Epilepsy & Behavior最新文献

{"title":"Ketogenic diet therapy for epilepsy: Clinical pearls","authors":"Anna Lecticia Pinto ,&nbsp;Maria Augusta Montenegro ,&nbsp;Kette Valente ,&nbsp;Leticia Brito Sampaio","doi":"10.1016/j.yebeh.2024.110091","DOIUrl":"10.1016/j.yebeh.2024.110091","url":null,"abstract":"<div><div>This manuscript provides practical insights, tips, and lessons particularly valuable for early-career healthcare professionals new to using ketogenic diet therapy (KDT) in clinical practice. The review aims to be accessible, emphasizing actionable knowledge that can be directly applied in a clinical setting. The KDT for epilepsy includes not only the classic KDT but also the modified Atkins diet, the medium-chain triglyceride ketogenic diet, and the low glycemic index treatment. This highly effective non-pharmacological treatment can be rapidly implemented for patients with drug-resistant epilepsy. Identifying suitable candidates and conferring criteria for selecting patients who are likely to benefit (’good responder’) from the ketogenic diet is critical for earlier intervention minimizing the burden of seizures and long-term polytherapy. On the other hand, this article outlines conditions where the ketogenic diet may not be appropriate, such as in patients with specific metabolic disorders, representing contraindications or cautions where there are concerns about adherence. Finally, the use of KDT in special settings (e.g., ICU) and how to deal with the most common side effects and abnormal laboratory results are provided based on an updated review and the experience from three level three epilepsy centers.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric epilepsy representations among children/adolescents and parents: The role of age, gender, and clinical variables","authors":"Bárbara Nazaré ,&nbsp;Teresa Pompeu Mendes","doi":"10.1016/j.yebeh.2024.110094","DOIUrl":"10.1016/j.yebeh.2024.110094","url":null,"abstract":"<div><div>According to the common-sense model of self-regulation, illness representations influence treatment adherence and, thus, health status. As pediatric epilepsy management is usually shared between children/adolescents and parents, we aimed to assess and compare illness representations of both groups. Additionally, the role of gender and clinical variables in pediatric epilepsy representations was explored. One hundred and seventy-three dyads of Portuguese children/adolescents with epilepsy and parents were assessed with the Brief Illness Perception Questionnaire. Pediatric epilepsy was perceived as a moderate threat. Although epilepsy symptoms and consequences were mainly perceived as low, the emotional impact of the illness was moderate to high. Compared to children/adolescents, parents presented higher understanding of epilepsy, higher concern, and more intense emotional responses to the illness. Adolescents understood the illness better than children. Gender did not relate to illness representations among children/adolescents or parents. Epilepsy severity and control were the clinical variables most strongly associated with illness representations. Pediatric epilepsy representations should be routinely assessed separately for children/adolescents and parents, particularly following changes in epilepsy severity. When pediatric illness representations are found to be incongruent with medical information, such beliefs should be challenged, preferably with a tailored approach.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between inflammation/immunity and epilepsy: A multi-omics mendelian randomization study integrating GWAS, eQTL, and mQTL data","authors":"Jing Mu,&nbsp;Changqing Cao,&nbsp;Yigu Gong,&nbsp;Guiying Hu","doi":"10.1016/j.yebeh.2024.110112","DOIUrl":"10.1016/j.yebeh.2024.110112","url":null,"abstract":"<div><h3>Objectives</h3><div>Increasing evidence suggests that activated innate/adaptive immunity induces an inflammatory response, thereby participating in epileptogenesis. However, the biological explanation of inflammation/immunity as a potential cause for epilepsy remains largely unknown. This research aimed to determine the causal effects of inflammation/immune-related genes in epilepsy based on multi-omics mendelian randomization (MR).</div></div><div><h3>Methods</h3><div>We employed summary-data-based MR (SMR) approach to combine GWAS for epilepsy (12,891 cases and 312,803 control) with gene expression quantitative trait loci (<em>cis</em>-eQTL, 31,684 participants) and DNA methylation QTL (<em>cis</em>-mQTL, 1,980 participants) data. Five additional MR methods were then used for sensitivity analyses to confirm the reliability of causal associations. In addition, enrichment analysis of key genes was conducted to provide insight into the biological functions of epilepsy risk variants.