Maximal/Exhaustive Treadmill Test Features in Patients with Temporal Lobe Epilepsy: Search for Sudden Unexpected Death Biomarkers
Changes in the interictal and early postictal diffusion and perfusion magnetic resonance parameters in familial spontaneous epileptic cats
A Survey of Medical Examiner Death Certification of Vignettes on Death in Epilepsy: Gaps in Identifying SUDEP
Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability
Lowering the length of stay (LOS) is thought to potentially decrease hospital costs and is a metric commonly used to manage capacity. Patients with epilepsy undergoing intracranial electrode monitoring may have longer LOS because the time to seizure is difficult to predict or control. This study investigates the effect of economic implications of increased LOS in patients undergoing invasive electrode monitoring for epilepsy.Methods
We retrospectively collected and analyzed patient data for 76 patients who underwent invasive monitoring with either subdural grid (SDG) implantation or stereoelectroencephalography (SEEG) over 2 years at our institution. Data points collected included invasive electrode type, LOS, profit margin, contribution margins, insurance type, and complication rates.Results
LOS correlated positively with both profit and contribution margins, meaning that as LOS increased, both the profit and contribution margins rose, and there was a low rate of complications in this patient group. This relationship was seen across a variety of insurance providers.Significance
These data suggest that LOS may not be the best metric to assess invasive monitoring patients (i.e., SEEG or SDG), and increased LOS does not necessarily equate with lower or negative institutional financial gain. Further research into LOS should focus on specific specialties, as each may differ in terms of financial implications.
Researchers at Columbia University in New York have conducted research which shows an association between stress and an increase in recurrent seizures in adults. Recognising that there is a limited amount of research on the relationship between epilepsy and stressors, depression and anxiety disorders the researchers wanted to see if such a link existed.
The researchers recruited patients from a low income community in New York who had either newly diagnosed epilepsy or a single unprovoked seizure. The researchers then collected information about a number of measures of stress including environmental stress, stressful life events, psychiatric disorders and the cumulative effect of adapting to stress.
The 81 patients were then monitored for 2 years. Almost 40% of those patients who had had an unprovoked seizure (52 patients in this group) had a further recurrence. In the newly diagnosed epilepsy patients (29 patients in this group) almost 70% had a recurrence.
In all patients, the risk of recurrence was increased 3 fold for those with lifetime generalised anxiety disorder and 2 fold for those with lifetime mood disorder.
While a small study the researchers state that in addition to other treatment, the use of low cost stress reducing interventions such as mindfulness may be a useful addition for individuals with recognised stress disorders.
Leaving a legacy in your will to help fund research into the causes and treatment of epilepsy could have a lasting impact. Epilepsy Research UK funds a wide range of research projects each year and we could not do that without the contributions of our supporters. Legacies are an important part of our income and underpin some of our most important work. Could you help make a real difference by leaving us a gift in your will?
Due to our membership of the Free Wills Network it is possible for you to get a simple Will written, or your existing Will changed, by a local solicitor at no cost to you.
There is absolutely no obligation on you to leave a gift to Epilepsy Research UK in your Will but, obviously, we hope that you do as gifts in Wills are a major source of our research funding every year.
It is a very simple process. Call us on 020 8747 5024, or email us your name and address with reply code ‘Free Wills’, and we will arrange for the National Free Wills Network to send you the names and addresses of at least two local firms of solicitors taking part in the scheme. The solicitor will then draw up your Will and you won’t have to pay the bill.
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Researchers from the Ohio State University have found that individuals with Lennox-Gastaut Syndrome (LGS) who took cannabidiol every day for 14 weeks saw the frequency of atonic seizures fall by more than 50 percent.
LGS is one of the most severe forms of epilepsy. The condition involves multiple types of seizures, including tonic, atonic, atypical absence, and myoclonic. Atonic seizures, also known as drop seizures, involve a sudden, brief loss of muscle tone.
Study co-author Dr. Anup Patel, of the College of Medicine at Ohio State, and colleagues recently presented their findings at the American Academy of Neurology’s 69th annual meeting, held in Boston, MA.
There is no cure for LGS, and the condition is extremely challenging to treat, as there is no one-size-fits-all approach. Anti-epileptic medications, such as valproate and lamotrigine, can help to control seizures, but many children who initially respond to such drugs develop tolerance to them later on.
However, the new study from Dr. Patel and colleagues suggests that cannabidiol may be a promising treatment strategy for LGS, after finding that the cannabis compound more than halved atonic seizure frequency in patients with the condition.
