Pub Date : 2024-09-27DOI: 10.1016/j.seizure.2024.09.020
Gabriele Vilyte , James Butler , Victoria Ives-Deliperi , Chrisma Pretorius
Purpose
Our understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa.
Methods
The study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital.
Results
A total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (N = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients.
Conclusion
While the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation.
目的：目前，我们对不同社会经济背景下功能性癫痫发作（FS）（又称精神性非癫痫发作（PNES））患者癫痫发作半身像的潜在差异了解有限。通过研究不同社会经济群体间癫痫发作表现的差异，我们旨在加深对社会经济因素如何影响 FS 表现的理解。本研究旨在描述南非开普敦私立和公立癫痫监测机构（EMU）患者的FS半身像：研究对象包括通过视频脑电图（video-EEG）确诊的FS患者，且无合并癫痫。在这项回顾性病例对照研究中，有关癫痫发作半身像的数据来自数字化病历，从每家医院最早的病历开始收集：共有 305 名来自私立医院的患者和 67 名来自公立医院的患者符合研究条件（N = 372）。与公立医院相比，私立医院倾向于报告更多的运动性和主观性癫痫发作类型。此外，公立医院的患者报告情绪性发作诱因（aOR=2.57，95% CI [1.03，6.37]）、意识或知觉丧失（aOR=2.58，95% CI [1.07，6.24]）和事件后快速恢复（aOR=6.01，95% CI [2.52，14.34]）的几率更高。与此同时，与私立医院患者相比，他们较少报告癫痫发作时间短（5 分钟）（aOR=0.73，95% CI [0.13，0.56]）、对事件失忆（aOR=0.19，95% CI [0.09，0.43]）、发作性失语（aOR=0.33，95% CI [0.14，0.76]）或跌倒和跌伤（aOR=0.43，95% CI [0.18，0.996]）：虽然两个社会经济组群的 FS 患者的癫痫发作表现基本一致，但也观察到一些微妙的差异，值得进一步研究。
{"title":"Functional seizure semiology and classification in a public and private hospital","authors":"Gabriele Vilyte , James Butler , Victoria Ives-Deliperi , Chrisma Pretorius","doi":"10.1016/j.seizure.2024.09.020","DOIUrl":"10.1016/j.seizure.2024.09.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Our understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa.</div></div><div><h3>Methods</h3><div>The study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital.</div></div><div><h3>Results</h3><div>A total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (<em>N</em> = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (<30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (>5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients.</div></div><div><h3>Conclusion</h3><div>While the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 71-79"},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382168","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 : 2024-09-25DOI: 10.1016/j.seizure.2024.09.019
Jordana Borges Camargo Diniz , Laís Silva Santana , Marianna Leite , João Lucas Silva Santana , Sarah Isabela Magalhães Costa , Luiz Henrique Martins Castro , João Paulo Mota Telles
Introduction
Interictal epileptiform discharges (IEDs) in electroencephalograms (EEGs) are an important biomarker for epilepsy. Currently, the gold standard for IED detection is the visual analysis performed by experts. However, this process is expert-biased, and time-consuming. Developing fast, accurate, and robust detection methods for IEDs based on EEG may facilitate epilepsy diagnosis. We aim to assess the performance of deep learning (DL) and classic machine learning (ML) algorithms in classifying EEG segments into IED and non-IED categories, as well as distinguishing whether the entire EEG contains IED or not.
Methods
We systematically searched PubMed, Embase, and Web of Science following PRISMA guidelines. We excluded studies that only performed the detection of IEDs instead of binary segment classification. Risk of Bias was evaluated with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Meta-analysis with the overall area under the Summary Receiver Operating Characteristic (SROC), sensitivity, and specificity as effect measures, was performed with R software.
Results
A total of 23 studies, comprising 3,629 patients, were eligible for synthesis. Eighteen models performed discharge-level classification, and 6 whole-EEG classification. For the IED-level classification, 3 models were validated in an external dataset with more than 50 patients and achieved a sensitivity of 84.9 % (95 % CI: 82.3–87.2) and a specificity of 68.7 % (95 % CI: 7.9–98.2). Five studies reported model performance using both internal validation (cross-validation) and external datasets. The meta-analysis revealed higher performance for internal validation, with 90.4 % sensitivity and 99.6 % specificity, compared to external validation, which showed 78.1 % sensitivity and 80.1 % specificity.
Conclusion
Meta-analysis showed higher performance for models validated with resampling methods compared to those using external datasets. Only a minority of models use more robust validation techniques, which often leads to overfitting.
