Objective: In this study, characteristics of signal profiles formed by motion, oscillation, and sound signals were analyzed to evaluate generalizability and variability in a single patient setting (intra-patient variability) and between patients (inter-patient variability). As a secondary objective, the effect of brivaracetam intervention on signal profiles was explored.
Methods: Patient data included 13 hyperkinetic seizures, 65 tonic seizures, 13 tonic-clonic seizures, and 138 motor seizures from 11 patients. All patients underwent an 8-week monitoring, and after a 3-week baseline, brivaracetam was initiated. Motion, oscillation, and sound features extracted from the video were used to form signal profiles. Variance of signals was calculated, and combined median and quartile visualizations were used to visualize the results. Similarly, the effect of intervention was visualized.
Results: Hyperkinetic motion signals showed a rapid increase in motion and sound signals without oscillations and achieved low intra-patient variance. Tonic component created a recognizable peak in motion signal typical for tonic and tonic-clonic seizures. For tonic seizures, inter-patient variance was low. Motor signal profiles were varying, and they did not form a generalizable signal profile. Visually recognizable changes were observed in the signal profiles of two patients.
Significance: Video-based motion signal analysis enabled the extraction of motion features characteristic for different motor seizure types which might be useful in further development of this system. Tonic component formed a recognizable seizure signature in the motion signal. Hyperkinetic and motor seizures may have not only significantly different motion signal amplitude but also overlapping signal profile characteristics which might hamper their automatic differentiation. Motion signals might be useful in the assessment of movement intensity changes to evaluate the treatment effect. Further research is needed to test generalizability and to increase reliability of the results.
{"title":"Characteristics of motion signal profiles of tonic-clonic, tonic, hyperkinetic, and motor seizures extracted from nocturnal video recordings.","authors":"Petri Ojanen, Csaba Kertész, Jukka Peltola","doi":"10.1002/epd2.20284","DOIUrl":"https://doi.org/10.1002/epd2.20284","url":null,"abstract":"<p><strong>Objective: </strong>In this study, characteristics of signal profiles formed by motion, oscillation, and sound signals were analyzed to evaluate generalizability and variability in a single patient setting (intra-patient variability) and between patients (inter-patient variability). As a secondary objective, the effect of brivaracetam intervention on signal profiles was explored.</p><p><strong>Methods: </strong>Patient data included 13 hyperkinetic seizures, 65 tonic seizures, 13 tonic-clonic seizures, and 138 motor seizures from 11 patients. All patients underwent an 8-week monitoring, and after a 3-week baseline, brivaracetam was initiated. Motion, oscillation, and sound features extracted from the video were used to form signal profiles. Variance of signals was calculated, and combined median and quartile visualizations were used to visualize the results. Similarly, the effect of intervention was visualized.</p><p><strong>Results: </strong>Hyperkinetic motion signals showed a rapid increase in motion and sound signals without oscillations and achieved low intra-patient variance. Tonic component created a recognizable peak in motion signal typical for tonic and tonic-clonic seizures. For tonic seizures, inter-patient variance was low. Motor signal profiles were varying, and they did not form a generalizable signal profile. Visually recognizable changes were observed in the signal profiles of two patients.</p><p><strong>Significance: </strong>Video-based motion signal analysis enabled the extraction of motion features characteristic for different motor seizure types which might be useful in further development of this system. Tonic component formed a recognizable seizure signature in the motion signal. Hyperkinetic and motor seizures may have not only significantly different motion signal amplitude but also overlapping signal profile characteristics which might hamper their automatic differentiation. Motion signals might be useful in the assessment of movement intensity changes to evaluate the treatment effect. Further research is needed to test generalizability and to increase reliability of the results.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300029","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":"Methohexital‐induced seizure during Wada test: A case report and alternative evaluation with etomidate","authors":"Monika Thapa, Amber Goins, Pradeepthi Badugu, Jamie Toms, Amey Savardekar, Mostafa Hotait, Roohi Katyal","doi":"10.1002/epd2.20287","DOIUrl":"https://doi.org/10.1002/epd2.20287","url":null,"abstract":"","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":"86 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267751","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}