“Our results suggest that cannabidiol may be effective for those with Lennox-Gastaut syndrome in treating drop seizures. This is important because this kind of epilepsy is incredibly difficult to treat. While there were more side effects for those taking cannabidiol, they were mostly well-tolerated. I believe that it may become an important new treatment option for these patients.”
Dr. Anup Patel
The literature is sparse on the complex interrelationships between stressors, depression, anxiety disorders, and epilepsy. We hypothesized that a relationship exists between stress and epilepsy. We evaluated whether markers of stress are associated with seizure recurrence in a low income community-based cohort of adults with single unprovoked seizure or newly diagnosed epilepsy.Methods
We ascertained adult residents of Northern Manhattan and Harlem, New York City, with a first unprovoked seizure or newly diagnosed epilepsy, between December 2010 and January 2013. At enrollment, we collected information about seizure phenomenology, demographics, clinical information, and measures of stress (environmental stress, stressful life events, facets of allostatic load—i.e., the cumulative effect of adaptation to stress, psychiatric disorders, and low collective efficacy). Collective efficacy assesses neighborhood characteristics and incorporates social cohesion and informal social control. All subjects were followed for 2 years for further seizures. Cox proportional hazard regression models were used to estimate the hazard ratios of seizure recurrence during the 2 years of follow-up.Results
We identified 52 subjects (64.2%) with a single unprovoked seizure and 29 (35.9%) with newly diagnosed epilepsy. Seizure recurrence was recorded in 38.5% (N = 20) of subjects with a single unprovoked seizure and in 69% of those with epilepsy (N = 20) (p = 0.01). In the overall sample, the hazard of seizure recurrence was increased by lifetime generalized anxiety disorder (3.0-fold) and by low collective efficacy (2.7-fold). In a second model, the hazard was increased by lifetime mood disorder (2.1-fold) and low collective efficacy (2.5-fold).Significance
Markers of stress (i.e., low collective efficacy, lifetime mood disorder, and lifetime generalized anxiety disorder) were associated with an increased risk for seizure recurrence in adults with a single unprovoked seizure or newly diagnosed epilepsy. Stress-reducing interventions, such as mindfulness, may be a useful, safe, and inexpensive adjunctive treatment for epilepsy.
To investigate acoustic auditory processing in patients with recent infantile spasms (IS).Methods
Patients (n = 22; 12 female; median age 8 months; range 5–11 months) had normal preceding development, brain magnetic resonance imaging (MRI), and neurometabolic testing (West syndrome of unknown cause, uWS). Controls were healthy babies (n = 22; 11 female; median age 6 months; range 3–12 months). Event-related potentials (ERPs) and psychometry (Bayley Scales of Infant Development, Second Edition, BSID-II) took place at a month following IS remission.Results
Following a repeated pure tone, uWS patients showed less suppression of the N100 at the mid-temporal electrodes (p = 0.006), and a prolonged response latency (p = 0.019). Their novelty P300 amplitude over the mid-temporal electrodes was halved (p = 0.001). The peak of the novelty P300 to environmental broadband sounds emerged later over the left temporal lobe in patients (p = 0.015), the lag correlating with duration of spasms (r = 0.547, p = 0.015). BSID-II scores were lower in patients (p < 0.001), with no correlation to ERP.Significance
Complex acoustic information is processed poorly following IS. This would impair language. Treatment did not reverse this phenomenon, but may have limited its severity. The data are most consistent with altered connectivity of the cortical acoustic processing areas induced by IS.
Neonates with hypoxic–ischemic encephalopathy (HIE) managed with therapeutic hypothermia (TH) often experience acute symptomatic seizures, prompting treatment with antiseizure medications (ASMs). Because the risk of seizure occurrence after hospital discharge is unknown, the optimal ASM treatment duration is unclear. We aimed to determine the risk of seizure occurrence after hospital discharge and the impact of ASM treatment duration on this outcome.Methods
We performed a single-center, retrospective study of consecutive neonates with HIE managed with TH who received ASMs for acute symptomatic seizures from June 2010 through December 2014. Neonates were monitored with continuous electroencephalography (EEG) during TH.Results
Follow-up data were available for 59 (82%) of 72 neonates who survived to discharge, with a median follow-up period of 19 months (interquartile range [IQR] 11–25). Acute symptomatic seizures occurred in 35 neonates (59%), including electrographic seizures in 21 neonates (36%). ASMs were continued upon discharge in 17 (49%) of 35 neonates. Seizures occurred in follow-up in four neonates (11%). No patient for whom ASMs were discontinued prior to discharge experienced seizures during the follow-up period.Significance
Among neonates with HIE, seizures after hospital discharge were rare in those with acute symptomatic seizures and did not occur in neonates without acute symptomatic seizures. ASM discontinuation prior to discharge did not increase the risk of seizures during the follow-up period, suggesting that ASMs may be discontinued in many neonates prior to discharge.
