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Juvenile Myoclonic Epilepsy: Myoclonic Status Epilepticus without Coma - Report of Three Cases. 青少年肌阵挛性癫痫:无昏迷的肌阵挛性癫痫持续状态3例报告。
Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI: 10.14581/jer.20015
Jagarlapudi M K Murthy

Status epilepticus (SE) is rare in juvenile myoclonic epilepsy (JME). This report presents three patients with myoclonic status epilepticus (MSE). MSE is defined as prolonged period of myoclonic jerks that are correlated with epileptiform discharges on electroencephalogram. The precipitating factors among the three patients were: introduction of carbamazepine in case1, missing the dose in case2, and introduction of oxcarbazepine in case3. Of the three patients, one patient was a misdiagnosed case of JME. In him the diagnosis of JME was established after 35 years when he developed MSE with the addition of oxcarbazepine to the antiseizure medication (ASM) which he was taking. Detailed review of the history revealed that he used to get occasional myoclonic jerks with deprived sleep and stress. This patient illustrates that the diagnosis of JME can be missed or delayed if history of myoclonic jerks is not elicited, particularly in patents with pubertal onset epilepsy. The other lesson is that possibility of JME should be considered in patients with drug resistant epilepsy (pseudo-drug resistance).

癫痫持续状态(SE)在青少年肌阵挛性癫痫(JME)中很少见。本文报告了3例肌阵挛性癫痫持续状态(MSE)。MSE被定义为长时间的肌阵挛性抽搐,与脑电图上的癫痫样放电有关。3例患者的诱发因素为:cas1引入卡马西平,cas2漏给剂量,cas3引入奥卡西平。在这3例患者中,有1例患者被误诊为JME。35年后,当他在服用抗癫痫药物(ASM)的同时加入奥卡西平,出现MSE时,他被诊断为JME。对病史的详细回顾显示,他曾因睡眠不足和压力过大而偶尔出现肌阵挛性抽搐。这个病人说明,如果没有肌阵挛性抽搐的病史,特别是在青春期发作的癫痫患者中,JME的诊断可能会被遗漏或延迟。另一个教训是,在耐药癫痫(伪耐药)患者中应考虑JME的可能性。
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引用次数: 0
Diagnosis and Treatment of Status Epilepticus. 癫痫持续状态的诊断与治疗。
Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI: 10.14581/jer.20008
Sang Kun Lee

The definition of status epilepticus (SE) was revised recently in accordance with the various evidences of neuronal injury and changes in clinical settings. Currently, the most acceptable duration of continuous seizure activity is 5 minutes. In 2015, the International League Against Epilepsy Task Force, which was convened to develop a definition and classification of SE, presented a new classification based on four axes: 1) semiology, 2) etiology, 3) electroencephalogram (EEG) correlates, and 4) age. The essential element of nonconvulsive SE (NCSE) is the presence of neurological abnormalities induced by a prolonged epileptic process. The definition of refractory SE involves either clinical or electrographic seizures that persist after adequate doses of an initial benzodiazepine and acceptable second-line antiseizure drugs. The use of EEG is critical in the diagnosis and treatment of NCSE. However, there are a wide range of EEG abnormalities in NCSE. Both the Neurocritical Care Society and the American Epilepsy Society have suggested a paradigm for treating convulsive SE (CSE). The first-line treatment of CSE with benzodiazepine is well-established. The second-line treatment comprises intravenous (IV) doses of fosphenytoin (phenytoin), valproate, phenobarbital, levetiracetam, or midazolam. Although fosphenytoin (phenytoin) and valproate are commonly used in NCSE, the effectiveness of antiepileptic drugs (AEDs) on NCSE has not been well studied. New AEDs such as IV levetiracetam and lacosamide can also be used to treat NCSE with fewer side effects and drug-drug interactions. For refractory SE, general anesthesia with IV midazolam, propofol, pentobarbital, or thiopental could be applied. Use of ketamine, megadose phenobarbital therapy, and multiple combinations of various AEDs including high doses of oral AEDs can also be considered. New-onset refractory status epilepticus (NORSE) and its subcategory, febrile infection-related epilepsy syndrome, involve autoimmune processes. AEDs alone are poorly effective in the treatment of SE in autoimmune encephalitis. Immunotherapy such as steroids, immunoglobulin, rituximab, or tocilizumab can be effective.

