Epilepsy Research最新文献

{"title":"Effects of sleeve gastrectomy and Roux-en-Y gastric bypass on pharmacokinetics of lamotrigine and valproate: A cohort study","authors":"Georgios Schoretsanitis ,&nbsp;Magnus Strømmen ,&nbsp;Hege-Merete Krabseth ,&nbsp;Olav Spigset ,&nbsp;Arne Helland","doi":"10.1016/j.eplepsyres.2024.107469","DOIUrl":"10.1016/j.eplepsyres.2024.107469","url":null,"abstract":"<div><h3>Background</h3><div>Bariatric surgeries may affect the pharmacokinetics of medications through alterations of the gastrointestinal physiology. Pharmacokinetic changes of first-line antiseizure medications such as lamotrigine and valproate following bariatric treatment have received little research attention so far.</div></div><div><h3>Methods</h3><div>In our prospective case study we included lamotrigine- or valproate-treated patients undergoing bariatric surgery at hospitals in Central Norway. Lamotrigine and valproate concentrations were assessed using serial blood samples over a dose interval, before and one, six and twelve months following surgery. Primary outcomes included changes in area under the time-concentration curve (AUC) with secondary outcomes comprising full pharmacokinetic profiling.</div></div><div><h3>Results</h3><div>Six lamotrigine-treated obese patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 3) and sleeve gastrectomy (SG) (n = 3), as well as two valproate-treated patients (one undergoing RYGB and one SG) were included. Largest changes for dose-adjusted AUC values after surgery were seen in RYGB-treated patients on lamotrigine (average increases of 38 % one month and 32 % 12 months postoperatively). In the patients on valproate, AUC values were decreased by 22 % after 6 months and by 30 % after 12 months. The interindividual variation was high. Formal statistical testing was not done due to few cases.</div></div><div><h3>Conclusion</h3><div>Postoperative pharmacokinetic changes for lamotrigine and valproate were modest, but for lamotrigine changes may be larger in patients undergoing RYGB than in those undergoing SG. Given the substantial interindividual variation, therapeutic drug monitoring should be used to capture pharmacokinetic changes and guide dose adjustments after bariatric surgery.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107469"},"PeriodicalIF":2.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An advocacy based cross sectional study of healthcare professionals of factors impacting on medication adherence across nine Sub-Saharan African countries","authors":"Niki Sotiropoulou ,&nbsp;Michael Kinney ,&nbsp;Tolu Olaniyan ,&nbsp;Kehinde Salako ,&nbsp;Shadrach Akinola ,&nbsp;Miria Chikasama ,&nbsp;Farmanga Ngobeh ,&nbsp;Margaret Sipilon ,&nbsp;Millie Kumenda ,&nbsp;Edward Shabangu ,&nbsp;Richard Laugharne ,&nbsp;Rohit Shankar","doi":"10.1016/j.eplepsyres.2024.107459","DOIUrl":"10.1016/j.eplepsyres.2024.107459","url":null,"abstract":"<div><h3>Background</h3><div>Adherence to anti-seizure medication (ASM) by people diagnosed with epilepsy in sub-Saharan Africa remains low. The factors for low adherence are not well understood. To improve adherence, it is important to understand the perceptions and views of healthcare professionals delivering epilepsy care to this population. The aim was to investigate the factors influencing ASM adherence.</div></div><div><h3>Methods</h3><div>This study uses a brief online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of six questions and was a mix of multiple choice and Likert scale questions.</div></div><div><h3>Results</h3><div>There were 217 healthcare professionals who replied to the questionnaire. The most important factors believed to be influencing adherence from a healthcare professional perspective are; lack of availability of medication for epilepsy (71 %), <em>affordability</em> of medication (60 %), the patient, family, carer lacking in understanding of medication (43 %), cultural misconceptions about epilepsy (40 %) and side effects of the medication (32 %). The survey was answered by many different healthcare professionals; 65 participants were doctors and 152 were other healthcare professionals such as nurses (59 %) pharmacists (10 %) and when comparing them, the three most important categories were consistent across groups.</div></div><div><h3>Conclusion</h3><div>Healthcare workers in Sub-Saharan Africa identify that the primary factors impacting adherence to ASMs, in their view, is affordability and availability of ASMs.Addressing this issue may reduce the treatment gap.