Kanika Jhanji, Zaitoon Shivji, Marion Lazaj, Lysa Boisse Lomax, Gavin P Winston, Garima Shukla
Objective: Very few publications have reported the impact of artisanal cannabis use on overall quality of life among people with drug-resistant epilepsy. This study aimed to evaluate the association of artisanal cannabis use among adults with drug-resistant epilepsy with quality of life, and to determine if an association exists between Quality-of-Life in Epilepsy Inventory-31 (QOLIE-31) 'T scores' and different clinical variables.
Methods: This study included patients admitted to a Canadian tertiary care epilepsy center as part of a larger study. These patients were confirmed to have drug-resistant epilepsy by an epileptologist at the Ambulatory Epilepsy Clinic. Patients were categorized into cannabis users (CAN group) (n = 25) and Non-cannabis users (Non-CAN group) (n = 21). Data was collected on RedCap® for epilepsy and cannabis use details. These were analyzed for an association using a binary multivariable logistic regression model between QOLIE-31 'T scores' and age, sex, epilepsy duration, age at initiation of use, duration of cannabis use and psychiatric related comorbidity for all patients. Additionally, different 'T subscores' of the questionnaire were compared between the CAN group and Non-CAN group.
Results: A statistically significant difference between the CAN group and Non-CAN group for the T subscore 'energy and fatigue' (p = .004) was found, with the CAN group scoring higher. However, for the 'overall T score' between the two groups there was no statically significant difference (p = .11). Additionally, a significant negative correlation between 'overall T score' and cannabis use disorder (p = .032) was found.
Significance: This study provides new data on association of quality of life in epilepsy with cannabis use and can serve as a foundation for larger future studies to better assess this association.
目的:很少有出版物报道吸食手工大麻对耐药性癫痫患者整体生活质量的影响。本研究旨在评估成人耐药性癫痫患者吸食手工大麻与生活质量之间的关系,并确定《癫痫生活质量调查表-31》(QOLIE-31)"T 评分 "与不同临床变量之间是否存在关联:这项研究包括加拿大一家三级护理癫痫中心收治的患者,是一项大型研究的一部分。这些患者经非住院癫痫门诊的癫痫专科医生确诊为耐药性癫痫。患者被分为大麻使用者(CAN 组)(n = 25)和非大麻使用者(Non-CAN 组)(n = 21)。在 RedCap® 上收集了有关癫痫和大麻使用详情的数据。使用二元多变量逻辑回归模型分析了所有患者的 QOLIE-31 "T 分数 "与年龄、性别、癫痫持续时间、开始使用的年龄、使用大麻的持续时间和精神病相关合并症之间的关联。此外,还对 CAN 组和非 CAN 组之间问卷的不同 "T 子分数 "进行了比较:结果:CAN 组和非 CAN 组在 "精力和疲劳 "的 T 子得分上存在明显差异(p = 0.004),CAN 组得分更高。然而,在 "总体 T 分 "方面,两组之间没有明显的统计学差异(p = .11)。此外,研究还发现 "总 T 分 "与大麻使用障碍之间存在明显的负相关(p = .032):本研究为癫痫患者的生活质量与大麻使用之间的关联提供了新数据,可作为今后开展更大规模研究的基础,以更好地评估这种关联。
{"title":"Quality of life and cannabis use among patients with drug-resistant epilepsy-An observational study from a Canadian tertiary care referral center.","authors":"Kanika Jhanji, Zaitoon Shivji, Marion Lazaj, Lysa Boisse Lomax, Gavin P Winston, Garima Shukla","doi":"10.1002/epd2.20276","DOIUrl":"https://doi.org/10.1002/epd2.20276","url":null,"abstract":"<p><strong>Objective: </strong>Very few publications have reported the impact of artisanal cannabis use on overall quality of life among people with drug-resistant epilepsy. This study aimed to evaluate the association of artisanal cannabis use among adults with drug-resistant epilepsy with quality of life, and to determine if an association exists between Quality-of-Life in Epilepsy Inventory-31 (QOLIE-31) 'T scores' and different clinical variables.</p><p><strong>Methods: </strong>This study included patients admitted to a Canadian tertiary care epilepsy center as part of a larger study. These patients were confirmed to have drug-resistant epilepsy by an epileptologist at the Ambulatory Epilepsy Clinic. Patients were categorized into cannabis users (CAN group) (n = 25) and Non-cannabis users (Non-CAN group) (n = 21). Data was collected on RedCap® for epilepsy and cannabis use details. These were analyzed for an association using a binary multivariable logistic regression model between QOLIE-31 'T scores' and age, sex, epilepsy duration, age at initiation of use, duration of cannabis use and psychiatric related comorbidity for all patients. Additionally, different 'T subscores' of the questionnaire were compared between the CAN group and Non-CAN group.</p><p><strong>Results: </strong>A statistically significant difference between the CAN group and Non-CAN group for the T subscore 'energy and fatigue' (p = .004) was found, with the CAN group scoring higher. However, for the 'overall T score' between the two groups there was no statically significant difference (p = .11). Additionally, a significant negative correlation between 'overall T score' and cannabis use disorder (p = .032) was found.</p><p><strong>Significance: </strong>This study provides new data on association of quality of life in epilepsy with cannabis use and can serve as a foundation for larger future studies to better assess this association.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Housam Soboh, Jacques Theitler, Revital Gandelman-Marton