简介脑电图（EEG）中的发作间期癫痫样放电（IED）是癫痫的重要生物标志物。目前，IED 检测的黄金标准是由专家进行视觉分析。然而，这一过程存在专家偏见，而且耗费时间。开发基于脑电图的快速、准确、稳健的 IED 检测方法可能有助于癫痫诊断。我们旨在评估深度学习（DL）和经典机器学习（ML）算法在将脑电图片段分为 IED 和非 IED 类别以及区分整个脑电图是否包含 IED 方面的性能：我们按照 PRISMA 指南系统地检索了 PubMed、Embase 和 Web of Science。我们排除了只进行 IED 检测而非二元节段分类的研究。通过诊断准确性研究质量评估（QUADAS-2）评估了偏倚风险。用 R 软件进行了以受者工作特征汇总（SROC）下的总面积、灵敏度和特异性作为效果测量指标的 Meta 分析：共有 23 项研究（包括 3629 名患者）符合综合分析的条件。18个模型进行了出院级别分类，6个模型进行了整个EEG分类。对于 IED 级别分类，3 个模型在一个包含 50 多名患者的外部数据集中进行了验证，灵敏度达到 84.9%（95% CI：82.3-87.2），特异度达到 68.7%（95% CI：7.9-98.2）。五项研究报告了使用内部验证（交叉验证）和外部数据集的模型性能。荟萃分析显示，内部验证的灵敏度为 90.4%，特异性为 99.6%，而外部验证的灵敏度为 78.1%，特异性为 80.1%：元分析表明，与使用外部数据集的模型相比，使用重采样方法验证的模型性能更高。只有少数模型使用了更稳健的验证技术，这往往会导致过度拟合。
{"title":"Advancing epilepsy diagnosis: A meta-analysis of artificial intelligence approaches for interictal epileptiform discharge detection","authors":"Jordana Borges Camargo Diniz , Laís Silva Santana , Marianna Leite , João Lucas Silva Santana , Sarah Isabela Magalhães Costa , Luiz Henrique Martins Castro , João Paulo Mota Telles","doi":"10.1016/j.seizure.2024.09.019","DOIUrl":"10.1016/j.seizure.2024.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Interictal epileptiform discharges (IEDs) in electroencephalograms (EEGs) are an important biomarker for epilepsy. Currently, the gold standard for IED detection is the visual analysis performed by experts. However, this process is expert-biased, and time-consuming. Developing fast, accurate, and robust detection methods for IEDs based on EEG may facilitate epilepsy diagnosis. We aim to assess the performance of deep learning (DL) and classic machine learning (ML) algorithms in classifying EEG segments into IED and non-IED categories, as well as distinguishing whether the entire EEG contains IED or not.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Web of Science following PRISMA guidelines. We excluded studies that only performed the detection of IEDs instead of binary segment classification. Risk of Bias was evaluated with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Meta-analysis with the overall area under the Summary Receiver Operating Characteristic (SROC), sensitivity, and specificity as effect measures, was performed with R software.</div></div><div><h3>Results</h3><div>A total of 23 studies, comprising 3,629 patients, were eligible for synthesis. Eighteen models performed discharge-level classification, and 6 whole-EEG classification. For the IED-level classification, 3 models were validated in an external dataset with more than 50 patients and achieved a sensitivity of 84.9 % (95 % CI: 82.3–87.2) and a specificity of 68.7 % (95 % CI: 7.9–98.2). Five studies reported model performance using both internal validation (cross-validation) and external datasets. The meta-analysis revealed higher performance for internal validation, with 90.4 % sensitivity and 99.6 % specificity, compared to external validation, which showed 78.1 % sensitivity and 80.1 % specificity.</div></div><div><h3>Conclusion</h3><div>Meta-analysis showed higher performance for models validated with resampling methods compared to those using external datasets. Only a minority of models use more robust validation techniques, which often leads to overfitting.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 80-86"},"PeriodicalIF":2.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382167","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 : 2024-09-21DOI: 10.1016/j.seizure.2024.09.015
Benjamin Cretin
Alzheimer's disease (AD) is known to be associated with an increased risk of epilepsy, which is not exclusively related to the late stage of the disease - when a major cognitive impairment is observed, previously known as the dementia stage - but also to its prodromal stage (mild cognitive impairment). Moreover, published case reports and cohorts have shown that epilepsy may occur even earlier, at the preclinical stage of AD: Epileptic seizures may therefore be the sole objective manifestation of the disease. Such a situation is called the epileptic variant of AD (evAD). EvAD is one of the etiologies of late-onset epilepsy, which means that it carries a risk of later progression to dementia and that it can only be diagnosed by assessing amyloid and tau biomarkers. However, evAD is a window of therapeutic opportunity that is probably optimal for preventing, through antiseizure medication treatment, the accelerated cognitive decline associated with AD-related brain hyperexcitability (manifested by seizures or interictal epileptiform activities).
众所周知，阿尔茨海默病（AD）与癫痫风险的增加有关，而癫痫风险的增加不仅与疾病的晚期有关，即出现严重认知障碍（以前称为痴呆阶段）时，也与疾病的前驱阶段（轻度认知障碍）有关。此外，已发表的病例报告和队列研究表明，癫痫可能会更早出现，即在 AD 的临床前阶段：因此，癫痫发作可能是这种疾病的唯一客观表现。这种情况被称为 AD 的癫痫变异型（evAD）。evAD是晚发性癫痫的病因之一，这意味着它具有日后发展为痴呆症的风险，而且只能通过评估淀粉样蛋白和tau生物标记物来诊断。然而，evAD 是一个治疗机会之窗，它可能是通过抗癫痫药物治疗预防与 AD 相关的大脑过度兴奋（表现为癫痫发作或发作间期癫痫样活动）引起的认知能力加速衰退的最佳时机。
{"title":"Epileptic variant in the spectrum of Alzheimer's disease - practical implications.","authors":"Benjamin Cretin","doi":"10.1016/j.seizure.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.seizure.2024.09.015","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is known to be associated with an increased risk of epilepsy, which is not exclusively related to the late stage of the disease - when a major cognitive impairment is observed, previously known as the dementia stage - but also to its prodromal stage (mild cognitive impairment). Moreover, published case reports and cohorts have shown that epilepsy may occur even earlier, at the preclinical stage of AD: Epileptic seizures may therefore be the sole objective manifestation of the disease. Such a situation is called the epileptic variant of AD (evAD). EvAD is one of the etiologies of late-onset epilepsy, which means that it carries a risk of later progression to dementia and that it can only be diagnosed by assessing amyloid and tau biomarkers. However, evAD is a window of therapeutic opportunity that is probably optimal for preventing, through antiseizure medication treatment, the accelerated cognitive decline associated with AD-related brain hyperexcitability (manifested by seizures or interictal epileptiform activities).</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331055","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 : 2024-09-20DOI: 10.1016/j.seizure.2024.09.011
See Wai Chan , Angela Chun , Linh Nguyen , Beth Bubolz , Anne E. Anderson , Yi-Chen Lai
Objective
We sought to examine the effects of acute seizures and respiratory derangement on the cardiac electrical properties reflected on the electrocardiogram (ECG); and to analyze their potential interactions with a diagnosis of epilepsy in children.