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107459"},"PeriodicalIF":2.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142532706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the efficacy of transcranial direct current stimulation for refractory epilepsy: A meta-analysis of RCTs and non-RCTs","authors":"Yuteng Sun ,&nbsp;Xian Tang ,&nbsp;Ye Li ,&nbsp;Chao Gao ,&nbsp;Zhiyuan Shen ,&nbsp;Xiaosu Guo ,&nbsp;Xin Guo ,&nbsp;Zibin Wei ,&nbsp;Yicun Jia ,&nbsp;Mengyi Zheng ,&nbsp;Yaxin Zhang ,&nbsp;Yuan Xing ,&nbsp;Shujuan Tian","doi":"10.1016/j.eplepsyres.2024.107456","DOIUrl":"10.1016/j.eplepsyres.2024.107456","url":null,"abstract":"<div><div>An increasing number of research indicate that non-invasive neurostimulation techniques, like transcranial direct current stimulation (tDCS), can effectively control refractory epilepsy. While previous meta-analyses have primarily focused on randomized controlled trials (RCTs), this study expands the scope by including both RCTs and non-RCTs to provide a more comprehensive assessment of tDCS efficacy in treating refractory epilepsy. Through a systematic search of \"PUBMED, Embase and Cochrane\", we sought relevant studies related to the research topic. We utilized the Cochrane Collaboration tool to assess the risk of bias for the RCTs and the Methodological Index for Non-Randomized Studies (MINORS) tool to evaluate the quality of the non-RCTs included in this meta-analysis. In addition, a protocol for this meta-analysis was registered on PROSPERO (CRD42024496837 <span><span>http://www.crd.york.ac.uk/</span><svg><path></path></svg></span> PROSPERO). A total of 14 studies, including 8 RCTs and 6 non-RCTs , involving 307 subjects with refractory epilepsy, were included in this meta-analysis. The combined analysis of RCTs and non-RCTs indicated that tDCS was effective in reducing seizure frequency (SF) in refractory epilepsy patients, with significant improvements observed both four weeks (MD = −4.54; p ＜ 0.01; 95 % CI = −5.69 to −3.38) and eight weeks (MD = −3.49; p ＜ 0.01; 95 % CI = −5.37 to −1.61) after stimulation.</div><div>There were no statistically significant differences in Interictal Epileptiform Discharges (IEDs) shortly after stimulation (MD = −3.59; p = 0.42; 95 % CI = −12.33–5.16). However, a reduction was observed at four weeks (MD = −5.28; p ＜ 0.01; 95 % CI = −6.88 to −3.68) and eight weeks post-stimulation (MD = −3.37; p ＜ 0.01; 95 % CI = −5.35 to −1.40). The patient's adverse reactions were mild, and they could be relieved shortly after discontinuation of the stimulus. The quality of evidence across outcomes was assessed as moderate. The results indicate that tDCS demonstrates promising efficacy and safety in managing seizures in refractory epilepsy. While this meta-analysis provides valuable findings, additional large-scale randomized controlled trials are needed to further confirm the efficacy of tDCS for refractory epilepsy.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"208 ","pages":"Article 107456"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of recurrence after a first unprovoked seizure with different risk factors: A 10-year prospective cohort study","authors":"Xin-yu Chen ,&nbsp;Feng-huang Zhou ,&nbsp;Ge Tan ,&nbsp;Deng Chen ,&nbsp;Ling Liu","doi":"10.1016/j.eplepsyres.2024.107457","DOIUrl":"10.1016/j.eplepsyres.2024.107457","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the recurrence risk following a first unprovoked seizure using both single-factor and multiple-factor approaches, as well as to further analyze the potential risk factors associated with recurrence.</div></div><div><h3>Methods</h3><div>In a prospective cohort study, a total of 201 individuals who experienced their initial unprovoked seizure were recruited from January 2010 to December 2019. The cumulative recurrence rates were calculated by Kaplan–Meier survival curves. Multivariate analyses for recurrence risk were conducted utilizing the Cox regression model. Additionally, interaction effects were evaluated by quantifying the attributable proportion due to interaction (AP).