Vanita Shukla, Sylvia Cheng, Juliette Hukin, Linda Huh, Anita N. Datta
Successful treatment of acute lymphoblastic leukemia (ALL) requires multiagent chemotherapy regimens and central nervous system prophylaxis, including intrathecal methotrexate. Although acute symptomatic seizures can occur during ALL treatment, epilepsy is less common. Furthermore, drug resistant epilepsy (DRE) is rare, presenting with two phenotypes: focal epilepsy, such as temporal lobe, or epileptic encephalopathies (EE), such as Lennox–Gastaut syndrome (LGS). For ALL survivors, the development of DRE has significant impact on morbidity, mortality, and quality of life. We describe four patients with ALL remission, who developed EEs, of which 3 had LGS. Mean age at ALL diagnosis was 1.9 years; range 1.1–2.5 years. All, but one, had normal development prior to ALL. No patient had CNS leukemic involvement. All patients received CNS prophylaxis with intrathecal methotrexate, without cranial radiotherapy. Three had symptomatic methotrexate neurotoxicity during treatment. The mean age at first seizure was 5.6 years; range 3.9–7.5 years, with a mean latency of 3.7 years from ALL diagnosis. All patients developed drug resistant EEs, moderate intellectual disability, and neuropsychiatric co‐morbidities. Two patients had a minimal response to corpus callosotomy (CC), and one did not respond the ketogenic diet. Successful treatment of childhood ALL is rarely associated with the development of DRE and EEs. Young age at ALL diagnosis (<3 years) may be a predisposing factor. Palliative treatments, including ketogenic diet and CC have limited benefit in these patients. Individual genetic susceptibility to MTX toxicity is likely related to epileptogenesis, and further research is required for epilepsy biomarkers.
急性淋巴细胞白血病（ALL）的成功治疗需要多药化疗方案和中枢神经系统预防，包括鞘内甲氨蝶呤。虽然在急性淋巴细胞白血病治疗期间可能会出现急性症状性癫痫发作，但癫痫并不常见。此外，耐药性癫痫（DRE）也很罕见，表现为两种表型：局灶性癫痫（如颞叶）或癫痫性脑病（EE）（如伦诺克斯-加斯托综合征（LGS））。对于 ALL 幸存者来说，DRE 的发生对发病率、死亡率和生活质量有重大影响。我们描述了四名ALL缓解期患者发生的EE，其中三人患有LGS。确诊为 ALL 时的平均年龄为 1.9 岁；范围为 1.1-2.5 岁。除一名患者外，其他患者在确诊 ALL 之前均发育正常。没有患者累及中枢神经系统白血病。所有患者均接受了鞘内甲氨蝶呤中枢神经系统预防治疗，未接受头颅放疗。三名患者在治疗期间出现了甲氨蝶呤神经毒性症状。首次癫痫发作的平均年龄为5.6岁，范围为3.9-7.5岁，从确诊为ALL起平均潜伏期为3.7年。所有患者都出现了耐药性EEs、中度智力障碍和神经精神并发症。两名患者对胼胝体切开术（CC）反应轻微，一名患者对生酮饮食没有反应。儿童 ALL 的成功治疗很少与 DRE 和 EE 的发生有关。诊断为ALL的年龄较小（3岁）可能是一个诱发因素。包括生酮饮食和CC在内的姑息治疗对这些患者的益处有限。对MTX毒性的个体遗传易感性可能与癫痫发生有关，因此需要进一步研究癫痫生物标志物。
{"title":"Developmental and epileptic encephalopathies after successful treatment of pediatric ALL: A case series and review of literature","authors":"Vanita Shukla, Sylvia Cheng, Juliette Hukin, Linda Huh, Anita N. Datta","doi":"10.1002/epd2.20280","DOIUrl":"https://doi.org/10.1002/epd2.20280","url":null,"abstract":"Successful treatment of acute lymphoblastic leukemia (ALL) requires multiagent chemotherapy regimens and central nervous system prophylaxis, including intrathecal methotrexate. Although acute symptomatic seizures can occur during ALL treatment, epilepsy is less common. Furthermore, drug resistant epilepsy (DRE) is rare, presenting with two phenotypes: focal epilepsy, such as temporal lobe, or epileptic encephalopathies (EE), such as Lennox–Gastaut syndrome (LGS). For ALL survivors, the development of DRE has significant impact on morbidity, mortality, and quality of life. We describe four patients with ALL remission, who developed EEs, of which 3 had LGS. Mean age at ALL diagnosis was 1.9 years; range 1.1–2.5 years. All, but one, had normal development prior to ALL. No patient had CNS leukemic involvement. All patients received CNS prophylaxis with intrathecal methotrexate, without cranial radiotherapy. Three had symptomatic methotrexate neurotoxicity during treatment. The mean age at first seizure was 5.6 years; range 3.9–7.5 years, with a mean latency of 3.7 years from ALL diagnosis. All patients developed drug resistant EEs, moderate intellectual disability, and neuropsychiatric co‐morbidities. Two patients had a minimal response to corpus callosotomy (CC), and one did not respond the ketogenic diet. Successful treatment of childhood ALL is rarely associated with the development of DRE and EEs. Young age at ALL diagnosis (<3 years) may be a predisposing factor. Palliative treatments, including ketogenic diet and CC have limited benefit in these patients. Individual genetic susceptibility to MTX toxicity is likely related to epileptogenesis, and further research is required for epilepsy biomarkers.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":"6 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142188504","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}