Methods
Emergency center (EC) visits with seizure or epilepsy diagnostic codes from 1/2011–12/2013 were included if they had ECG within 24 h of EC visit. Patients were excluded if they had pre-existing cardiac conditions, ion channelopathy, or were taking specific cardiac medications. Control subjects were 1:1 age and gender matched. Abnormal ECG was defined as changes in rhythm, PR, QRS, or corrected QT intervals; QRS axis or morphology; ST segment; or T wave morphology from normal standards. We identified independent associations between clinical factors and abnormal ECG findings using multivariable logistic regression modeling.
Results
Ninety-five children with epilepsy presented to the EC with seizures, respiratory distress, and other concerns. Three hundred children without epilepsy presented with seizures. There was an increased prevalence of minor ECG abnormalities in children with epilepsy (49 %) compared to the control subjects (29 %) and those without epilepsy (36 %). Epilepsy (OR: 1.61, 95 %CI: 1.01–2.6), need for supplemental oxygen (OR 3.06, 95 % CI: 1.45–6.44) or mechanical ventilation (OR: 2.5, 95 % CI: 1.03–6.05) were independently associated with minor ECG abnormalities. Secondary analyses further demonstrated an independent association between level of respiratory support and ECG abnormalities only in the epilepsy group.
Significance
Independent association of increased respiratory support with minor ECG abnormalities suggests a potential respiratory influence on the hearts of children with epilepsy.
{"title":"Associations between epilepsy, respiratory impairment, and minor ECG abnormalities in children","authors":"See Wai Chan , Angela Chun , Linh Nguyen , Beth Bubolz , Anne E. Anderson , Yi-Chen Lai","doi":"10.1016/j.seizure.2024.09.011","DOIUrl":"10.1016/j.seizure.2024.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to examine the effects of acute seizures and respiratory derangement on the cardiac electrical properties reflected on the electrocardiogram (ECG); and to analyze their potential interactions with a diagnosis of epilepsy in children.</div></div><div><h3>Methods</h3><div>Emergency center (EC) visits with seizure or epilepsy diagnostic codes from 1/2011–12/2013 were included if they had ECG within 24 h of EC visit. Patients were excluded if they had pre-existing cardiac conditions, ion channelopathy, or were taking specific cardiac medications. Control subjects were 1:1 age and gender matched. Abnormal ECG was defined as changes in rhythm, PR, QRS, or corrected QT intervals; QRS axis or morphology; ST segment; or T wave morphology from normal standards. We identified independent associations between clinical factors and abnormal ECG findings using multivariable logistic regression modeling.</div></div><div><h3>Results</h3><div>Ninety-five children with epilepsy presented to the EC with seizures, respiratory distress, and other concerns. Three hundred children without epilepsy presented with seizures. There was an increased prevalence of minor ECG abnormalities in children with epilepsy (49 %) compared to the control subjects (29 %) and those without epilepsy (36 %). Epilepsy (OR: 1.61, 95 %CI: 1.01–2.6), need for supplemental oxygen (OR 3.06, 95 % CI: 1.45–6.44) or mechanical ventilation (OR: 2.5, 95 % CI: 1.03–6.05) were independently associated with minor ECG abnormalities. Secondary analyses further demonstrated an independent association between level of respiratory support and ECG abnormalities only in the epilepsy group.</div></div><div><h3>Significance</h3><div>Independent association of increased respiratory support with minor ECG abnormalities suggests a potential respiratory influence on the hearts of children with epilepsy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 39-44"},"PeriodicalIF":2.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320367","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 : 2024-09-19DOI: 10.1016/j.seizure.2024.09.013
Suyi Ooi , Chris Tailby , Naoto Nagino , Patrick W. Carney , Graeme D. Jackson , David N. Vaughan
Objectives
To assess the feasibility of using a seizure recurrence prediction tool in a First Seizure Clinic, considering (1) the accuracy of initial clinical diagnoses and (2) performance of automated computational models in predicting seizure recurrence after first unprovoked seizure (FUS).
Methods
To assess diagnostic accuracy, we analysed all sustained and revised diagnoses in patients seen at a First Seizure Clinic over 5 years with 6+ months follow-up (‘accuracy cohort’, n = 487).
To estimate prediction of 12-month seizure recurrence after FUS, we used a logistic regression of clinical factors on a multicentre FUS cohort (‘prediction cohort’, n = 181), and compared performance to a recently published seizure recurrence model.