</div></div><div><h3>Results</h3><div>A total of 386 inflammation/immune-related genes were selected for further analyses. Primary SMR analysis indicated that 37 DNA methylation sites and six genes regulated by them had potential causal relationship with epilepsy. MR analysis further refined the results, identifying three genes that had a causal effect on epilepsy. Notably, VEGFA (OR: 0.925; 95 % CI: 0.862–0.994) expression was negatively correlated with epilepsy risk, whereas IL16 (OR: 1.076; 95 % CI: 1.028–1.126) and HLA-DPA1 (OR: 1.041; 95 % CI: 1.009–1.074) expressions were positively associated with epilepsy risk. Functional enrichment analysis revealed that the identified genes were involved in GO-BP terms related to VEGF activation signaling and chemotaxis regulation.</div></div><div><h3>Conclusion</h3><div>This analysis confirms the causal role of inflammation/immunity in epilepsy, and the identified candidate genes provide clues for drug development in clinical practice.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical findings of long-term ambulatory video EEG following routine EEG","authors":"Ewan S. Nurse ,&nbsp;Dean R. Freestone ,&nbsp;Gabriel Dabscheck ,&nbsp;Mark J. Cook","doi":"10.1016/j.yebeh.2024.110104","DOIUrl":"10.1016/j.yebeh.2024.110104","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to assess the diagnostic yield of routine EEG (rEEG) followed by long-term ambulatory EEG (aEEG) in a retrospective cohort, focusing on the rates of abnormal EEG findings, and overall event capture.</div></div><div><h3>Methods</h3><div>Data were retrospectively collected from deidentified clinical reports of patients who underwent both rEEG and subsequent aEEG, with both modalities including video recordings. The study included 95 patients, with demographic, clinical information, and EEG findings extracted for analysis. Statistical analyses included chi-squared proportion tests and Wilcoxon rank-sum tests to assess the influence of variables such as age, sex, referral source, and aEEG duration on outcomes. Bayes factors were calculated to evaluate the power of the statistical tests.</div></div><div><h3>Results</h3><div>Among the 95 patients, 33 % were 16 years old or younger. The median duration of aEEG was 3.9 days. Abnormal EEG findings increased from 18 % with rEEG to 33 % with aEEG. Epileptic seizures were captured in 3 % of rEEG and 8 % of aEEG, while non-epileptic events were captured in 35 % of aEEG compared to none in rEEG. Younger age was associated with higher rates of abnormal findings, but this was not adequately powered. Females had a higher likelihood of event capture on aEEG, though this finding was also underpowered. The majority of adult and paediatric patients with a normal rEEG went on to have a normal aEEG.</div></div><div><h3>Conclusion</h3><div>Ambulatory EEG significantly improves the diagnostic yield for both epileptic and non-epileptic events compared to routine EEG, particularly in adults. This study supports the broader use of aEEG for comprehensive epilepsy evaluation and suggests further research to optimise its clinical utility.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health workers’ perceptions of epilepsy and its treatment implications: A survey of nurses and other healthcare workers’ in Addis Ababa, Ethiopia","authors":"Enat Yewnetu ,&nbsp;Rugare Mugumbate ,&nbsp;Etsegenet F. Tizazu ,&nbsp;Mehila Zebenigus ,&nbsp;Kindu Woldemichael","doi":"10.1016/j.yebeh.2024.110078","DOIUrl":"10.1016/j.yebeh.2024.110078","url":null,"abstract":"<div><div>In Ethiopia, the epilepsy knowledge gap among healthcare workers remains high. In this study, we conducted a survey among health care workers in Addis Ababa, Ethiopia, exploring their knowledge, attitudes, beliefs, and perceptions about social inclusion and exclusion regarding epilepsy. Furthermore, we analysed if and how these factors influence the management and quality of care provided. During a training workshop, 50 participants completed the survey. Nurses made up 22% of the participants, midwives comprised 11%, health officers constituted 16%, and medical officers represented 4%. Of the respondents, 69% were male, and 59% had experience in treating patients with epilepsy. This study showed that while 51% of respondents correctly identified epilepsy as being diagnosed after two seizures, many were uncertain about the criteria. Although 90% believed epilepsy is treatable, some were unsure or held misconceptions. Regarding its contagiousness, 82% correctly stated it is not contagious, but some held incorrect beliefs. Treatment options varied, with most recognizing clinical medicines, but some still believed in alternative methods like spiritual or herbal healing. Additionally, understanding of person-centered care was lacking, with several respondents admitting they were unfamiliar with the concept. The factors contributing to the epilepsy treatment gap in Ethiopia were a lack of comprehensive knowledge among healthcare workers about epilepsy, misconceptions such as the belief that epilepsy is contagious, inadequate management practices, challenges in accessing and securing medications due to shortages, and limited community awareness about the condition. Additionally, the study exposed a concerning gap in understanding of person-centered care among some healthcare workers. This study underscores the urgent need for targeted training programs, healthcare policies, and community awareness initiatives to enhance the quality of care for individuals with epilepsy in Ethiopia and similar settings.