Journal of epilepsy research最新文献

Surgery has been and is now a well-established treatment indicated for adults and children with drug-resistant epilepsy (DRE). The surgical landscape for children with DRE appears to be expanding, and surgical cases of pediatric epilepsy have increased significantly in the past decade, contrary to adult epilepsy. Several fundamental changes have led to the widespread surgical treatment for DRE in children, based on a risk-benefit analysis of pediatric epilepsy surgery, and a change in our overall approach to evaluation. There are unique and age-related differences associated with pediatric epilepsy surgery, characterized by different types of etiologies, concerns for developmental progress, and safety issues. Indications for "pediatric epilepsy surgery" have been broadened to include a wide spectrum of etiologies without excluding children with "generalized" seizures, "generalized or multifocal eletroencephlography", or patients with contra-lateral epileptiform activity or magnetic resonance imaging abnormalities. Furthermore, epilepsy surgery is increasingly considered in infancy and early childhood, which has similar surgical outcomes as the case of late childhood, in an effort to improve the eventual development outcome. Seizure freedom, or at least seizure reduction, is an excellent result with resolution of the associated epileptic encephalopathy, normalization of the EEG, and decrease in the total epileptic burden in the pediatric field.

Background and purpose: The current tools available for localization of expressive language, including functional magnetic resonance imaging (fMRI) and cortical stimulation mapping (CSM), require that the patient remain stationary and follow language commands with precise timing. Many pediatric epilepsy patients, however, have intact language skills but are unable to participate in these tasks due to cognitive impairments or young age. In adult subjects, there is evidence that language laterality can be determined by resting state (RS) fMRI activity, however there are few studies on the use of RS to accurately predict language laterality in children.

Methods: A retrospective review of pediatric patients at Texas Children's Hospital was performed to identify patients who have undergone epilepsy surgical planning over 3 years with language localization using traditional methods of Wada testing, CSM, or task-based fMRI with calculated laterality index, as well as a 7-minute RS scan available without excessive motion or noise. We found the correlation between each subject's left and right Broca's region activity and each of 68 cortical regions.

Results: A group of nine patients with left-lateralized language were found to have greater voxel-wise correlations than a group of six patients with right-lateralized language between a left hemispheric Broca's region seed and the following six cortical regions: left inferior temporal, left lateral orbitofrontal, left pars triangularis, right lateral orbitofrontal, right pars orbitalis and right superior frontal regions.

Conclusions: In a cohort of children with epilepsy, we found that patients with left- and right-hemispheric language lateralization have different RS networks.

Background and purpose: This study aimed to assess medication-related quality of life in Thai patients with epilepsy. The second objective was to evaluate the associations between the medication therapy-related quality of life and patient characteristics.

Methods: This was a cross-sectional study. A convenience sample of 173 outpatients with epilepsy was recruited from a university hospital in Bangkok, Thailand. Inclusion criteria were aged 18 or over who were continuously taking an epileptic drug for at least 3 months, understanding Thai language, and willing to participate in the study. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to measure the medication therapy-related quality of life. Pearson's correlation coefficients and stepwise multiple linear regressions were employed to assess the relationships between eight PROMPT-QoL domain scores and patient demographic and clinical characteristics.

Results: Mean age was 36.4±9.5 years and approximately 57% were female. Among eight domains of the PROMPT-QoL, the therapeutic relationships with health care providers and psychological impacts of medication use domains yielded the highest (77.9) and lowest (61.9) mean scores, respectively. Seven out of eight PROMPT-QoL domain scores were considered as moderate-to-good. Age, gender, duration of epilepsy, seizure frequency, and treatment preference were significantly associated with PROMPT-QoL domain scores in multivariate linear regression analyses.

Conclusions: This study showed that Thai patients with epilepsy had moderate-to-good medication therapy-related quality of life. Healthcare providers should pay more attention to patients' psychological impacts of antiepileptic drugs and those with characteristics related to lower medication therapy-related quality of life.

Background and purpose: Epilepsy patients are more likely to experience depressive symptoms and cognitive impairment compared to individuals in the general population. As the reasons for this are not definitively known, we sought to determine what factors correlate most strongly with cognition and a screening test for depression in epilepsy patients.