Results
Initial diagnosis was sustained over 6+ months follow-up in 69% of patients in the ‘accuracy cohort’. Misdiagnosis occurred in 5%, and determination of unclassified diagnosis in 9%. Progression to epilepsy occurred in 17%, either following FUS or initial acute symptomatic seizure.
Within the ‘prediction cohort’ with FUS, 12-month seizure recurrence rate was 41% (95% CI [33.8%, 48.5%]). Nocturnal seizure, focal seizure semiology and developmental disability were predictive factors. Our model yielded an Area under the Receiver Operating Characteristic curve (AUC) of 0.60 (95% CI [0.59, 0.64]).
Conclusions
High clinical accuracy can be achieved at the initial visit to a First Seizure Clinic. This shows that diagnosis will not limit the application of seizure recurrence prediction tools in this context. However, based on the modest performance of currently available seizure recurrence prediction tools using clinical factors, we conclude that data beyond clinical factors alone will be needed to improve predictive performance.
{"title":"Prediction begins with diagnosis: Estimating seizure recurrence risk in the First Seizure Clinic","authors":"Suyi Ooi , Chris Tailby , Naoto Nagino , Patrick W. Carney , Graeme D. Jackson , David N. Vaughan","doi":"10.1016/j.seizure.2024.09.013","DOIUrl":"10.1016/j.seizure.2024.09.013","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the feasibility of using a seizure recurrence prediction tool in a First Seizure Clinic, considering (1) the accuracy of initial clinical diagnoses and (2) performance of automated computational models in predicting seizure recurrence after first unprovoked seizure (FUS).</div></div><div><h3>Methods</h3><div>To assess diagnostic accuracy, we analysed all sustained and revised diagnoses in patients seen at a First Seizure Clinic over 5 years with 6+ months follow-up (‘accuracy cohort’, n = 487).</div><div>To estimate prediction of 12-month seizure recurrence after FUS, we used a logistic regression of clinical factors on a multicentre FUS cohort (‘prediction cohort’, n = 181), and compared performance to a recently published seizure recurrence model.</div></div><div><h3>Results</h3><div>Initial diagnosis was sustained over 6+ months follow-up in 69% of patients in the ‘accuracy cohort’. Misdiagnosis occurred in 5%, and determination of unclassified diagnosis in 9%. Progression to epilepsy occurred in 17%, either following FUS or initial acute symptomatic seizure.</div><div>Within the ‘prediction cohort’ with FUS, 12-month seizure recurrence rate was 41% (95% CI [33.8%, 48.5%]). Nocturnal seizure, focal seizure semiology and developmental disability were predictive factors. Our model yielded an Area under the Receiver Operating Characteristic curve (AUC) of 0.60 (95% CI [0.59, 0.64]).</div></div><div><h3>Conclusions</h3><div>High clinical accuracy can be achieved at the initial visit to a First Seizure Clinic. This shows that diagnosis will not limit the application of seizure recurrence prediction tools in this context. However, based on the modest performance of currently available seizure recurrence prediction tools using clinical factors, we conclude that data beyond clinical factors alone will be needed to improve predictive performance.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 87-95"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394717","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 : 2024-09-19DOI: 10.1016/j.seizure.2024.09.014
Yijun Weng, Bihong Ma, Xi Lin
Background
Perampanel, the first third-generation anti-seizure medication targeting the AMPA receptor, has been used in the treatment of patients with focal seizures, with or without secondary generalized seizures, and primary generalized tonic-clonic seizures. This study focused on the effectiveness and safety of perampanel for pediatric patients with at least 1-year follow-up in real-world settings.
Methods
We systematically searched PubMed, EMBASE, and Web of Science for real-world studies published before April 27, 2024. The data of interest were extracted and analyzed using the R software (version 4.2.1).
Results
From 1181 retrieved citations, 25 records involved a total of 2985 individuals were included in the meta-analysis. The 50 % responder rate pooled from the 22 studies yielded an overall 55.0 % (95 % CI: 46.1–63.8 %), with significant evidence of between-study heterogeneity (I2 = 93 %, P < 0.01, τ2 = 0.038). The seizure-free rate pooled from 22 studies yielded an overall rate of 28.9 % (95 % CI: 19.6–39.1 %). Twenty studies reported the retention rate of perampanel treatment with a pooled proportion was 71.1 % (95 % CI: 61.1–80.2 %). The estimate of the adverse events incidence rate pooled from the 23 studies yielded an overall 29.0 % (95 % CI: 23.4–34.9 %). Subgroup analyses were conducted based on follow-up time (12 months or ≥ 24 months).
Conclusion
Perampanel is generally well tolerated and effective in the treatment of epilepsy in children and adolescents with mid-long-term follow-up. The 50 % responder rate in children and adolescents improved with time. The retention rate and the seizure-free rate during at least 24 months of follow-up were not as sustained as those in 12 months of follow-up. Adverse events, particularly psychiatric and behavioral, should be monitored during clinical practice administration.