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug repurposing in status epilepticus","authors":"Matthew C Walker","doi":"10.1016/j.yebeh.2024.110109","DOIUrl":"10.1016/j.yebeh.2024.110109","url":null,"abstract":"<div><div>The treatment of status epilepticus (SE) has changed little in the last 20 years, largely because of the high risks and costs of new drug development for SE. Moreover, SE poses specific challenges to drug development, such as patient diversity, logistical hurdles, and the need for acute treatment strategies that differ from chronic seizure prevention. This has reduced the appetite of industry to develop new drugs in this area. Drug repurposing is an attractive approach to address this unmet need. It offers significant advantages, including reduced development time, lower costs, and higher success rates, compared to novel drug development.</div><div>Here I demonstrate how novel methods integrating biological knowledge and computational methods can be applied to drug repurposing in status epilepticus. Biological approaches focus on addressing mechanisms underlying drug resistance in SE (using for example ketamine, tacrolimus and safinamide) and longer-term consequences (using for example omaveloxolone, celecoxib and losartan). Additionally, artificial intelligence platforms, such as ChatGPT, can rapidly generate promising drug lists, while in silico methods can analyze gene expression changes to predict molecular targets. Combining AI and in silico approaches has identified several candidate drugs, including metformin, sirolimus and riluzole, for SE treatment. Despite the promise of repurposing, challenges remain, such as intellectual property issues and regulatory barriers. Nonetheless, drug repurposing presents a viable solution to the high costs and slow progress of traditional drug development for SE.</div><div>This paper is based on a presentation made at the 9th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures, in April 2024.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication adherence and its relationship with stress, anxiety and depression in parents or caregivers of epileptic children","authors":"Parisa Aghaie,&nbsp;Mohammad Barzegar","doi":"10.1016/j.yebeh.2024.110090","DOIUrl":"10.1016/j.yebeh.2024.110090","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy during childhood can have a highly important effect on the family system. Parents of epileptic children may experience stress, anxiety, and depression. Adherence to treatment has been reported to be suboptimal among children with epilepsy.</div></div><div><h3>Method</h3><div>In this descriptive, correlational study, the convinience sampling method was used to select 100 caregivers of children with epilepsy, referring to the neurological department and clinic. The required data were collected using the Pediatric Epilepsy Medication Self-Management Questionnaire (PEMSQ) to evaluate parents’ medication self-management, one of which is adherence to treatment. In addition, the Depression Anxiety and Stress Scale (DASS-21) was utilized to assess the levels of stress, anxiety, and depression in parents.</div></div><div><h3>Result</h3><div>Based on the results, the mean scores (SD) of depression, anxiety, and stress were 33 (9), 27 (10), and 26 (9), respectively. The total score for medication self-management was 111.72 ± 13.5. Among the four fields of PEMSQ, knowledge and expectations from the patient had the lowest score, while treatment barriers represented the highest score. there was a statistically significant, mild correlation between parental stress level and parental disease knowledge and expectations.</div></div><div><h3>Conclusion</h3><div>The findings of the current study revealed that most caregivers had high levels of stress, anxiety, and depression. there is a statistically significant but mostly weak relationship between parents’ stress, anxiety, and depression and disease knowledge and expectations, medication adherence, beliefs about medication efficacy, barriers to treatment, and overall medication self-management.