根据神经损伤的各种证据和临床环境的变化,最近对癫痫持续状态(SE)的定义进行了修订。目前,最可接受的持续癫痫发作时间为5分钟。2015年,为制定SE的定义和分类而召集的国际抗癫痫联盟工作组提出了一种基于四个轴的新分类:1)符号学,2)病因学,3)脑电图(EEG)相关物,4)年龄。非惊厥性SE (NCSE)的基本要素是存在由长时间癫痫过程引起的神经异常。难治性SE的定义包括在初始给予足够剂量的苯二氮卓类药物和可接受的二线抗癫痫药物后仍持续发作的临床或电性癫痫发作。脑电图在NCSE的诊断和治疗中至关重要。然而,在NCSE中存在广泛的脑电图异常。神经危重症护理协会和美国癫痫协会都提出了一种治疗惊厥性SE (CSE)的范例。苯二氮卓类药物是CSE的一线治疗方法。二线治疗包括静脉注射(IV)剂量的苯妥英(苯妥英)、丙戊酸、苯巴比妥、左乙拉西坦或咪达唑仑。虽然苯妥英(phenytoin)和丙戊酸盐常用于NCSE,但抗癫痫药物(AEDs)对NCSE的有效性尚未得到很好的研究。新的抗癫痫药,如静脉注射左乙拉西坦和拉科沙胺也可用于治疗NCSE,副作用和药物相互作用较少。对于难治性SE,可采用静脉咪达唑仑、异丙酚、戊巴比妥或硫喷妥等全麻。也可以考虑使用氯胺酮、大剂量苯巴比妥治疗,以及多种抗癫痫药的多种组合,包括高剂量口服抗癫痫药。新发难治性癫痫持续状态(NORSE)及其亚类发热性感染相关癫痫综合征涉及自身免疫过程。单独使用aed治疗自身免疫性脑炎SE效果不佳。免疫治疗如类固醇、免疫球蛋白、利妥昔单抗或托珠单抗是有效的。
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引用次数: 11
Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus. 苯妥英、丙戊酸和左乙拉西坦治疗儿童癫痫持续状态的疗效比较。
Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI: 10.14581/jer.20011
Mudasir Nazir, Rayees Ahmad Tarray, Ravouf Asimi, Wajid Ali Syed

Background and purpose: Status epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduced for management of SE are valproic acid and levetiracetam.

Methods: This prospective randomized study included 150 pediatric patients admitted as SE. Patients were randomized into three equal groups (50 each) to receive one of the three anticonvulsants in addition to standard treatment. Patients were monitored in hospital regarding their vitals, time to regain consciousness, and seizure recurrence.

Results: At 24 hours seizures were controlled in 44 patients (88%) in phenytoin group, 39 patients (78%) in levetiracetam (LEV) group and 46 patients (92%) in valproate (VAL) group (p=0.115). The mean time to regain consciousness in phenytoin, LEV and VAL groups was 122.3±45.4, 120.8±42.8, and 75.0±30.7 minutes (mean±standard deviation) respectively. Patients in VAL group regained consciousness earlier than both phenytoin and LEV group patients (p<0.0001). At 3 months follow-up, seven (14.28%) out of 49 patients in phenytoin group, 14 (28.57%) out of 49 in LEV group and two (4%) out of 50 patients in VAL group had a seizure recurrence (p=0.0032).

Conclusions: In our study we found that both IV LEV and IV VAL safe and efficacious. The primary outcome, seizure recurrence at 24 hours, did not show a statistically significant difference in three groups (p>0.05). Also, seizure recurrence at 1 week did not reach a statistically significant difference. However, time to regain consciousness and seizure recurrence at 3 months was significantly less in VAL group (p<0.05).