Objective: Despite recommendations to initiate antiseizure medication treatment once the diagnosis of epilepsy is confirmed, a certain proportion of patients with epilepsy who should receive antiseizure medication treatment remain untreated. We aimed to evaluate the rate of and the reasons for the treatment gap in patients with epilepsy who were referred to their first visit in our epilepsy clinic.
Methods: We retrospectively reviewed the computerized database and the medical records of all the patients with epilepsy who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021).
Results: Forty-nine (6.5%) of 746 patients with epilepsy were not treated with antiseizure medications: 27 (3.6%) were nonadherent to treatment, 12 (1.6%) patients were not definitively diagnosed with epilepsy prior to their first epilepsy clinic visit, and in 10 (1.3%) patients antiseizure medication treatment was not recommended. Untreated patients had shorter epilepsy duration compared to patients treated with antiseizure medications (p = .003). At last follow-up, 77% of the untreated patients at first visit were receiving antiseizure medications compared to 97% of the initially treated group, and fewer were receiving antiseizure medication polytherapy (p = .0001).
Significance: Although the rate of treatment gap was relatively low, we believe that it should be further reduced. Efforts may focus on addressing individual causes of nonadherence to antiseizure medication treatment and on promoting knowledge of diagnosis and treatment of epilepsy among healthcare professionals.
{"title":"Primary treatment gap among adults with epilepsy: A cross-sectional analysis.","authors":"Housam Soboh, Jacques Theitler, Revital Gandelman-Marton","doi":"10.1002/epd2.20275","DOIUrl":"https://doi.org/10.1002/epd2.20275","url":null,"abstract":"<p><strong>Objective: </strong>Despite recommendations to initiate antiseizure medication treatment once the diagnosis of epilepsy is confirmed, a certain proportion of patients with epilepsy who should receive antiseizure medication treatment remain untreated. We aimed to evaluate the rate of and the reasons for the treatment gap in patients with epilepsy who were referred to their first visit in our epilepsy clinic.</p><p><strong>Methods: </strong>We retrospectively reviewed the computerized database and the medical records of all the patients with epilepsy who had their first visit in our outpatient epilepsy clinic during a 10-year period (2012-2021).</p><p><strong>Results: </strong>Forty-nine (6.5%) of 746 patients with epilepsy were not treated with antiseizure medications: 27 (3.6%) were nonadherent to treatment, 12 (1.6%) patients were not definitively diagnosed with epilepsy prior to their first epilepsy clinic visit, and in 10 (1.3%) patients antiseizure medication treatment was not recommended. Untreated patients had shorter epilepsy duration compared to patients treated with antiseizure medications (p = .003). At last follow-up, 77% of the untreated patients at first visit were receiving antiseizure medications compared to 97% of the initially treated group, and fewer were receiving antiseizure medication polytherapy (p = .0001).</p><p><strong>Significance: </strong>Although the rate of treatment gap was relatively low, we believe that it should be further reduced. Efforts may focus on addressing individual causes of nonadherence to antiseizure medication treatment and on promoting knowledge of diagnosis and treatment of epilepsy among healthcare professionals.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miguel Leal Rato, Miguel Schön, Maria Paula Zafra, Diana Aguiar de Sousa, Teresa Pinho E Melo, Ana Catarina Franco, Ana Rita Peralta, Carolina Ferreira-Atuesta, Luis Carlos Mayor-Romero, Rob P W Rouhl, Carla Bentes
Objective: Epileptic seizures occur frequently after stroke due to changes in brain function and structure, and up to around 10% of stroke patients experience stroke recurrence in the first year. We aimed to establish the risk of acute symptomatic seizures in patients with recurrent stroke.