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life and depression in peer-supported people with chronic neurological disease − A look at epilepsy and multiple sclerosis self-help groups and internet forums","authors":"Carmen Uhlmann ,&nbsp;Hanna Dzierzega ,&nbsp;Petra Schmid","doi":"10.1016/j.yebeh.2024.110101","DOIUrl":"10.1016/j.yebeh.2024.110101","url":null,"abstract":"<div><h3>Background</h3><div>Epilepsy and multiple sclerosis (MS) are both chronic neurological diseases with a high symptom burden, including depression and resulting in lower health-related quality of life (HRQoL). Peer-support groups seem to be beneficial to improve HRQoL and depression. Since the course of the two diseases varies, the question arises if they differ in terms of HRQoL, depression and coping strategies and which predictors are related to HRQoL in peer-supported people.</div></div><div><h3>Methods</h3><div>A total of 90 participants with epilepsy (n = 46) or MS (n = 44), recruited from local or online peer-support groups, were surveyed by questionnaire. HRQoL (SF-36), coping with illness (FKV-LIS), depression (BDI-II), socio-demographic and clinical data were examined.</div></div><div><h3>Results</h3><div>The two peer-supported groups did not differ, neither in coping strategies nor in HRQoL, with the exception of the physical related scales. However, the HRQoL values in both groups were worse than in general population. An important predictor of HRQoL in epilepsy as well as in MS was depression, which was present in 40 % of cases.</div></div><div><h3>Conclusions</h3><div>Even people with MS or epilepsy who attended a peer-support group, i.e. who have been actively coping with their disease, had a reduced HRQoL. Neither coping strategies nor other disease related variables but comorbid depression was the most significant predictor of poorer HRQoL. Our results support the necessity to treat comorbid depression and thereby improve HRQoL, even in peer-supported people.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Status epilepticus: Challenges in rural and remote locations in low- and low-middle income countries","authors":"Gagandeep Singh,&nbsp;Mamta Gupta","doi":"10.1016/j.yebeh.2024.110098","DOIUrl":"10.1016/j.yebeh.2024.110098","url":null,"abstract":"<div><div>The incidence of status epilepticus is possibly increased in low- and low-middle income countries but paradoxically, there are more challenges in the management of the condition in these countries. These challenges include the lack of recognition of status epilepticus in the community, impenetrable access to treatment and non-availability of medications to treat status epilepticus. We propose that status epilepticus be an index condition and an entry-point for improving emergency care for neurological disorders in low- and low-middle income countries. Ostensible solutions include measures to improve awareness and identification of status epilepticus in the community, a responsive health system and better knowledge and skills available with emergency health care providers.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectral properties of bursts in therapeutic burst suppression predict successful treatment of refractory status epilepticus","authors":"Stephanie Gollwitzer ,&nbsp;Rüdiger Hopfengärtner ,&nbsp;Stefan Rampp ,&nbsp;Tamara Welte ,&nbsp;Dominik Madžar ,&nbsp;Johannes Lang ,&nbsp;Caroline Reindl ,&nbsp;Jenny Stritzelberger ,&nbsp;Julia Koehn ,&nbsp;Joji Kuramatsu ,&nbsp;Stefan Schwab ,&nbsp;Hagen B. Huttner ,&nbsp;Hajo Hamer","doi":"10.1016/j.yebeh.2024.110093","DOIUrl":"10.1016/j.yebeh.2024.110093","url":null,"abstract":"<div><div>Burst suppression (BS) on EEG induced by intravenous anesthesia (IVAT) is standard therapy for refractory status epilepticus (RSE). If BS has any independent therapeutic effect on RSE is disputed. We aimed to define EEG characteristics of BS predicting termination or recurrence of status after weaning. All RSE patients treated with IVAT while undergoing continuous EEG monitoring on the neurological intensive care unit between 2014 and 2019 were screened for inclusion. A one hour-period of visually preselected BS-EEG was analyzed. Bursts were segmented by a special thresholding technique and underwent power spectral analysis. Out of 48 enrolled patients, 25 (52.1 %) did not develop seizure recurrence (group Non SE) after weaning from IVAT; in 23 patients (47.9 %), SE reestablished (group SE). In group Non SE, bursts contained higher amounts of EEG delta power (91.59 % vs 80.53 %, p &lt; 0.0001), while faster frequencies were more pronounced in bursts in group SE (theta: 11.38 % vs 5.41 %, p = 0.0008; alpha: 4.89 % vs 1.82 %, p &lt; 0.0001; beta: 3.23 % vs 1.21 %, p = 0.0002). Spectral profiles of individual bursts closely resembled preceding seizure patterns in group SE but not in group Non SE. Accordingly, persistence of spectral composition of initial ictal patterns in bursts, suggests ongoing SE, merely interrupted but not altered by BS. Fast oscillations in bursts indicate a high risk of status recurrence after weaning from IVAT. EEG guided individualized sedation regimes might therefore be superior to standardized anesthesia protocols.</div></div>","PeriodicalId":11847,"journal":{"name":"Epilepsy & Behavior","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}