Daniela Santos Oliveira, Helena Rocha, Duarte Vieira, Manuel Rito, Ricardo Rego
Postictal paresis (“Todd's paralysis”) is commonly observed as a unilateral, transient motor weakness, lasting minutes to hours, after focal or focal to bilateral tonic–clonic seizures, contralateral to the epileptogenic zone. Bilateral postictal paresis is exceedingly rare and could be misinterpreted, especially if the preceding convulsive phase was not witnessed. An 18‐year‐old right‐handed male patient with refractory focal epilepsy with seizure onset at age 3 years, was admitted for presurgical video‐EEG monitoring. His seizures were predominantly nocturnal, consisting of a laryngeal somatosensory aura, occasionally evolving to bilateral tonic or tonic–clonic seizures with occasional asymmetrical limb extension during the tonic phase (right arm extension). Postictally, consciousness recovery was fast, if ever lost. At that stage, we documented severe dysarthria and bilateral symmetrical arm paresis lasting several minutes. The ictal pattern and interictal epileptiform activity were projected on the fronto‐central midline. Brain MRI was highly suggestive of a bottom‐of‐sulcus dysplasia with underlying transmantle sign on the left premotor, fronto‐opercular region and an FDG‐PET‐CT showed a concordant left fronto‐operculo‐insular hypometabolism. A complete lesionectomy was performed, with the additional guidance of intraoperative electrocorticography, resulting in sustained seizure freedom. Anatomo‐pathology confirmed a type 2b focal cortical dysplasia. We speculate that, in our patient, a left fronto‐opercular ictal onset with an early spread to both primary motor cortices and relative sparing of consciousness networks allowed the emergence of a clinically detectable postictal bilateral paresis.
{"title":"Bilateral Todd's paralysis in a patient with left fronto‐opercular epilepsy","authors":"Daniela Santos Oliveira, Helena Rocha, Duarte Vieira, Manuel Rito, Ricardo Rego","doi":"10.1002/epd2.20278","DOIUrl":"https://doi.org/10.1002/epd2.20278","url":null,"abstract":"Postictal paresis (“Todd's paralysis”) is commonly observed as a unilateral, transient motor weakness, lasting minutes to hours, after focal or focal to bilateral tonic–clonic seizures, contralateral to the epileptogenic zone. Bilateral postictal paresis is exceedingly rare and could be misinterpreted, especially if the preceding convulsive phase was not witnessed. An 18‐year‐old right‐handed male patient with refractory focal epilepsy with seizure onset at age 3 years, was admitted for presurgical video‐EEG monitoring. His seizures were predominantly nocturnal, consisting of a laryngeal somatosensory aura, occasionally evolving to bilateral tonic or tonic–clonic seizures with occasional asymmetrical limb extension during the tonic phase (right arm extension). Postictally, consciousness recovery was fast, if ever lost. At that stage, we documented severe dysarthria and bilateral symmetrical arm paresis lasting several minutes. The ictal pattern and interictal epileptiform activity were projected on the fronto‐central midline. Brain MRI was highly suggestive of a bottom‐of‐sulcus dysplasia with underlying transmantle sign on the left premotor, fronto‐opercular region and an FDG‐PET‐CT showed a concordant left fronto‐operculo‐insular hypometabolism. A complete lesionectomy was performed, with the additional guidance of intraoperative electrocorticography, resulting in sustained seizure freedom. Anatomo‐pathology confirmed a type 2b focal cortical dysplasia. We speculate that, in our patient, a left fronto‐opercular ictal onset with an early spread to both primary motor cortices and relative sparing of consciousness networks allowed the emergence of a clinically detectable postictal bilateral paresis.","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":"8 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142188505","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}