Methods: Retrospective cohort study including consecutive admissions to a Stroke Unit due to acute ischemic stroke, during a 5-year period. Additional inclusion of patients admitted to two centers in different countries to corroborate findings (confirmatory cohort). We aimed to compare acute symptomatic seizure incidence in patients with and without previous stroke. Patients with history of epilepsy were excluded. Logistic regression modeling was performed to identify predictors in middle cerebral artery (MCA) stroke.
Results: We included 1473 patients (1085 with MCA stroke), of which 117 had a recurrent ischemic stroke (84 with MCA stroke). Patients with recurrent stroke had a seizure risk during hospital stay similar to that of patients with a first-ever stroke (5.1% vs. 4.5%, OR 1.15, 95% CI .48-2.71, p = .75). Risk of acute symptomatic seizures was also similar (5.0% vs. 4.1, OR 1.22, 95% CI .29-5.27, p = .78). Older age, female sex, and hemorrhagic transformation were predictors of seizures in patients with a first MCA ischemic stroke, but not in recurrent stroke patients. Electrographic characteristics were similar between the two groups in patients who had an electroencephalogram (46 with first stroke, 5 with recurrent stroke). The low rate of seizures (1.5%) in the confirmatory cohort (n = 198) precluded full comparison with the initial cohort. Nevertheless, the rate of seizures was not higher in stroke recurrence.
Significance: History of previous stroke was not associated with an increased risk of acute symptomatic seizures during hospital stay. Larger, prospective studies, with prospective electrophysiological evaluation, are needed to explore the impact of stroke recurrence on seizure risk.
目的:由于脑功能和结构的改变,中风后经常会出现癫痫发作,多达约 10%的中风患者会在第一年内中风复发。我们旨在确定复发性中风患者急性症状性癫痫发作的风险:方法:回顾性队列研究,包括 5 年内因急性缺血性中风连续入住中风病房的患者。另外还纳入了不同国家两个中心收治的患者,以证实研究结果(确证队列)。我们的目的是比较曾患中风和未患中风患者的急性症状性癫痫发作率。有癫痫病史的患者被排除在外。采用逻辑回归模型确定大脑中动脉(MCA)卒中的预测因素:我们纳入了 1473 例患者(1085 例为 MCA 中风),其中 117 例为复发性缺血性中风(84 例为 MCA 中风)。复发性中风患者在住院期间的癫痫发作风险与首次中风患者相似(5.1% vs. 4.5%,OR 1.15,95% CI .48-2.71,p = .75)。急性症状发作的风险也相似(5.0% vs. 4.1,OR 1.22,95% CI .29-5.27,p = .78)。高龄、女性和出血性转变是首次 MCA 缺血性卒中患者癫痫发作的预测因素,但不是复发性卒中患者癫痫发作的预测因素。两组患者的脑电图特征相似(46 例首次中风患者,5 例复发中风患者)。由于确诊组群(n = 198)的癫痫发作率较低(1.5%),因此无法与初始组群进行全面比较。尽管如此,中风复发患者的癫痫发作率并不高:意义:既往中风史与住院期间急性症状性癫痫发作风险增加无关。需要进行更大规模的前瞻性研究,并进行前瞻性电生理评估,以探讨中风复发对癫痫发作风险的影响。
{"title":"Acute symptomatic seizures in patients with recurrent ischemic stroke: A multicentric study.","authors":"Miguel Leal Rato, Miguel Schön, Maria Paula Zafra, Diana Aguiar de Sousa, Teresa Pinho E Melo, Ana Catarina Franco, Ana Rita Peralta, Carolina Ferreira-Atuesta, Luis Carlos Mayor-Romero, Rob P W Rouhl, Carla Bentes","doi":"10.1002/epd2.20279","DOIUrl":"https://doi.org/10.1002/epd2.20279","url":null,"abstract":"<p><strong>Objective: </strong>Epileptic seizures occur frequently after stroke due to changes in brain function and structure, and up to around 10% of stroke patients experience stroke recurrence in the first year. We aimed to establish the risk of acute symptomatic seizures in patients with recurrent stroke.