The majority of people with epilepsy experience headaches, regardless of their sex or age, according to a study published in Seizure – European Journal of Epilepsy.
Headaches can have an extremely negative impact on quality of life. Their high prevalence in people with epilepsy (shown here) suggests they need to be recognised and managed.
The authors, based at Vilnius University, in Lithuania, write: “Clinicians should recognise headache as a common comorbidity of epilepsy, as it may influence antiepileptic drug choice, and may need specific treatment.”
For the study, the researchers recruited 280 people with epilepsy and asked them to complete a carefully-designed questionnaire. This requested information about various social and demographic factors, their health status, whether or not they experienced headaches and the type of headaches they suffered. An expert neurologist also interviewed the participants.
The results showed that more than 83% of subjects reported some type of headache. Almost 78% of these were inter-ictal (occurring in between seizures) and included: tension-type headaches (39%), migraines (31.7%), headaches caused by medication-overuse (7.8%) and persistent headache attributed to earlier traumatic head injury (16%).
To analyse the burden headaches had on people’s lives, the researchers used a recognised measure called the ‘Headache-Attributed Lost Time (HALT)’ index. They found that more than 40% of the headaches were grade 1 on the index, corresponding to minimal or infrequent impact; approximately 10% were grade 2, corresponding to mild or infrequent impact; almost 15% were grade 3, corresponding to moderate impact; and around 35% were grade 4, corresponding to severe impact.
When they compared their findings with those from an earlier study of the ‘general population’, the team discovered that the frequencies of most types of headache were similar. However, they found migraines to be more common in men with epilepsy than in the general population, and headaches caused by medication overuse to be more common in people with epilepsy than in the general population.
The authors conclude that headaches in epilepsy may need specific treatment and should receive more clinical attention.
Author: Dr Özge Özkaya
Click here for more articles about conditions related to epilepsy.
Complications of subdural and depth electrodes in 269 patients undergoing 317 procedures for invasive monitoring in epilepsy
Intracranial monitoring is fundamental to epilepsy surgery, with reported complication rates of 3–17%. We aimed to assess the differences in complication rates between subdural and depth electrodes.Methods
We conducted a retrospective review of 317 electrode implantation procedures. All documented abnormal postoperative findings were recorded in our study. Those that resulted in a significant alteration of treatment course, including neurologic deficit, long-term medication use, reoperation, or hospital readmission, were deemed clinically significant. When possible, findings were attributed to a particular electrode type based on relative location to each electrode.Results
Postoperative abnormalities were associated with SDE placement in 152 (47.9%) procedures and 40 (25.2%) DE placements (p < 0.001). Twenty-nine (9.1%) clinically significant complications were seen in the subdural electrode (SDE) group compared to 10 associated with DEs (6.3%, p = 0.37). SDEs were associated with increased rates of any postoperative hemorrhage (p < 0.001) or extraaxial collection (p = 0.007). Subdural grid placement was associated with an increased risk of any extraaxial collection (odds ratio [OR 2.42), as well as clinically significant collections (OR 9.47). Previous craniotomy was found to be associated with any abnormal postoperative finding (OR 1.71) as well as radiographic hemorrhage (OR 1.99). Concurrent resection is also associated with abnormal findings (OR 1.83) and extraaxial collections (OR 2.37). The overall complication rate was 9.1%, with 13 procedures (4.1%) resulting in neurologic deficit. However, only two patients (0.6%) had permanent neurologic sequelae resulting from lead placement.Significance
Subdural electrodes appear to have an increased rate of abnormal postoperative findings, including hemorrhage and extraaxial collections; however, there was no difference in clinically significant findings. Subdural grids also appear to be associated with symptomatic extraaxial collections, and previous craniotomy increases the risk of hemorrhage. Overall, intracranial monitoring remains a safe and effective procedure for localization of operative seizure foci. Patient selection and risk education for various modalities is an essential aspect of preoperative evaluation.