{"title":"Real-world effectiveness and safety of perampanel for children and adolescents with epilepsy: A meta-analysis with at least 1-year follow-up","authors":"Yijun Weng, Bihong Ma, Xi Lin","doi":"10.1016/j.seizure.2024.09.014","DOIUrl":"10.1016/j.seizure.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Perampanel, the first third-generation anti-seizure medication targeting the AMPA receptor, has been used in the treatment of patients with focal seizures, with or without secondary generalized seizures, and primary generalized tonic-clonic seizures. This study focused on the effectiveness and safety of perampanel for pediatric patients with at least 1-year follow-up in real-world settings.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, EMBASE, and Web of Science for real-world studies published before April 27, 2024. The data of interest were extracted and analyzed using the R software (version 4.2.1).</div></div><div><h3>Results</h3><div>From 1181 retrieved citations, 25 records involved a total of 2985 individuals were included in the meta-analysis. The 50 % responder rate pooled from the 22 studies yielded an overall 55.0 % (95 % CI: 46.1–63.8 %), with significant evidence of between-study heterogeneity (I<sup>2</sup> = 93 %, <em>P</em> < 0.01, τ<sup>2</sup> = 0.038). The seizure-free rate pooled from 22 studies yielded an overall rate of 28.9 % (95 % CI: 19.6–39.1 %). Twenty studies reported the retention rate of perampanel treatment with a pooled proportion was 71.1 % (95 % CI: 61.1–80.2 %). The estimate of the adverse events incidence rate pooled from the 23 studies yielded an overall 29.0 % (95 % CI: 23.4–34.9 %). Subgroup analyses were conducted based on follow-up time (12 months or ≥ 24 months).</div></div><div><h3>Conclusion</h3><div>Perampanel is generally well tolerated and effective in the treatment of epilepsy in children and adolescents with mid-long-term follow-up. The 50 % responder rate in children and adolescents improved with time. The retention rate and the seizure-free rate during at least 24 months of follow-up were not as sustained as those in 12 months of follow-up. Adverse events, particularly psychiatric and behavioral, should be monitored during clinical practice administration.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 96-104"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394718","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 : 2024-09-19DOI: 10.1016/j.seizure.2024.09.012
Mary Nyakato, Shubaya Kasule Naggayi, Pamela Rosemary Akun, Sam Ononge, Alfred Odong, Erias Adams Baguma, Hellen Nansiiro, Dennis Kalibbala, Simple Ouma, Innocent Besigye, Richard Idro
Introduction: Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.
Objectives: The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.
Methods: A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.
Results: Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.
Conclusion: Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.
简介点头综合征（NS）是一种在儿童中发病的严重神经系统疾病，人们对其了解甚少。在乌干达，一些 NS 病例已成长为有生育能力的成年人。患有 NS 的母亲所生的婴儿可能容易出现神经发育障碍。患有 NS 的母亲在认知方面的缺陷可能会进一步影响对其子女的照顾，从而影响神经认知发育、身体发育和行为：本研究旨在确定母亲患有点头综合征的儿童在神经发育、行为、营养和身体发育方面的结果：2021 年 5 月至 2022 年 4 月在乌干达北部进行了一项横断面比较研究。母亲患有点头综合征的 0-5 岁儿童与母亲未患有点头综合征的 0-5 岁儿童进行了比较，两者的年龄、性别和居住地相匹配。采用标准化方法对神经发育、行为、营养和身体发育情况进行评估，并采用 t 检验对结果进行分组比较：共有 106 名儿童参加了研究。53名儿童的母亲患有NS，53名儿童的母亲未患有NS；他们的平均年龄分别为26.9（2.22）个月和27.5（2.12）个月。母亲患有 NS 的儿童在精细运动（37.5(12.1) vs 44.2(14.3)，P = 0.011）、接受性语言（37.8（10.8） vs 43.9（12.9），p = 0.010）、整体认知发展（74.36（17.8） vs 83.34（19.6），p = 0.015）和注意力（0.64（0.20） vs 0.76（0.15），p = 0.001）。行为评分方面没有差异。母亲患有 NS 的儿童的年龄体重 z 分数（WAZ）（p = 0.003）和年龄身长/身高 z 分数（LAZ/HAZ）（p = 0.001）也明显较低；其中有 19 人（35.9%）发育不良：结论：母亲患有 NS 的儿童在神经发育、营养和体格生长方面都较差。结论：母亲患有 NS 的儿童在神经发育、营养和身体发育方面都较差，因此有必要采取干预措施来改善这些儿童的发育状况。
{"title":"Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome.","authors":"Mary Nyakato, Shubaya Kasule Naggayi, Pamela Rosemary Akun, Sam Ononge, Alfred Odong, Erias Adams Baguma, Hellen Nansiiro, Dennis Kalibbala, Simple Ouma, Innocent Besigye, Richard Idro","doi":"10.1016/j.seizure.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.seizure.2024.09.012","url":null,"abstract":"<p><strong>Introduction: </strong>Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.</p><p><strong>Objectives: </strong>The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.</p><p><strong>Methods: </strong>A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.</p><p><strong>Results: </strong>Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.</p><p><strong>Conclusion: </strong>Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331056","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 : 2024-09-19DOI: 10.1016/j.seizure.2024.09.009
Yi-Di Liu , Feng-Jun Zhu , Yan Chen , Lin Li , Hua-Fang Zou , Yang Sun , Chun Lin , Cong Li , Ze-Shi Tan , Xiao-Fan Ren , De-Zhi Cao
<div><h3>Objective</h3><div>To investigate the clinical outcomes and safety of surgery in infants (< 12 months of age) with drug-resistant epilepsy, clarify surgical indications, and select appropriate surgical methods.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of infants with drug-resistant epilepsy who underwent epilepsy surgery and were followed up for > 6 months at the Epilepsy Center of Shenzhen Children's Hospital. Clinical data included etiology, seizure type, surgical procedure, preoperative auxiliary examinations, pathological findings, and intraoperative and postoperative complications. Clinical outcomes were assessed based on postoperative seizure frequency, antiseizure medicines (ASMs) use, and neurocognitive development. Intraoperative blood loss, operative duration, postoperative complications, and duration of intensive care were evaluated to assess the safety of epilepsy surgery. Univariate and logistic analyses were performed to explore the factors influencing prognosis.