背景和目的:癫痫持续状态(SE)是一种常见的儿童神经系统急症,需要立即和积极的治疗。目前,苯妥英是继苯二氮卓类药物后用于进一步预防癫痫发作的最常用药物。最近引入的其他治疗SE的药物有丙戊酸和左乙拉西坦。方法:本前瞻性随机研究纳入150例SE患儿。患者被随机分为三组(每组50人),在标准治疗的基础上接受三种抗惊厥药物中的一种。在医院监测患者的生命体征、恢复意识时间和癫痫复发情况。结果:苯妥英组24 h癫痫发作得到控制44例(88%),左乙莱西坦(LEV)组39例(78%),丙戊酸钠(VAL)组46例(92%)(p=0.115)。苯妥英、LEV、VAL组患者恢复意识的平均时间分别为122.3±45.4、120.8±42.8、75.0±30.7 min(平均±标准差)。VAL组患者意识恢复较苯妥英和LEV组患者早(pp=0.0032)。结论:在我们的研究中,我们发现静脉LEV和静脉VAL都是安全有效的。主要转归24小时癫痫复发率三组比较差异无统计学意义(p>0.05)。1周癫痫复发率差异无统计学意义。然而,VAL组3个月恢复意识的时间和癫痫复发明显少于VAL组(p
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引用次数: 3
Molecular Immunohistochemical Profile of Angiocentric Glioma. 血管中心性胶质瘤的分子免疫组织化学特征。
Pub Date : 2020-12-31 eCollection Date: 2020-12-01 DOI: 10.14581/jer.20013
Lanisha D Fuller, Richard A Prayson

Background and purpose: Angiocentric glioma is a rare, World Health Organization grade I tumor that is seen predominantly in children and young adults and typically presents with seizures. Histologically, it shows features of both infiltrating glioma and ependymoma.

Methods: We examined molecular immunohistochemical markers which could help in distinguishing this entity from its differential diagnostic considerations.

Results: We retrospectively reviewed the clinicopathologic features of angiocentric gliomas and performed immunohistochemical staining for isocitrate dehydrogenase 1 (IDH-1) (R132H), p53, ATRX, BRAF V600E, Ki-67, and H3 K27M on formalin-fixed, paraffin-embedded tissue. Seven cases in total were found and included six excisional specimens and one biopsy. ATRX staining was retained in all cases. There was no evidence of staining with antibodies to IDH-1 (R132H), H3 K27M, or BRAF V600E. Five tumors showed no staining with antibody to p53 and two tumors showed less than 5% positivity. Ki-67 indices were less than 1% in five tumors, 4-5% in one tumor, and 9-10% in one tumor.

Conclusions: In conclusion, the immunohistochemical markers for ATRX, p53, IDH-1 (R132H), BRAF V600E, H3 K27M show wild-type staining, potentially aiding in avoiding misdiagnoses in cases morphologically similar to other low-grade gliomas. Ki-67 labeling indices are low in most tumors.

背景和目的:血管中心性胶质瘤是一种罕见的世界卫生组织一级肿瘤,主要见于儿童和年轻人,通常表现为癫痫发作。组织学上表现为浸润性胶质瘤和室管膜瘤。方法:我们检查了分子免疫组织化学标记,可以帮助区分这种实体,从其鉴别诊断考虑。结果:我们回顾性回顾了血管中心性胶质瘤的临床病理特征,并对福尔马林固定石蜡包埋组织进行了异柠檬酸脱氢酶1 (IDH-1) (R132H)、p53、ATRX、BRAF V600E、Ki-67和H3 K27M的免疫组化染色。共发现7例,包括6例切除标本和1例活检。所有病例均保留ATRX染色。没有证据表明有IDH-1 (R132H)、H3 K27M或BRAF V600E抗体染色。5例肿瘤未见p53抗体染色,2例阳性低于5%。Ki-67指标5例小于1%,1例小于4-5%,1例小于9-10%。结论:ATRX、p53、IDH-1 (R132H)、BRAF V600E、H3 K27M的免疫组化标记物呈野生型染色,可能有助于避免形态学与其他低级别胶质瘤相似的病例的误诊。Ki-67标记指数在大多数肿瘤中较低。
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引用次数: 2
Epilepsy Research in Mali: A Pilot Pharmacokinetics Study on First-Line Antiepileptic Drug Treatment. 马里癫痫研究:一线抗癫痫药物治疗的药代动力学试验研究。
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20006
Modibo Sangare, Fatoumata Doumbia, Oumar Sidibe, Aboucacar Alassane Oumar, Sekou Bah, Modibo Kouyate, Seidina S Diakite, Karim Traore, Adama Karembe, Mohamed S Haidara, Souleymane P Coulibaly, Souleymane Coulibaly, Arouna Togora, Housseini Dolo, Drissa Traore, Seydou Doumbia, Mahamadou Diakite, Youssoufa Maiga, Amadou Diawara, Callixte Kuate, Hyung-Goo Kim, Gordon A Awandare

Background and purpose: The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali.