</p><p><strong>Methods: </strong>Retrospective cohort study including consecutive admissions to a Stroke Unit due to acute ischemic stroke, during a 5-year period. Additional inclusion of patients admitted to two centers in different countries to corroborate findings (confirmatory cohort). We aimed to compare acute symptomatic seizure incidence in patients with and without previous stroke. Patients with history of epilepsy were excluded. Logistic regression modeling was performed to identify predictors in middle cerebral artery (MCA) stroke.</p><p><strong>Results: </strong>We included 1473 patients (1085 with MCA stroke), of which 117 had a recurrent ischemic stroke (84 with MCA stroke). Patients with recurrent stroke had a seizure risk during hospital stay similar to that of patients with a first-ever stroke (5.1% vs. 4.5%, OR 1.15, 95% CI .48-2.71, p = .75). Risk of acute symptomatic seizures was also similar (5.0% vs. 4.1, OR 1.22, 95% CI .29-5.27, p = .78). Older age, female sex, and hemorrhagic transformation were predictors of seizures in patients with a first MCA ischemic stroke, but not in recurrent stroke patients. Electrographic characteristics were similar between the two groups in patients who had an electroencephalogram (46 with first stroke, 5 with recurrent stroke). The low rate of seizures (1.5%) in the confirmatory cohort (n = 198) precluded full comparison with the initial cohort. Nevertheless, the rate of seizures was not higher in stroke recurrence.</p><p><strong>Significance: </strong>History of previous stroke was not associated with an increased risk of acute symptomatic seizures during hospital stay. Larger, prospective studies, with prospective electrophysiological evaluation, are needed to explore the impact of stroke recurrence on seizure risk.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mosaic CLTC pathogenic variant causing focal epilepsy with normal intelligence.","authors":"Michelle A Sveistrup, Kenneth A Myers","doi":"10.1002/epd2.20270","DOIUrl":"https://doi.org/10.1002/epd2.20270","url":null,"abstract":"","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camilo Espinosa-Jovel, Sandra Riveros, Natalia Valencia-Enciso, Alberto Velásquez, Juan Vergara-Palma, Fidel Sobrino-Mejía
Objective: Timely treatment is one of the most relevant prognostic factors in patients with urgent epileptic seizures. Despite the available evidence, treatment times remain suboptimal. The aim of this study was to demonstrate the impact of the "seizure code" in an emergency department, focusing on both treatment times and hospital outcomes of patients with urgent epileptic seizures.
Methods: An ambispective cohort study was conducted in the emergency department of a public hospital in Bogotá, Colombia. Treatment times and hospital outcomes were evaluated both before and after the implementation of the seizure code.
