducted using Pubmed and Web of Science databases to identify cases of EPC who underwent rTMS, including children and adults. Additionally, we present two patients from our centre who underwent rTMS at a low frequency (0.5 Hz) with simultaneous EEG recording with the aim of assessing potential improvement in seizure frequency and severity.
Results
Eight articles were selected comprising 16 patients (15 with EPC and one with continuous myoclonia). In three of these patients, no clinical or EEG changes were noted; the remaining cases showed transitory clinical improvements. We report two patients with EPC, in whom low frequency rTMS was associated with transient reduction in frequency and severity of seizures and improvements in hand function and dexterity. In one of these cases, rTMS suggested a potential target for intracranial recordings, subacute cortical stimulation and localised resection.
Conclusion
In selected patients with EPC, rTMS can be used as a potential diagnostic and therapeutic tool.
简介：癫痫持续状态（Epilepsia Partialis Continua，EPC）是一种具有挑战性的疾病，重复经颅磁刺激（rTMS）可诱发神经调控效应，具有潜在的诊断和治疗价值：我们使用 Pubmed 和 Web of Science 数据库进行了全面的文献检索，以确定接受经颅磁刺激治疗的 EPC 病例，包括儿童和成人。此外，我们还介绍了本中心的两名患者，他们接受了低频（0.5赫兹）经颅磁刺激，同时进行了脑电图记录，目的是评估癫痫发作频率和严重程度的潜在改善情况：结果：共选取了8篇文章，包括16名患者（15名EPC患者和1名持续肌张力障碍患者）。其中三例患者未发现临床或脑电图变化，其余病例临床症状有短暂改善。我们报告了两名 EPC 患者，低频经颅磁刺激可短暂降低癫痫发作的频率和严重程度，改善手部功能和灵活性。在其中一个病例中，经颅磁刺激提示了颅内记录、亚急性皮质刺激和局部切除的潜在目标：结论：经颅磁刺激可作为一种潜在的诊断和治疗工具，用于选定的EPC患者。
{"title":"Neuromodulation with Transcranial Magnetic Stimulation in Epilepsia Partialis Continua: Scoping review and clinical experience","authors":"Matilde Velasco-Mérida , Marian Lázaro , John S Duncan , Gonzalo Alarcon , Ioannis Stavropoulos , Antonio Valentín","doi":"10.1016/j.seizure.2024.10.018","DOIUrl":"10.1016/j.seizure.2024.10.018","url":null,"abstract":"<div><h3>Introduction</h3><div>Epilepsia Partialis Continua (EPC) is a challenging condition in which repetitive transcranial magnetic stimulation (rTMS) can induce a neuromodulation effect of potential diagnostic and therapeutic value.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using Pubmed and Web of Science databases to identify cases of EPC who underwent rTMS, including children and adults. Additionally, we present two patients from our centre who underwent rTMS at a low frequency (0.5 Hz) with simultaneous EEG recording with the aim of assessing potential improvement in seizure frequency and severity.</div></div><div><h3>Results</h3><div>Eight articles were selected comprising 16 patients (15 with EPC and one with continuous myoclonia). In three of these patients, no clinical or EEG changes were noted; the remaining cases showed transitory clinical improvements. We report two patients with EPC, in whom low frequency rTMS was associated with transient reduction in frequency and severity of seizures and improvements in hand function and dexterity. In one of these cases, rTMS suggested a potential target for intracranial recordings, subacute cortical stimulation and localised resection.</div></div><div><h3>Conclusion</h3><div>In selected patients with EPC, rTMS can be used as a potential diagnostic and therapeutic tool.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 74-81"},"PeriodicalIF":2.7,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631279","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 : 2024-10-28DOI: 10.1016/j.seizure.2024.10.013
James W. Wheless , Jeffrey S. Raskin , Anthony L. Fine , Kelly G. Knupp , John Schreiber , Adam P. Ostendorf , Gregory W. Albert , Eric H. Kossoff , Joseph R. Madsen , Prakash Kotagal , Adam L. Numis , Nisha Gadgil , Deborah L. Holder , Elizabeth A. Thiele , George M. Ibrahim
Purpose
To provide consensus-based recommendations for use of vagus nerve stimulation (VNS) therapy in the management of pediatric epilepsy.
Methods
Delphi methodology with two rounds of online survey was used to build consensus. A steering committee developed 43 statements related to pediatric epilepsy and the use of VNS therapy, which were evaluated by a panel of 12 neurologists/neurosurgeons with expertise in pediatric epilepsy, who graded their agreement with each statement on a scale of 1 (“I do not agree at all”) to 5 (“I strongly agree”). For each statement, consensus was established if ≥70% of the agreement scores were 4 or 5 and <30% were 1 or 2 in the final survey.
Results
Twenty-four statements regarding the need for seizure reduction in pediatric epilepsy, the recommended treatment algorithm, the benefits and safety of VNS therapy, management of side effects of VNS therapy, patient selection for VNS therapy, and the use, dosing, and titration of VNS therapy achieved consensus. VNS and other neuromodulation therapies should be considered for pediatric patients with drug-resistant epilepsy who are not candidates for resective surgery, or who do not remain seizure free after resective surgery. When VNS therapy is initiated, the target dose range should be achieved via the fastest and safest titration schedule for each patient. Scheduled programming can be helpful in dose titration.
Conclusion
The expert consensus statements represent the panelists’ collective opinion on the best practice use of VNS therapy to optimize outcomes in the management of pediatric epilepsy.
{"title":"Expert opinion on use of vagus nerve stimulation therapy in the management of pediatric epilepsy: A Delphi consensus study","authors":"James W. Wheless , Jeffrey S. Raskin , Anthony L. Fine , Kelly G. Knupp , John Schreiber , Adam P. Ostendorf , Gregory W. Albert , Eric H. Kossoff , Joseph R. Madsen , Prakash Kotagal , Adam L. Numis , Nisha Gadgil , Deborah L. Holder , Elizabeth A. Thiele , George M. Ibrahim","doi":"10.1016/j.seizure.2024.10.013","DOIUrl":"10.1016/j.seizure.2024.10.013","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide consensus-based recommendations for use of vagus nerve stimulation (VNS) therapy in the management of pediatric epilepsy.</div></div><div><h3>Methods</h3><div>Delphi methodology with two rounds of online survey was used to build consensus. A steering committee developed 43 statements related to pediatric epilepsy and the use of VNS therapy, which were evaluated by a panel of 12 neurologists/neurosurgeons with expertise in pediatric epilepsy, who graded their agreement with each statement on a scale of 1 (“I do not agree at all”) to 5 (“I strongly agree”). For each statement, consensus was established if ≥70% of the agreement scores were 4 or 5 and <30% were 1 or 2 in the final survey.</div></div><div><h3>Results</h3><div>Twenty-four statements regarding the need for seizure reduction in pediatric epilepsy, the recommended treatment algorithm, the benefits and safety of VNS therapy, management of side effects of VNS therapy, patient selection for VNS therapy, and the use, dosing, and titration of VNS therapy achieved consensus. VNS and other neuromodulation therapies should be considered for pediatric patients with drug-resistant epilepsy who are not candidates for resective surgery, or who do not remain seizure free after resective surgery. When VNS therapy is initiated, the target dose range should be achieved via the fastest and safest titration schedule for each patient. Scheduled programming can be helpful in dose titration.</div></div><div><h3>Conclusion</h3><div>The expert consensus statements represent the panelists’ collective opinion on the best practice use of VNS therapy to optimize outcomes in the management of pediatric epilepsy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"123 ","pages":"Pages 97-103"},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631278","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}
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