Methods: We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring.

Results: At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p<0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications.

Conclusions: Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.

背景与目的:在癫痫患者监测中,血浆抗癫痫药(aed)水平的适应症和益处一直存在争议,发达国家的癫痫治疗差距很大。这项研究的目的是强调马里农村和城市之间的癫痫治疗差距。方法:我们于2016年9月至2019年5月进行了aed治疗的中试研究。在6个月内,120名患有癫痫的儿童和青年成人(农村地区,90名;市区30例患者接受苯巴比妥、丙戊酸和/或卡马西平治疗。在我们的农村研究地点,我们测定了AED血浆水平,监测癫痫发作的频率、严重程度和持续时间,并每月进行麦吉尔生活质量问卷调查。在我们的城市研究地点,每位患者在没有密切监测的情况下进行了脑电图和脑部计算机断层扫描。结果:在农村研究点,患者多采用单药治疗;纳入后1个月(M1) (n=90)和3个月(M3) (n=27) AED水平正常,M1组为50%,M3组为55.6%,M1组为42.2%,M3组为33.3%,M1组为7.8%,M3组为11.1%。M1和M3的AED水平有显著差异。结论:癫痫的诊断和治疗是马里真正关注的问题。我们的数据显示,适当的AED治疗和密切的随访导致马里农村患者的生活质量更好。我们将在马里的AED治疗中推广个性化医疗方法。
{"title":"Epilepsy Research in Mali: A Pilot Pharmacokinetics Study on First-Line Antiepileptic Drug Treatment.","authors":"Modibo Sangare,&nbsp;Fatoumata Doumbia,&nbsp;Oumar Sidibe,&nbsp;Aboucacar Alassane Oumar,&nbsp;Sekou Bah,&nbsp;Modibo Kouyate,&nbsp;Seidina S Diakite,&nbsp;Karim Traore,&nbsp;Adama Karembe,&nbsp;Mohamed S Haidara,&nbsp;Souleymane P Coulibaly,&nbsp;Souleymane Coulibaly,&nbsp;Arouna Togora,&nbsp;Housseini Dolo,&nbsp;Drissa Traore,&nbsp;Seydou Doumbia,&nbsp;Mahamadou Diakite,&nbsp;Youssoufa Maiga,&nbsp;Amadou Diawara,&nbsp;Callixte Kuate,&nbsp;Hyung-Goo Kim,&nbsp;Gordon A Awandare","doi":"10.14581/jer.20006","DOIUrl":"https://doi.org/10.14581/jer.20006","url":null,"abstract":"<p><strong>Background and purpose: </strong>The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali.</p><p><strong>Methods: </strong>We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring.</p><p><strong>Results: </strong>At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different <i>p</i><0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications.</p><p><strong>Conclusions: </strong>Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"10 1","pages":"31-39"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/c1/jer-20006.PMC7494886.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38425665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial Intelligence and Computational Approaches for Epilepsy. 癫痫的人工智能和计算方法。
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20003
Sora An, Chaewon Kang, Hyang Woon Lee

Studies on treatment of epilepsy have been actively conducted in multiple avenues, but there are limitations in improving its efficacy due to between-subject variability in which treatment outcomes vary from patient to patient. Accordingly, there is a growing interest in precision medicine that provides accurate diagnosis for seizure types and optimal treatment for an individual epilepsy patient. Among these approaches, computational studies making this feasible are rapidly progressing in particular and have been widely applied in epilepsy. These computational studies are being conducted in two main streams: 1) artificial intelligence-based studies implementing computational machines with specific functions, such as automatic diagnosis and prognosis prediction for an individual patient, using machine learning techniques based on large amounts of data obtained from multiple patients and 2) patient-specific modeling-based studies implementing biophysical in-silico platforms to understand pathological mechanisms and derive the optimal treatment for each patient by reproducing the brain network dynamics of the particular patient per se based on individual patient's data. These computational approaches are important as it can integrate multiple types of data acquired from patients and analysis results into a single platform. If these kinds of methods are efficiently operated, it would suggest a novel paradigm for precision medicine.