Nonadherence to prescribed dosing regimens is a significant problem in the treatment of pediatric and adult chronic epilepsy, and can result in severe consequences to patient outcomes. In this first-of-kind preclinical study, the impact of nonadherence on seizure control was studied by simulating human patterns of nonadherence in an animal epilepsy model.Methods
In study 1, three different patterns of nonadherence were modeled in newly diagnosed epileptic rats treated with carbamazepine: perfect adherence (100% of pellets contained carbamazepine), variable nonadherence (50% of pellets contained carbamazepine with different dosing patterns between animals), and complete nonadherence (0% of pellets contained carbamazepine). In study 2, a cohort of newly diagnosed epileptic rats were subjected to a “drug holiday” nonadherence paradigm, that is, a 2-week on (100%), 2-week off (0%), and 2-week on (100%) carbamazepine paradigm.Results
In the first experiment, the 100% (0.3 ± 0.2 SD convulsive seizures per day) adherent cohort demonstrated better seizure control than either the 0% (1.1 ± 0.8 SD) or 50% (0.8 ± 0.6 SD) adherent cohorts, which had similar levels of seizure control. In the second study, poor seizure control was exhibited during the second 2 weeks; that is, the drug holiday epoch; however, this did not negatively affect restoration of seizure control upon reinstatement of CBZ.Significance
The results from this pilot investigation suggest that nonadherence to carbamazepine is associated with significant negative but reversible effects on seizure control in an animal model of epilepsy. Furthermore, these results demonstrate that animal studies of nonadherence can yield potentially important and translatable insights into the consequences of nonadherence on seizure control.
Electrical source imaging (ESI) is a well-established approach to localizing the epileptic focus in drug-resistant focal epilepsy. So far, ESI has been used primarily on interictal events. Emerging evidence suggests that ictal ESI is also feasible and potentially useful. We aimed to investigate the diagnostic accuracy of ESI on ictal events using high-density electroencephalography (EEG).Methods
We performed ictal ESI on 14 patients (9 with temporal lobe epilepsy) admitted for presurgical evaluation who presented seizures during a long-term (≥18 h) high-density EEG recording (13 with 256 electrodes and one with 128 electrodes), and subsequently 8 of them underwent epilepsy surgery (postoperative follow-up >1 year). Artifact-free EEG epochs at ictal οnset were selected for further analysis. The predominant ictal rhythm was identified and filtered (±1 Hz around the main frequency). ESI was computed for each time point using an individual head model and a distributed linear inverse solution, and the average across source localizations was localized. For validation, results were compared with the resection area and postoperative outcome.Results
Ictal ESI correctly localized the epileptic seizure-onset zone in the resection area in five of six postoperatively seizure-free patients. Interictal and ictal ESI were concordant in 9 of 14 patients and partially concordant in additional 4 of 14 patients (93%). Divergent solutions were found in only one of the 14 patients (7%).Significance
Ictal ESI is a promising localization technique in focal epilepsy.
Dementia is among the top 15 conditions with the most substantial increase in burden of disease in the past decade, and along with epilepsy, among the top 25 causes of years lived with disability worldwide. The epidemiology of dementia in persons with epilepsy, and vice versa, is not well characterized. The purpose of this systematic review was to examine the prevalence, incidence, and reported risk factors for dementia in epilepsy and epilepsy in dementia.Methods
Embase, PsycINFO, MEDLINE, and the Cochrane databases were searched from inception. Papers were included if they reported the incidence and/or prevalence of dementia and epilepsy. Two individuals independently performed duplicate abstract and full-text review, data extraction, and quality assessment. Random-effects models were used to generate pooled estimates when feasible.Results
Of the 3,043 citations identified, 64 were reviewed in full text and 19 articles were included. The period prevalence of dementia ranged from 8.1 to 17.5 per 100 persons among persons with epilepsy (insufficient data to pool). The pooled period prevalence of epilepsy among persons with dementia was 5 per 100 persons (95% confidence interval [CI] 1–9) in population-based settings and 4 per 100 persons (95% CI 1–6) in clinic settings. There were insufficient data to report a pooled overall incidence rate and only limited data on risk factors.Significance
There are significant gaps in knowledge regarding the epidemiology of epilepsy in dementia and vice versa. Accurate estimates are needed to inform public health policy and prevention, and to understand health resource needs for these populations.