Results: A total of 336 patients were included (94 in the pre-seizure code period and 242 in the post-seizure code period). Both cohorts were comparable in terms of clinical and demographic baseline characteristics. After the implementation of the seizure code, in-hospital treatment times improved among patients with status epilepticus and seizure cluster. For the group of patients with status epilepticus, the time from arrival to the first benzodiazepine decreased from a median of 100.5 min (IQR: 43-152.5) to a median of 20 min (IQR: 10-45) (p = .0063), and the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 155 min (IQR: 49-194) to a median of 39 min (IQR: 25-57) (p = .0071). For the group of patients with seizure cluster, the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 296 min (IQR: 112.5-409) to a median of 72 min (IQR: 46-111) (p < .001). The seizure code significantly decreased the risk of inappropriate benzodiazepine use (p = .0087), in-hospital seizure recurrence (p < .001), in-hospital mortality (p = .0074), and prolonged hospitalizations (more than 48 h) (p = .0475).
Significance: The seizure code shortens the time to treatment, reduces the length of hospital stay, decreases the risk of inappropriate benzodiazepine use, and lowers both the in-hospital seizure recurrence and in-hospital mortality among patients with urgent epileptic seizures.
{"title":"Seizure emergency code strategy: Improving treatment times and hospital outcomes for patients with urgent epileptic seizures.","authors":"Camilo Espinosa-Jovel, Sandra Riveros, Natalia Valencia-Enciso, Alberto Velásquez, Juan Vergara-Palma, Fidel Sobrino-Mejía","doi":"10.1002/epd2.20273","DOIUrl":"https://doi.org/10.1002/epd2.20273","url":null,"abstract":"<p><strong>Objective: </strong>Timely treatment is one of the most relevant prognostic factors in patients with urgent epileptic seizures. Despite the available evidence, treatment times remain suboptimal. The aim of this study was to demonstrate the impact of the \"seizure code\" in an emergency department, focusing on both treatment times and hospital outcomes of patients with urgent epileptic seizures.</p><p><strong>Methods: </strong>An ambispective cohort study was conducted in the emergency department of a public hospital in Bogotá, Colombia. Treatment times and hospital outcomes were evaluated both before and after the implementation of the seizure code.</p><p><strong>Results: </strong>A total of 336 patients were included (94 in the pre-seizure code period and 242 in the post-seizure code period). Both cohorts were comparable in terms of clinical and demographic baseline characteristics. After the implementation of the seizure code, in-hospital treatment times improved among patients with status epilepticus and seizure cluster. For the group of patients with status epilepticus, the time from arrival to the first benzodiazepine decreased from a median of 100.5 min (IQR: 43-152.5) to a median of 20 min (IQR: 10-45) (p = .0063), and the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 155 min (IQR: 49-194) to a median of 39 min (IQR: 25-57) (p = .0071). For the group of patients with seizure cluster, the time from arrival to the first non-benzodiazepine antiseizure medication decreased from a median of 296 min (IQR: 112.5-409) to a median of 72 min (IQR: 46-111) (p < .001). The seizure code significantly decreased the risk of inappropriate benzodiazepine use (p = .0087), in-hospital seizure recurrence (p < .001), in-hospital mortality (p = .0074), and prolonged hospitalizations (more than 48 h) (p = .0475).</p><p><strong>Significance: </strong>The seizure code shortens the time to treatment, reduces the length of hospital stay, decreases the risk of inappropriate benzodiazepine use, and lowers both the in-hospital seizure recurrence and in-hospital mortality among patients with urgent epileptic seizures.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xing-Chang Wei, Zarina Assis, Martin Sherriff, Walter J Hader, Juan Pablo Appendino
In childhood drug-resistant focal epilepsy, the identification of a magnetic resonance imaging lesion significantly affects the management and prognosis, although it is often challenging. Herein we report the preliminary results of a modified MR sequence, in which both magnetization transfer and chemical shift selective preparation pulses are added to a 3D fast spin echo T1-weighted sequence to recognize focal cortical dysplasia. The scan time is short, and the images have expected uniform suppression of the background normal gray and white matter. We report four children with focal epilepsy, in whom the focal cortical and subcortical lesions are superiorly conspicuous on the aforementioned MR sequence compared to the high-resolution fluid-attenuated inversion recovery images obtained with typical epilepsy MR protocols.