治疗癫痫的研究已经从多种途径积极开展,但由于受试者之间的差异,治疗结果因患者而异,在提高疗效方面存在局限性。因此,人们对精确医学越来越感兴趣,这种医学可以为癫痫患者提供准确的癫痫类型诊断和最佳治疗。在这些方法中,使其可行的计算研究正在迅速发展,并已广泛应用于癫痫。这些计算研究主要分为两大类:1)基于人工智能的研究,实现具有特定功能的计算机器,如对个体患者的自动诊断和预后预测;使用基于从多个患者获得的大量数据的机器学习技术和2)基于患者特定建模的研究,实现生物物理芯片平台,以了解病理机制,并通过基于个体患者数据复制特定患者本身的大脑网络动态,为每位患者获得最佳治疗。这些计算方法很重要,因为它可以将从患者获得的多种类型的数据和分析结果集成到单个平台中。如果这些方法有效地运作,它将为精准医疗提供一个新的范例。
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引用次数: 25
A Novel Intronic Variant in SLC2A1 Gene in a Saudi Patient with Myoclonic Epilepsy. 沙特一名肌阵挛性癫痫患者SLC2A1基因的新内含子变异
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20007
Hussein Algahtani, Bader Shirah, Ahmad Albarakaty, Mohammad H Al-Qahtani, Angham Abdulrahman Abdulkareem, Muhammad Imran Naseer

Cerebral metabolism is primarily dependent on glucose for which a facilitated diffusion by glucose transporter protein 1 (GLUT1) across the blood-brain barrier is crucial. This GLUT1 is encoded by the SLC2A1 gene. Mutations in SLC2A1 will lead to a variety of symptoms known as GLUT1 deficiency syndrome. In this article, we report a novel heterozygous intronic variant c.1278+12delC in the SLC2A1 gene in a Saudi patient with myoclonic epilepsy. We also report a new clinical phenotype where the patient has pure myoclonic epilepsy with no focal, absence, or atonic seizures and normal developmental and cognitive functions that started in childhood rather than infancy. Our study enriches the mutation-spectrum of the SLC2A1 gene and stresses on the importance of whole-exome sequencing in the diagnosis of genetic epilepsies. Early diagnosis and initiation of a ketogenic diet are important goals for the successful management of patients with GLUT1 deficiency syndrome.

脑代谢主要依赖于葡萄糖,葡萄糖转运蛋白1 (GLUT1)通过血脑屏障的扩散是至关重要的。这种GLUT1由SLC2A1基因编码。SLC2A1的突变会导致被称为GLUT1缺乏症的各种症状。在这篇文章中,我们报道了一种新的杂合的SLC2A1基因突变c.1278+12delC在沙特患有肌阵挛性癫痫的患者。我们还报告了一种新的临床表型,患者有纯粹的肌阵挛性癫痫,没有局灶性、缺失性或无张力性癫痫发作,正常的发育和认知功能开始于儿童期而不是婴儿期。我们的研究丰富了SLC2A1基因的突变谱,强调了全外显子组测序在遗传性癫痫诊断中的重要性。早期诊断和开始生酮饮食是成功管理GLUT1缺乏症患者的重要目标。
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引用次数: 1
The Dilemma of Choroidal Fissure Cyst and Seizure. 脉络膜裂囊肿与癫痫的困境。
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20001
Tariq Al-Saadi
which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Journal of Epilepsy Research pISSN 2233-6249 / eISSN 2233-6257 The Dilemma of Choroidal Fissure Cyst and Seizure Tariq Al-Saadi, MD Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal, Canada; Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman
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引用次数: 1
Epilepsy in Children with Tuberous Sclerosis Complex: A Prospective Observational Study in Bangladesh. 患有结节性硬化症的儿童癫痫:孟加拉国的一项前瞻性观察研究。
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20004
Md Mizanur Rahman, Kanij Fatema

Background and purpose: Epilepsy is an important neurologic feature of patients with tuberous sclerosis complex (TSC). Most common seizure types are focal seizure and epileptic spasm. Seizure control often requires multiple antiepileptic drugs. This study has been done to evaluate the seizure types, electro-encephalography (EEG), neuroimaging features, and drug treatment of epilepsy in TSC.