</div></div><div><h3>Results</h3><div>Epilepsy surgery was performed on 44 infants with drug-resistant epilepsy, including 7 patients who underwent two operations. The age of seizure onset ranged from 1 day to 11 months (median: 1 month, interquartile range (IQR): 0.1–3.8), the disease course was 1–11 months (median: 4 months, IQR: 2–7), and the age at surgery was 6.9 ± 3.6 months. Twenty-three patients underwent hemispherectomy (52.3 %), and two underwent subtotal hemispherectomy. Five patients underwent multilobar disconnection, five underwent frontal lobotomy, and the remaining nine underwent focal resection. The surgical duration was 7.5 ± 2 h. Intraoperative blood loss ranged from 50 to 1800 ml (median: 275 ml, IQR: 200–500), with all patients receiving an intraoperative blood transfusion of 0.5–6 U (median: 1.5 U, IQR: 1.5–3). The intensive care unit stay was 1–4 days (median: 1 day, IQR: 1–2). The postoperative complication rate was 13.6 % (6/44; two cases of hydrocephalus with intracranial infection, two isolated hydrocephalus, and two subdural hematomas). Excluding one child who died of severe lung infection approximately one year after surgery and one child lost to follow-up after surgery, all other cases were regularly followed up for 10 –49 months (median: 30 months, IQR: 16.5–36). After surgery, patients were treated with 0–3 ASMs (median: 1 ASM, IQR: 0–2); 27.9 % (12/43) stopped taking ASMs and 51.2 % (22/43) had reduced number of ASMs. Engel I was achieved in 76.7 % (33/43) of the patients at the last follow-up. In 17 cases with complete developmental quotient follow-up data, the preoperative and postoperative developmental quotient means were 28.8 ± 21 and 43.2 ± 20.1, showing statistically significant differences (<em>p<0.05</em>)</div></div><div><h3>Significance</h3><div>Epilepsy surgery in infants under 12 months of age is safe and effective. Early preoperative evaluation is crucial for identifying structural
{"title":"Preliminary observation on clinical outcome and safety of surgery in early infants (<12 months) with drug-resistant epilepsy","authors":"Yi-Di Liu , Feng-Jun Zhu , Yan Chen , Lin Li , Hua-Fang Zou , Yang Sun , Chun Lin , Cong Li , Ze-Shi Tan , Xiao-Fan Ren , De-Zhi Cao","doi":"10.1016/j.seizure.2024.09.009","DOIUrl":"10.1016/j.seizure.2024.09.009","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the clinical outcomes and safety of surgery in infants (< 12 months of age) with drug-resistant epilepsy, clarify surgical indications, and select appropriate surgical methods.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of infants with drug-resistant epilepsy who underwent epilepsy surgery and were followed up for > 6 months at the Epilepsy Center of Shenzhen Children's Hospital. Clinical data included etiology, seizure type, surgical procedure, preoperative auxiliary examinations, pathological findings, and intraoperative and postoperative complications. Clinical outcomes were assessed based on postoperative seizure frequency, antiseizure medicines (ASMs) use, and neurocognitive development. Intraoperative blood loss, operative duration, postoperative complications, and duration of intensive care were evaluated to assess the safety of epilepsy surgery. Univariate and logistic analyses were performed to explore the factors influencing prognosis.</div></div><div><h3>Results</h3><div>Epilepsy surgery was performed on 44 infants with drug-resistant epilepsy, including 7 patients who underwent two operations. The age of seizure onset ranged from 1 day to 11 months (median: 1 month, interquartile range (IQR): 0.1–3.8), the disease course was 1–11 months (median: 4 months, IQR: 2–7), and the age at surgery was 6.9 ± 3.6 months. Twenty-three patients underwent hemispherectomy (52.3 %), and two underwent subtotal hemispherectomy. Five patients underwent multilobar disconnection, five underwent frontal lobotomy, and the remaining nine underwent focal resection. The surgical duration was 7.5 ± 2 h. Intraoperative blood loss ranged from 50 to 1800 ml (median: 275 ml, IQR: 200–500), with all patients receiving an intraoperative blood transfusion of 0.5–6 U (median: 1.5 U, IQR: 1.5–3). The intensive care unit stay was 1–4 days (median: 1 day, IQR: 1–2). The postoperative complication rate was 13.6 % (6/44; two cases of hydrocephalus with intracranial infection, two isolated hydrocephalus, and two subdural hematomas). Excluding one child who died of severe lung infection approximately one year after surgery and one child lost to follow-up after surgery, all other cases were regularly followed up for 10 –49 months (median: 30 months, IQR: 16.5–36). After surgery, patients were treated with 0–3 ASMs (median: 1 ASM, IQR: 0–2); 27.9 % (12/43) stopped taking ASMs and 51.2 % (22/43) had reduced number of ASMs. Engel I was achieved in 76.7 % (33/43) of the patients at the last follow-up. In 17 cases with complete developmental quotient follow-up data, the preoperative and postoperative developmental quotient means were 28.8 ± 21 and 43.2 ± 20.1, showing statistically significant differences (<em>p<0.05</em>)</div></div><div><h3>Significance</h3><div>Epilepsy surgery in infants under 12 months of age is safe and effective. Early preoperative evaluation is crucial for identifying structural","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 165-171"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511657","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}