{"title":"Superior lesion detection on 3D FSE T1WI with magnetization transfer and CHESS preparation pulses in children with focal epilepsy: Preliminary results.","authors":"Xing-Chang Wei, Zarina Assis, Martin Sherriff, Walter J Hader, Juan Pablo Appendino","doi":"10.1002/epd2.20271","DOIUrl":"https://doi.org/10.1002/epd2.20271","url":null,"abstract":"<p><p>In childhood drug-resistant focal epilepsy, the identification of a magnetic resonance imaging lesion significantly affects the management and prognosis, although it is often challenging. Herein we report the preliminary results of a modified MR sequence, in which both magnetization transfer and chemical shift selective preparation pulses are added to a 3D fast spin echo T1-weighted sequence to recognize focal cortical dysplasia. The scan time is short, and the images have expected uniform suppression of the background normal gray and white matter. We report four children with focal epilepsy, in whom the focal cortical and subcortical lesions are superiorly conspicuous on the aforementioned MR sequence compared to the high-resolution fluid-attenuated inversion recovery images obtained with typical epilepsy MR protocols.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruce Hermann, Robyn M Busch, Anny Reyes, Kayela Arrotta, Mayu Fujikawa, Victoria Ives-Deliperi, Aimee Dollman, Urvashi Shah, Carrie R McDonald
To present the background, rationale, details pertaining to use and essential computational steps, synopsis of findings to date, and future directions for the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE)-an initiative of the ILAE Neuropsychology Task Force. Examined are: (a) the 6 steps leading to the derivation of a cognitive phenotype from neuropsychological test data with an accompanying case example, (b) concise review of all IC-CoDE research to date, (c) summary of identified correlates of IC-CoDE outcomes, and (d) future research and clinical directions for the initiative. The IC-CoDE is computationally uncomplicated with individual or group data and represents a novel approach leading to new insights in the neuropsychology of epilepsy, with applications to diverse datasets internationally informing the reliability and validity of the approach. The IC-CoDE represents a novel approach to the analysis and interpretation of neuropsychological data in epilepsy that offers to advance a global taxonomy of cognitive disorders in epilepsy facilitating international collaboration and big data science.
{"title":"A user's guide for the International Classification of Cognitive Disorders in Epilepsy.","authors":"Bruce Hermann, Robyn M Busch, Anny Reyes, Kayela Arrotta, Mayu Fujikawa, Victoria Ives-Deliperi, Aimee Dollman, Urvashi Shah, Carrie R McDonald","doi":"10.1002/epd2.20268","DOIUrl":"https://doi.org/10.1002/epd2.20268","url":null,"abstract":"<p><p>To present the background, rationale, details pertaining to use and essential computational steps, synopsis of findings to date, and future directions for the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE)-an initiative of the ILAE Neuropsychology Task Force. Examined are: (a) the 6 steps leading to the derivation of a cognitive phenotype from neuropsychological test data with an accompanying case example, (b) concise review of all IC-CoDE research to date, (c) summary of identified correlates of IC-CoDE outcomes, and (d) future research and clinical directions for the initiative. The IC-CoDE is computationally uncomplicated with individual or group data and represents a novel approach leading to new insights in the neuropsychology of epilepsy, with applications to diverse datasets internationally informing the reliability and validity of the approach. The IC-CoDE represents a novel approach to the analysis and interpretation of neuropsychological data in epilepsy that offers to advance a global taxonomy of cognitive disorders in epilepsy facilitating international collaboration and big data science.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto Michelucci, Elena Pasini, Patrizia Riguzzi, Maria Tappatà, Maria Pia Giannoccaro, Elisa Micalizzi, Anastasia Lechiara, Pietro Mattioli, Luana Benedetti, Flavio Villani