Methods: This prospective observational study has been conducted on epilepsy patients with TSC at Bangabandhu Sheikh Mujib Medical University from 2011 to 2019.

Results: Seventy patients with a mean±standard deviation age of 5.64±3.96 years were identified and 57.1% were female. Most common type of seizure was focal seizure (46%). Epileptic spasm occurred in 17% of patients and all of them had seizure onset before 1 year. In 47% of patients EEG showed focal epileptic discharge; hypsarrhythmia was found in most of the patients with epileptic spasm. Majority of the patients needed more than one drug to control seizure. Only 34% of patients were seizure free for at least 12 months and 22.8% had drug resistant epilepsy.

Conclusions: This study highlights the pattern of seizure, treatment pattern, response to drug, and short-time outcome of children with TSC with epilepsy in a developing country like Bangladesh.

背景与目的:癫痫是结节性硬化症(TSC)患者的重要神经系统特征。最常见的发作类型是局灶性发作和癫痫性痉挛。控制癫痫发作通常需要多种抗癫痫药物。本研究对TSC患者癫痫发作类型、脑电图、神经影像学特征及药物治疗进行了评价。方法:对2011 - 2019年Bangabandhu Sheikh Mujib医科大学癫痫合并TSC患者进行前瞻性观察研究。结果:共发现70例患者,平均±标准差年龄5.64±3.96岁,其中女性占57.1%。最常见的癫痫类型是局灶性癫痫发作(46%)。17%的患者发生癫痫性痉挛,均在1年前发作。47%的患者脑电图显示局灶性癫痫放电;多数癫痫性痉挛患者伴有低心律失常。大多数患者需要一种以上的药物来控制癫痫发作。只有34%的患者至少12个月没有癫痫发作,22.8%的患者患有耐药癫痫。结论:本研究突出了孟加拉国等发展中国家TSC癫痫患儿的癫痫发作模式、治疗模式、药物反应和短期结局。
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引用次数: 3
Burden and Its Predictors among Caregivers of Patient with Epilepsy. 癫痫患者护理人员负担及其预测因素。
Pub Date : 2020-06-30 eCollection Date: 2020-06-01 DOI: 10.14581/jer.20005
Rita Pokharel, Prakash Poudel, Sami Lama, Kriti Thapa, Rambha Sigdel, Erina Shrestha

Background and purpose: Epilepsy is a chronic unpredictable debilitating condition. Epilepsy has great impacts not only on patients with epilepsies but also the persons around them. Burden among caregivers is understudied area. In view of the dearth of literature or studies focused on caregivers of children with epilepsy in Nepalese context, this study is expected to assess burden and its predictors among caregivers of children with epilepsy.

Methods: A total of 106 caregivers were interviewed using purposive sampling technique. The Zarit Burden Interview Scale short version was used to assess burden and Hospital Anxiety Depression Scale was used to assess anxiety and depression. Data were analysed using SPSS ver. 16.0. Chi-square test, multinomial logistic regression and linear regression analysis were done for analysis of inferential statistics to find out the predictors of burden.

Results: Majority of the caregivers (71.7%) were females and 64.2% of caregivers were mothers of children. Majority of responders (77.4%) were Hindus. Mild to moderate burden was found in 27.4% and high burden was found in 14.2% of the caregivers. Borderline anxiety, borderline depression, anxiety and depression were present in 7.5%, 8.5%, 6.6%, and 6.6% caregivers respectively. Burden was significantly higher in caregivers of epileptic children with poorly controlled seizure (p=0.003) and with co-morbidities (p=0.009). Similarly, burden score had significant positive correlation (p=0.001) with depression and significant negative correlation (p=0.005) with age of onset of epilepsy in children.