<div><h3>Background</h3><p>The median cost of anti-seizure medications (ASM) in the United States (U.S.) nearly doubled per person between 2006 and 2021. This increase, combined with shifts in ASM usage and the impact of the COVID-19 pandemic on drug supply chains amid rising inflation, underscored the urgent need to scrutinize ASM pricing dynamics. This study aimed to analyze the complex dynamics of ASM pricing in the U.S. over the past decade (2013–2023); this included how the entry of generic ASMs influenced the pricing of brand-name counterparts and what impacted price variations across different ASM formulations (e.g., significant inflation, the COVID-19 pandemic).</p></div><div><h3>Methods</h3><p>This study utilized National Average Drug Acquisition Cost (NADAC) data from November 2013 to July 2023. We adjusted ASM prices for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS). Statistical analyses included fixed effects regressions and multivariable regression analysis to evaluate the impact of inflation, the number of medication labelers, and the COVID-19 pandemic on ASM prices.</p></div><div><h3>Results</h3><p>Our study analyzed 23 ASMs approved by the U.S. Food and Drug Administration (FDA), which encompassed 223 oral formulations:112 brand-name and 111 generics. From 2013–2016 to 2020–2023, accounting for standard deviations (SD), the average price of brand-name ASMs increased from $8.71 (SD 5.9) to $15.43 (SD 10.7), while generic ASMs saw a slight decrease from $1.39 (SD 1.8) to $1.26 (SD 1.6). Consequently, the price gap between brand-name and generic ASMs surged from 1452.39 % to 3399.26 %. The proportion of matched brand-name and generic ASMs with a price difference of 1000 %–9999 % increased from 32.88 % (2013–2016) to 41.43 % (2020–2023), while those exceeding 10,000 % rose from 16.44 % to 20 % in the same period. Generic immediate-release (IR) formulations were significantly less expensive than extended-release (ER) or delayed-release (DR) counterparts, with cost differences reaching up to 7751.20 %. The number of medication labelers was inversely related to generic ASM prices, which decreased by 5.45 % (<em>p</em> = 0.001) with each additional generic labeler, while brand-name ASM prices increased by 2.46 % (<em>p</em> < 0.001) with each additional generic labeler. The COVID-19 pandemic led to a 24.4 % increase in brand-name ASM prices and a 23.1 % decrease in generic ASM prices.</p></div><div><h3>Conclusions</h3><p>The findings reveal an expanding price disparity between brand-name and generic oral ASMs. An inverse relationship was observed between the number of medication labelers and generic ASM prices, with additional labelers driving down generic prices. However, introducing more generic labelers led to a significant increase in brand-name ASM prices. Furthermore, following patent expirations, brand-name ASM prices rose—a trend explained by the "generics paradox," where, contrary
{"title":"Pricing dynamics of anti-seizure medications in the U.S.","authors":"Pradeep Javarayee , Tengizi Mtchedlidze , Wanda Snell , Vibha Mahesha , Jennifer Meylor , Shamshad Shahrukh , Shannon Pollock , Jeetendra Sah , Yilu Dong , Hema Patel","doi":"10.1016/j.seizure.2024.09.010","DOIUrl":"10.1016/j.seizure.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><p>The median cost of anti-seizure medications (ASM) in the United States (U.S.) nearly doubled per person between 2006 and 2021. This increase, combined with shifts in ASM usage and the impact of the COVID-19 pandemic on drug supply chains amid rising inflation, underscored the urgent need to scrutinize ASM pricing dynamics. This study aimed to analyze the complex dynamics of ASM pricing in the U.S. over the past decade (2013–2023); this included how the entry of generic ASMs influenced the pricing of brand-name counterparts and what impacted price variations across different ASM formulations (e.g., significant inflation, the COVID-19 pandemic).</p></div><div><h3>Methods</h3><p>This study utilized National Average Drug Acquisition Cost (NADAC) data from November 2013 to July 2023. We adjusted ASM prices for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS). Statistical analyses included fixed effects regressions and multivariable regression analysis to evaluate the impact of inflation, the number of medication labelers, and the COVID-19 pandemic on ASM prices.</p></div><div><h3>Results</h3><p>Our study analyzed 23 ASMs approved by the U.S. Food and Drug Administration (FDA), which encompassed 223 oral formulations:112 brand-name and 111 generics. From 2013–2016 to 2020–2023, accounting for standard deviations (SD), the average price of brand-name ASMs increased from $8.71 (SD 5.9) to $15.43 (SD 10.7), while generic ASMs saw a slight decrease from $1.39 (SD 1.8) to $1.26 (SD 1.6). Consequently, the price gap between brand-name and generic ASMs surged from 1452.39 % to 3399.26 %. The proportion of matched brand-name and generic ASMs with a price difference of 1000 %–9999 % increased from 32.88 % (2013–2016) to 41.43 % (2020–2023), while those exceeding 10,000 % rose from 16.44 % to 20 % in the same period. Generic immediate-release (IR) formulations were significantly less expensive than extended-release (ER) or delayed-release (DR) counterparts, with cost differences reaching up to 7751.20 %. The number of medication labelers was inversely related to generic ASM prices, which decreased by 5.45 % (<em>p</em> = 0.001) with each additional generic labeler, while brand-name ASM prices increased by 2.46 % (<em>p</em> < 0.001) with each additional generic labeler. The COVID-19 pandemic led to a 24.4 % increase in brand-name ASM prices and a 23.1 % decrease in generic ASM prices.</p></div><div><h3>Conclusions</h3><p>The findings reveal an expanding price disparity between brand-name and generic oral ASMs. An inverse relationship was observed between the number of medication labelers and generic ASM prices, with additional labelers driving down generic prices. However, introducing more generic labelers led to a significant increase in brand-name ASM prices. Furthermore, following patent expirations, brand-name ASM prices rose—a trend explained by the \"generics paradox,\" where, contrary","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 26-33"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271444","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 : 2024-09-12DOI: 10.1016/j.seizure.2024.09.002
Julia Shawarba , Karl Roessler , Matthias Tomschik , Jonathan Wais , Fabian Winter , Florian Mayer , Gregor Kasprian , Christine Haberler , Tatjana Traub-Weidinger , Martin Niederle , Thomas Czech , Johannes Herta , Christian Dorfer , Martha Feucht
Purpose
Imaging and resection strategies for pediatric gangliogliomas (GG) and dysembryoplastic neuroepitheliomas (DNET) presenting with epilepsy were retrospectively analyzed in a consecutive institutional series of surgically treated patients.