Ann Mertens, Maria T Papadopoulou, Matthildi Athina Papathanasiou Terzi, Gaëtan Lesca, Mateusz Biela, Robert Smigiel, Eleni Panagiotakaki
We report on an 11 year old Polish girl who experienced paroxysmal episodes with decreased consciousness, (hemi)plegia, movement disorders, slurred speech, dysphagia, and abnormal eye movements. An extensive etiological work-up (brain MRI, EEG, EMG, NCS, toxic, metabolic, infectious, and auto-immune screening) was not conclusive. A genetic analysis with whole-exome sequencing demonstrated a de novo heterozygous mutation in the ATP1A3 gene (c.2232C>G, p.Asn744Lys). A 48 h video-EEG monitoring that was conducted in our unit later confirmed the absence of ictal discharge during an episode of hemidystonia, demonstrating its non-epileptic etiology. However, several discharges of generalized spike waves, which were facilitated by intermittent photic stimulation and eyelid closure were recorded, of which a few were associated with eyelid myoclonia. Taken together, these findings are characteristic of epilepsy with eyelid myoclonia. The clinical picture of this patient partially fulfills the diagnostic criteria of relapsing encephalopathy with cerebellar ataxia as well as alternating hemiplegia of childhood. It is increasingly recognized that the distinct syndromes described with ATP1A3 mutations are overlapping and could be identified in the same patients. Certain variations in ATP1A3 have been linked to an increased risk of developing generalized epilepsy syndromes. We hereby present the second case in the literature of a patient with epilepsy with eyelid myoclonia with an ATP1A3-related neurological disorder.
{"title":"Epilepsy with eyelid myoclonia in a patient with ATP1A3-related neurologic disorder.","authors":"Ann Mertens, Maria T Papadopoulou, Matthildi Athina Papathanasiou Terzi, Gaëtan Lesca, Mateusz Biela, Robert Smigiel, Eleni Panagiotakaki","doi":"10.1002/epd2.20272","DOIUrl":"https://doi.org/10.1002/epd2.20272","url":null,"abstract":"<p><p>We report on an 11 year old Polish girl who experienced paroxysmal episodes with decreased consciousness, (hemi)plegia, movement disorders, slurred speech, dysphagia, and abnormal eye movements. An extensive etiological work-up (brain MRI, EEG, EMG, NCS, toxic, metabolic, infectious, and auto-immune screening) was not conclusive. A genetic analysis with whole-exome sequencing demonstrated a de novo heterozygous mutation in the ATP1A3 gene (c.2232C>G, p.Asn744Lys). A 48 h video-EEG monitoring that was conducted in our unit later confirmed the absence of ictal discharge during an episode of hemidystonia, demonstrating its non-epileptic etiology. However, several discharges of generalized spike waves, which were facilitated by intermittent photic stimulation and eyelid closure were recorded, of which a few were associated with eyelid myoclonia. Taken together, these findings are characteristic of epilepsy with eyelid myoclonia. The clinical picture of this patient partially fulfills the diagnostic criteria of relapsing encephalopathy with cerebellar ataxia as well as alternating hemiplegia of childhood. It is increasingly recognized that the distinct syndromes described with ATP1A3 mutations are overlapping and could be identified in the same patients. Certain variations in ATP1A3 have been linked to an increased risk of developing generalized epilepsy syndromes. We hereby present the second case in the literature of a patient with epilepsy with eyelid myoclonia with an ATP1A3-related neurological disorder.</p>","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141605","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":"Efficacy of creatine supplementation in a patient with epilepsy with SLC6A8 gene mutations.","authors":"Yiqi Zhang, Xianyun Liu, Xi Peng","doi":"10.1002/epd2.20277","DOIUrl":"https://doi.org/10.1002/epd2.20277","url":null,"abstract":"","PeriodicalId":50508,"journal":{"name":"Epileptic Disorders","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141604","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}
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":" ","pages":""},"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":" ","pages":""},"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":" ","pages":""},"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}
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