Methods: Our study population included 379 adult patients diagnosed with epilepsy or seizure in our neurology clinic. We collected detailed demographic and clinical data during patient visits using structured clinical documentation support tools that we have built within our commercial electronic medical records system (Epic), including a depression score (Neurological Disorders Depression Inventory for Epilepsy, NDDIE) and cognition score test measures (specifically in this study, Mini-Mental State Examination [MMSE]). Medication, age, gender, body mass index, duration of epilepsy, seizure frequency, current number of anti-epileptic medications, years of education were assessed in relation to baseline score as well as change in score from initial visit to first annual follow-up.

Results: Of the analyzed factors, two statistically significant associations were found after correction for multiple testing. Male gender and lower anti-seizure medication count were associated with better mood, as assessed by NDDIE score, at initial visit. Specifically, male gender was associated with a 1.3 decrease in NDDIE and for each additional anti-seizure medication, there was an associated 1.2 increase in NDDIE.

Conclusions: However, these factors were not associated with change in NDDIE score from initial to first annual follow-up visit. These findings, although interesting, are preliminary. Additionally, these findings were based on a homogenous (mainly Caucasian) clinic-based population and detailed information on previous medication use was lacking. Further work is needed to replicate these findings and to understand any mechanisms that may explain these associations.

Background and purpose: Recent studies have recognised the memory deficit as one of the most common psychiatric issues in the patients with epilepsy, which severely affects the quality of life. Our previous studies have demonstrated the possible involvement of serotonergic system in the pathogenesis of epilepsy and associated memory deficit. The possible involvement of 5-HT_1A and 5-HT_2A/2C receptor has not been explored yet. Therefore, this study has been envisaged to explore the effect of 5-HT_1A and 5-HT_2A/2C receptor modulation on epilepsy and memory deficit in pentylenetetrazole-kindled mice.

Methods: In the present experimental approach, we examined the efficacy of modulation of 5-HT_1A and 5-HT_2A/2C receptor in pentylenetetrazole-induced kindling in male Swiss mice (n=75). Mice were kindled by sub-convulsive dose of pentylenetetrazole (35 mg/kg, intraperitoneal injection), at the interval of 48±2 hours). Successfully kindled animals were treated with 5-HT_1A and 5-HT_2A/2C receptor modulators. The effect of different treatments on seizure severity score and memory impairment was analysed.

Results: 5-HT_1A receptor agonist improved the memory functions while seizure severity was not improved, and the opposite effect was observed with 5-HT_1A receptor antagonist. On the other hand, 5-HT_2A/2C receptor agonist significantly improved memory deficit as well as seizure severity in the kindled animals.

Conclusions: The outcome of the study indicates the possible involvement of 5-HT_2A/2C receptor in the pathogenesis of epilepsy and associated memory deficit, which can be further explored for its management.

Background and purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indian children. This research was conducted to study the clinico-etiological profiles and short-term outcomes of children aged 1 month to 12 years with convulsive RSE, at a public hospital.

Methods: The study was conducted between 1st April 2016 and 28th February 2017 after receiving clearance from an Institutional Ethics Committee. All children (aged 1 month to 12 years) who presented to the pediatrics department of a tertiary-care public hospital with convulsive status epilepticus (SE), or who developed SE during their hospital stay, were enrolled. All patients were investigated and managed according to a standard protocol. Outcomes were assessed based on the Glasgow Outcome Scale. Details of children who progressed to RSE were compared to those without RSE.

Results: Fifty children (28 males) with CSE were enrolled, of which 20 (40%) progressed to RSE. Central nervous system (CNS) infection was the most common etiology (53% in SE and 55% in RSE, p > 0.05). Non-compliance with anti-epileptic drugs was the second most common etiology. The overall mortality rate was 38%, and although the odds of death in RSE (50%) were higher than in SE (30%), this difference was not statistically significant (p = 0.15). The odds of having a poor outcome was six times higher in children with RSE as compared to those with SE (odds ratio, 6.0; 95% confidence interval, 1.6-22.3; p = 0.005).

Conclusions: When managing CNS infections, pediatricians need to be aware of the high risk of developing RSE. In addition, the possibility of RSE should be considered and managed promptly in an intensive-care setting, to reduce the mortality and morbidity of this severe neurological condition.