Methods
Twenty-two children (median 8 years, 3–18 years) presented with seizures for 30 months median (14–55.2 months) due to a histologically verified GG/DNET.
Results
There were 20 GG and 2 DNT, 68 % located temporal, 32 % extra-temporal. Seizure history was significantly longer in temporal cases (38 versus 14 months median, p < 0.01). MRI contrast enhancement was present in 50 % and methionine (MET) positron emission tomography (PET) uptake in 70 % (standard uptake values (SUVs) 2.92 mean, from 1.6 to 6.4). 27 % had glucose PET hypometabolism. Primarily, in temporal GG, ECoG (electrocorticography) -guided lesionectomies were performed in 87 % and antero-mesial temporal lobe resections (AMTLR) in 13 %, whereas in extra-temporal GG/DNETs, lesionectomies were performed in 100 %. ILAE Class 1 seizure outcome was primarily achieved in 73 % of the temporal cases, and was increased to 93 % by performing six repeat surgeries using AMTLR. Extratemporal patients experienced ILAE Class 1 seizure outcomes in 86 % without additional surgeries, although harboring significantly more residual tumor (p < 0.005, mean follow-up 28 months).
Conclusion
In children, MET PET imaging for suspected GG is proposed preoperatively showing a high diagnostic sensitivity and an option to delineate the lesions for navigated resection, whereas MRI contrast behavior was of no differential diagnostic use. As a surgical strategy we propose primarily lesionectomies for extratemporal but AMTLR for temporal GG respecting eloquent brain areas.
{"title":"Seizure outcome in surgically treated pediatric gangliogliomas and dysembryoplastic neuroepitheliomas according to imaging and resection strategies","authors":"Julia Shawarba , Karl Roessler , Matthias Tomschik , Jonathan Wais , Fabian Winter , Florian Mayer , Gregor Kasprian , Christine Haberler , Tatjana Traub-Weidinger , Martin Niederle , Thomas Czech , Johannes Herta , Christian Dorfer , Martha Feucht","doi":"10.1016/j.seizure.2024.09.002","DOIUrl":"10.1016/j.seizure.2024.09.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Imaging and resection strategies for pediatric gangliogliomas (GG) and dysembryoplastic neuroepitheliomas (DNET) presenting with epilepsy were retrospectively analyzed in a consecutive institutional series of surgically treated patients.</p></div><div><h3>Methods</h3><p>Twenty-two children (median 8 years, 3–18 years) presented with seizures for 30 months median (14–55.2 months) due to a histologically verified GG/DNET.</p></div><div><h3>Results</h3><p>There were 20 GG and 2 DNT, 68 % located temporal, 32 % extra-temporal. Seizure history was significantly longer in temporal cases (38 versus 14 months median, <em>p</em> < 0.01). MRI contrast enhancement was present in 50 % and methionine (MET) positron emission tomography (PET) uptake in 70 % (standard uptake values (SUVs) 2.92 mean, from 1.6 to 6.4). 27 % had glucose PET hypometabolism. Primarily, in temporal GG, ECoG (electrocorticography) -guided lesionectomies were performed in 87 % and antero-mesial temporal lobe resections (AMTLR) in 13 %, whereas in extra-temporal GG/DNETs, lesionectomies were performed in 100 %. ILAE Class 1 seizure outcome was primarily achieved in 73 % of the temporal cases, and was increased to 93 % by performing six repeat surgeries using AMTLR. Extratemporal patients experienced ILAE Class 1 seizure outcomes in 86 % without additional surgeries, although harboring significantly more residual tumor (<em>p</em> < 0.005, mean follow-up 28 months).</p></div><div><h3>Conclusion</h3><p>In children, MET PET imaging for suspected GG is proposed preoperatively showing a high diagnostic sensitivity and an option to delineate the lesions for navigated resection, whereas MRI contrast behavior was of no differential diagnostic use. As a surgical strategy we propose primarily lesionectomies for extratemporal but AMTLR for temporal GG respecting eloquent brain areas.</p></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 19-25"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1059131124002504/pdfft?md5=5e1697d81f8f45d3237a713349375b78&pid=1-s2.0-S1059131124002504-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271443","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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