Conclusions: Burden, anxiety and depression are common problems in caregivers of children with epilepsy. Poorly controlled seizure, presence of associated comorbidities, younger age of onset of seizure in children and presence of depression in caregivers are the important factors that predict burden among caregivers of children with epilepsy.

背景和目的:癫痫是一种慢性、不可预测的衰弱性疾病。癫痫不仅对癫痫患者,而且对患者周围的人都有很大的影响。照顾者的负担是研究不足的领域。鉴于缺乏文献或研究聚焦于尼泊尔癫痫儿童照料者,本研究预计将评估癫痫儿童照料者的负担及其预测因素。方法:采用目的抽样法对106名护理人员进行访谈。负担评估采用Zarit负担访谈量表,焦虑抑郁评估采用医院焦虑抑郁量表。数据采用SPSS分析软件进行分析。16.0. 通过卡方检验、多项逻辑回归和线性回归分析进行推理统计分析,找出负担的预测因素。结果:照顾者以女性居多(71.7%),以儿童母亲居多(64.2%)。大多数应答者(77.4%)是印度教徒。轻度至中度负担占27.4%,重度负担占14.2%。7.5%、8.5%、6.6%和6.6%的照顾者存在边缘性焦虑、边缘性抑郁、焦虑和抑郁。癫痫发作控制不佳(p=0.003)和有合并症(p=0.009)的癫痫儿童的照料者负担明显更高。同样,负担评分与儿童抑郁呈显著正相关(p=0.001),与儿童癫痫发病年龄呈显著负相关(p=0.005)。结论:负担、焦虑和抑郁是癫痫患儿照料者普遍存在的问题。癫痫发作控制不佳、存在相关合并症、儿童癫痫发作年龄更小以及照顾者是否存在抑郁症是预测癫痫患儿照顾者负担的重要因素。
{"title":"Burden and Its Predictors among Caregivers of Patient with Epilepsy.","authors":"Rita Pokharel,&nbsp;Prakash Poudel,&nbsp;Sami Lama,&nbsp;Kriti Thapa,&nbsp;Rambha Sigdel,&nbsp;Erina Shrestha","doi":"10.14581/jer.20005","DOIUrl":"https://doi.org/10.14581/jer.20005","url":null,"abstract":"<p><strong>Background and purpose: </strong>Epilepsy is a chronic unpredictable debilitating condition. Epilepsy has great impacts not only on patients with epilepsies but also the persons around them. Burden among caregivers is understudied area. In view of the dearth of literature or studies focused on caregivers of children with epilepsy in Nepalese context, this study is expected to assess burden and its predictors among caregivers of children with epilepsy.</p><p><strong>Methods: </strong>A total of 106 caregivers were interviewed using purposive sampling technique. The Zarit Burden Interview Scale short version was used to assess burden and Hospital Anxiety Depression Scale was used to assess anxiety and depression. Data were analysed using SPSS ver. 16.0. Chi-square test, multinomial logistic regression and linear regression analysis were done for analysis of inferential statistics to find out the predictors of burden.</p><p><strong>Results: </strong>Majority of the caregivers (71.7%) were females and 64.2% of caregivers were mothers of children. Majority of responders (77.4%) were Hindus. Mild to moderate burden was found in 27.4% and high burden was found in 14.2% of the caregivers. Borderline anxiety, borderline depression, anxiety and depression were present in 7.5%, 8.5%, 6.6%, and 6.6% caregivers respectively. Burden was significantly higher in caregivers of epileptic children with poorly controlled seizure (<i>p</i>=0.003) and with co-morbidities (<i>p</i>=0.009). Similarly, burden score had significant positive correlation (<i>p</i>=0.001) with depression and significant negative correlation (<i>p</i>=0.005) with age of onset of epilepsy in children.</p><p><strong>Conclusions: </strong>Burden, anxiety and depression are common problems in caregivers of children with epilepsy. Poorly controlled seizure, presence of associated comorbidities, younger age of onset of seizure in children and presence of depression in caregivers are the important factors that predict burden among caregivers of children with epilepsy.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":"10 1","pages":"24-30"},"PeriodicalIF":0.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/89/a5/jer-20005.PMC7494882.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38425664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 17
期刊
Journal of epilepsy research
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