ObjectiveThe aim of this study was to describe the clinical features of contactin‐associated protein‐like 2 (CASPR2)‐IgG‐associated seizures.MethodsNine patients were retrospectively collected from two epilepsy centers. For each patient we obtained a full clinical, neurophysiological, and MRI study along with detection of antineuronal autoantibodies from serum and CSF. The patients were followed up for 1–6 years.ResultsThe patients were nine male subjects aged 56–85 years (mean: 66) with a 1‐ to 14‐year (mean: 6,3 median: 6) history of seizures. The seizures were classified as focal onset seizures with impaired awareness, usually preceded by epigastric aura (two), piloerection (two), olfactory hallucinations (two), nausea and dizziness (one). Tonic–clonic seizures were present in five patients. Seizure frequency was high in six cases and sporadic in three. Most patients reported memory impairment (eight) or behavioral/mood changes (four). Interictal EEGs usually showed bilateral or unilateral temporal epileptiform abnormalities. A number of seizures arising from the temporal lobes, with bilateral asynchronous onset, were recorded on long‐term video‐EEG monitoring in two patients. MRI disclosed nonspecific white matter T2 hyperintensities suggestive of chronic vascular changes in four patients and bilateral T2‐FLAIR amygdalo‐hippocampal hyperintensity in three cases. Neuropsychological study demonstrated various degrees of cognitive impairment in the majority of cases. Increased titers of CASPR2 autoantibodies were detected in the serum and CSF, which persisted over time in four cases. Drug resistance to common anti‐seizure medications was present in seven cases who benefited from immunotherapy.SignificanceCASPR2‐IgG testing should be performed among old male patients with a recent or even not recent onset of focal seizures with impaired awareness particularly when these seizures are accompanied by cognitive impairment or behavioral disturbances. In these cases, anti‐seizure medications may be ineffective while immunotherapy may lead to a prompt improvement of seizures and cognitive deficits.
{"title":"CASPR2‐related epilepsy: A distinctive and unrecognized form of epilepsy in adult and elderly males","authors":"Roberto Michelucci, Elena Pasini, Patrizia Riguzzi, Maria Tappatà, Maria Pia Giannoccaro, Elisa Micalizzi, Anastasia Lechiara, Pietro Mattioli, Luana Benedetti, Flavio Villani","doi":"10.1002/epd2.20269","DOIUrl":"https://doi.org/10.1002/epd2.20269","url":null,"abstract":"ObjectiveThe aim of this study was to describe the clinical features of contactin‐associated protein‐like 2 (CASPR2)‐IgG‐associated seizures.MethodsNine patients were retrospectively collected from two epilepsy centers. For each patient we obtained a full clinical, neurophysiological, and MRI study along with detection of antineuronal autoantibodies from serum and CSF. The patients were followed up for 1–6 years.ResultsThe patients were nine male subjects aged 56–85 years (mean: 66) with a 1‐ to 14‐year (mean: 6,3 median: 6) history of seizures. The seizures were classified as focal onset seizures with impaired awareness, usually preceded by epigastric aura (two), piloerection (two), olfactory hallucinations (two), nausea and dizziness (one). Tonic–clonic seizures were present in five patients. Seizure frequency was high in six cases and sporadic in three. Most patients reported memory impairment (eight) or behavioral/mood changes (four). Interictal EEGs usually showed bilateral or unilateral temporal epileptiform abnormalities. A number of seizures arising from the temporal lobes, with bilateral asynchronous onset, were recorded on long‐term video‐EEG monitoring in two patients. MRI disclosed nonspecific white matter T2 hyperintensities suggestive of chronic vascular changes in four patients and bilateral T2‐FLAIR amygdalo‐hippocampal hyperintensity in three cases. Neuropsychological study demonstrated various degrees of cognitive impairment in the majority of cases. Increased titers of CASPR2 autoantibodies were detected in the serum and CSF, which persisted over time in four cases. Drug resistance to common anti‐seizure medications was present in seven cases who benefited from immunotherapy.SignificanceCASPR2‐IgG testing should be performed among old male patients with a recent or even not recent onset of focal seizures with impaired awareness particularly when these seizures are accompanied by cognitive impairment or behavioral disturbances. In these cases, anti‐seizure medications may be ineffective while immunotherapy may lead to a prompt improvement of seizures and cognitive deficits.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141944205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}