Cardiorespiratory function alterations are commonly observed with epileptic seizures and may lead to syncope and sudden unexpected death in epilepsy (SUDEP). Although most previous research has focused on controlling heart rate (HR) and respiration, little is known about seizure-related regulation of systemic blood pressure (BP). Herein, we have investigated whether the periictal modulation of systemic BP and HR depends on seizure characteristics.Methods
Systemic arterial BP, HR, and peripheral capillary oxygen saturation (SPO2) were continuously and noninvasively monitored using the ccNexfin device in those epilepsy patients undergoing video–electroencephalography (EEG) telemetry. Data are given as mean ± standard deviation (SD).Results
Forty-five seizures in 37 patients were included. In focal seizures (FS, n = 35), the mean arterial BP (MAP) increased by 33 ± 35% and the HR by 53 ± 44%, whereas the SPO2 remained unaltered. The MAP and HR increases were significantly greater in FS with alterations in consciousness than in those without. For those FS that evolved to bilateral convulsive seizures (BCS, n = 10), all of the ictal recordings were compromised by artifacts. However, 2 min after seizure cessation, the MAP was enhanced by only 16 ± 14% and returned to a baseline slightly below preictal levels after 5 min, whereas the HR was increased by 77 ± 33% and remained elevated throughout the postictal phase.Significance
Periictal regulation of systemic BP and HR displays distinct patterns depending on the type of seizure with focal onset. These changes were unrelated to alterations in SPO2. The potential clinical implications of these findings are discussed in the article.
Epilepsy & Behavior initiated a new category of paper entitled “Reflections on a Career in Epilepsy”. These contributions come from emeritus clinical and basic science researchers in the field of epilepsy who provide a brief autobiographical narrative of their careers which, collectively, begin to paint a mosaic of the recent history of advances in epilepsy research and care. By design, these pieces are completely unstructured from the point of view of E&B. That is, in a limited number of pages, the authors are free to relate whatever they wish regarding their work and careers, the context in which their work occurred, core mentors and colleagues, successes and failures, lessons learned, perceptions of the status of their field and the way forward, and/or whatever else they may wish to comment on. The slate is blank and theirs to complete. These are not easy pieces to write. How does one best communicate the broad landscape of a career with the most important and salient details, what learned lessons does one want to convey to colleagues and junior investigators, and what exactly does one want the historical record to reflect—all to be articulated in limited space? We are honored to have a stellar initial group of scientists committed to this endeavor which are reprinted in this Virtual Special Issue. They are, and will continue to be, representative of the clinical and basic sciences, from areas within adult and pediatric epilepsy, with very varied interests, but with the common bond of a life in epilepsy spent trying to improve care and quality of life for people with epilepsy.
Language skills remain largely unchanged following epilepsy surgery in childhood, according to new research published in the scientific journal Epilepsy and Behaviour.
There have been few investigations into brain function after epilepsy surgery in childhood, and these have largely focused on memory and intelligence rather than language.
During the current study, researchers at the Hospital for Sick Children, in Toronto, recruited 97 children who were being considered for epilepsy surgery. Sixty-one of the 97 subsequently underwent surgery.
Following recruitment, subjects underwent an initial (baseline) assessment of their language skills, using standardised tests of picture naming, vocabulary, letter fluency, understanding and intelligence. An average of seven years later, the participants (61 of whom had undergone surgery, 36 of whom had not) underwent ‘follow-up’ language assessment with the same types of tests.
The researchers used the data to compare language between a range of population ‘categories’, e.g. surgical vs non-surgical, pre-surgical vs post- surgical and seizure freedom vs seizure continuation.
The results showed that the language performance of people who underwent surgery and those who didn’t were similar at baseline and at follow-up. This suggests that surgery itself does not have a detrimental effect on language skills in the longer term.
The team found that children who had spent a larger proportion of their lives free of seizures at follow-up generally obtained higher scores in all language tasks. However, interestingly, this was only the case across comparison groups, because at an individual level no significant improvement in language was seen after seizures became controlled. This implies that the effects of uncontrolled seizures may prevent the improvement of language, even once seizures have stopped.
The researchers also found that people who were older at the onset of epilepsy, those who had a higher IQ, and those who attained higher scores at baseline also tended to achieve higher scores at follow-up in all language tasks. People who had a localised, one-sided seizure focus tended to do better in some languages tasks at follow-up.
Identifying the long-term effects of surgery in childhood on cognitive ability is important, because it provides information to doctors, families and people with epilepsy to allow them to make informed decisions about whether or not to pursue epilepsy surgery.
Author: Dr Özge Özkaya
Click here for more articles about other treatments for epilepsy.
Edited By Bruce Hermann PhD, Associate Editor, Marco Mula MD, Associate Editor, Christian Elger MD, Associate Editor and Steven Schachter MD, Editor-in-Chief
In people with temporal lobe epilepsy (TLE), grey matter – the darker part of the brain that consists of densely packed nerve cell bodies – becomes reduced in particular areas. A recent study, published in the Journal of Clinical Neurology, has now shown that this decrease is more pronounced in people with right-sided TLE than in those with left-sided TLE.
The research also suggests that the extent of grey matter ‘volume’ reduction is linked to clinical characteristics such as the duration of the person’s condition and the frequency of their seizures.
During the study, the researchers, led by Dr Seung Bong Hong, at Sungkyunkwan University School in South Korea, recruited a total of 60 people with TLE, half left-sided and half right-sided, who had undergone successful epilepsy surgery. They also enrolled 30 age-matched, healthy controls for comparison. The researchers examined the brains of the subjects using magnetic resonance imaging (MRI) and made measurements of their grey matter volume.
The results showed a decrease in grey matter in four structures of the brain in people with left TLE compared with controls. Two of the four structures were only affected on one side of the brain, one was affected on both sides and the other was affected only on the right side.
In subjects with right-sided TLE, grey matter loss was found to affect more brain structures than in those with left-sided TLE, but a large proportion were affected on both sides of the brain. This meant that grey matter reduction was more extensive in the right-sided TLE group overall.
In people with right-sided TLE, more extensive loss of grey matter was associated with a longer duration of epilepsy, a lower age of onset and more frequent seizures. In those with left-sided TLE, however, it was linked to a lower age of onset and a history of febrile seizures.
The results of this study, which correlate epilepsy pathology with clinical outcomes, suggest that the imaging methods used here may be useful in gaining a deeper understanding of the epileptic networks involved in TLE. This will hopefully lead to better management of the condition.
As the findings were in people who had responded well to epilepsy surgery for previous two years, this work could also contribute to the complex field of surgical assessment in the future.
Author: Dr Özge Özkaya
Click here for more articles about brain science including genetics.
According to a recent study, published in the journal Neurology, sirolimus* add-on treatment does not significantly reduce seizure frequency in children with tuberous sclerosis complex (TSC) and drug-resistant epilepsy.
The authors state, however, that due the small size of the study, larger ones are needed to verify this finding.
TSC is a genetic condition that causes tumours to form in different organs, and very often the brain. Here they can cause difficult-to-treat (drug-resistant) seizures, developmental delay, intellectual disability and autism. Previous research has suggested that sirolimus might be effective in reducing seizure frequency in children with TSC and many doctors prescribe it off-label.
During the present study, a team at Erasmus MC, in Rotterdam, recruited 23 children with TSC and drug-resistant epilepsy, aged between one and 11 years. The children were then randomly assigned to one of two groups: 1) in which sirolimus was added to their existing (‘standard’) epilepsy treatment regime immediately, and 2) in which sirolimus was added after six months. The team examined seizure frequency in both groups during the sixth month of sirolimus treatment.
The scientists found that, although sirolimus add-on treatment decreased seizure frequency by an average of 40% compared with standard therapy, this reduction was not ‘statistically significant’ (meaning that the chance that the result could have occurred by chance was too high for it to be conclusive). No change was seen in the children’s cognitive performance (which was also tested) when sirolimus was added to standard therapy.
Adverse side effects associated with sirolimus were also a problem, with five children leaving the trial before it had ended because of these.
However, the number of participants in the study may have been too small for the ‘true’ effects of sirolimus to be detected, particularly as recruitment targets weren’t met. Larger studies are warranted, to properly assess the effects of sirolimus add-on treatment in this population.
*Sirolimus is an inhibitor of a signalling complex called ‘mammalian target of rapamycin complex 1’ (mTORC1). This signalling pathway plays a role in acquired forms of epilepsy and may also be involved in TSC.
Author: Dr Özge Özkaya
Click here for more articles about other treatments for epilepsy.