</div></div><div><h3>Results</h3><div>The cumulative recurrence rates were as follows: 29.4 % at 6 months, 35.8 % at 1 year, 41.1 % at 2 years, 47.9 % at 5 years, and 57.5 % at 10 years. Notably, the majority of recurrences, specifically 61.2 %, manifested within the initial 6 months following the onset, with 74.4 % occurring within the first year, and 82.6 % within the initial 2 years. The recurrence risk of patients with epileptic abnormal discharges on VEEG, nocturnal seizure, abnormal MRI, prior brain insult and focal seizure was 71.9 %, 61.4 %, 61.5 %, 75.0 %, and 69.7 %, respectively. Epileptiform discharges (RR 2.5, 95 % CI 1.4–4.3, <em>P</em>=0.001) and prior brain insult (RR 2.1, 95 % CI 1.2–3.7, <em>P</em>=0.007) were predictors of recurrence. Interaction analysis showed the combination of epileptiform discharges and prior brain insult was associated with a 7-fold increased risk of recurrence (RR 7.0, 95 %CI 3.5–14.2)，with AP estimated at 0.34, the combination of epileptiform discharges and nocturnal seizure was associated with a 4-fold increased risk of recurrence(RR 4.3, 95 %CI 2.4–7.4), with AP estimated at −0.25,and the combination of prior brain insult and nocturnal seizures was associated with a 4-fold increased risk of recurrence(RR 4.1, 95 %CI 1.9–8.9), with AP estimated at −0.03.</div></div><div><h3>Conclusions</h3><div>Patients with epileptiform discharges VEEG, nocturnal seizures, abnormal MRI findings, prior brain insult, or focal seizures exhibited a substantial recurrence rate. Specifically, the presence of epileptiform discharges in VEEG recordings, and a history of prior brain insult were identified as independent risk factors associated with recurrence following an initial unprovoked seizure. Notably, individuals with multiple risk factors exhibited a significantly higher recurrence risk compared to those with no or a single risk factor.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107457"},"PeriodicalIF":2.0,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attenuation of mitochondrial refractory epilepsy in rotenone corneal kindling model of drug resistance by idebenone: An approach to bypass mitochondrial complex I","authors":"Arshbir Kaur,&nbsp;Arvinder Kaur,&nbsp;Samriti,&nbsp;Rajesh Kumar Goel","doi":"10.1016/j.eplepsyres.2024.107458","DOIUrl":"10.1016/j.eplepsyres.2024.107458","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the potential of bypassing mitochondrial complex I with idebenone to overcome drug resistance in a Rotenone corneal kindling (RCK) mouse model of mitochondrial refractory epilepsy.</div></div><div><h3>Material and method</h3><div>Resistance was developed by administering rotenone 2.5 mg/kg intraperitoneally once and corneal kindling twice daily. The kindling development took 15 days, and pre-treatment resistance validation was carried out with five different antiseizure drugs: pregabalin, levetiracetam, valproate, lamotrigine, and phenytoin. The treatment drug, Idebenone (IDB) was given at doses of 10, 20, and 40 mg/kg intraperitoneally for 10 days. The post-treatment resistance validation was evaluated with same standard drugs in same order along with other parameters assessment, such as NAD(P)H: quinone oxidoreductase 1 (NQO1), ATP, GSH, and TBARS.</div></div><div><h3>Results</h3><div>The pre-treatment resistance validation shows an inability of standard drugs to attenuate seizure scores by rotenone kindling, justifying the development of drug resistance. IDB successfully abolished the resistance developed in RCK model. IDB elevated the levels of ATP and NQO1 and showed antioxidant activity by elevating GSH and attenuating TBARS.</div></div><div><h3>Conclusion &amp; future direction</h3><div>IDB have successfully elevated the level of ATP, NQO1 in RCK model, hence proving the complex I bypass hypothesis. Thus, IDB can be the drug of choice for mitochondrial epilepsies involving drug refractoriness as adjuvant with anticonvulsant drugs.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107458"},"PeriodicalIF":2.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and real-world management of childhood epilepsy in Japan: A descriptive study using a health claim database","authors":"Takashi Saito ,&nbsp;Nozomi Miyagawa ,&nbsp;Kyoko Kanazawa ,&nbsp;Masaki Iwasaki ,&nbsp;Eiji Nakagawa","doi":"10.1016/j.eplepsyres.2024.107455","DOIUrl":"10.1016/j.eplepsyres.2024.107455","url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this epidemiological study was to assess the prevalence, comorbidities, and real-world management of childhood epilepsy to provide insights for enhancing epilepsy management and medical resource planning.</div></div><div><h3>Materials and methods</h3><div>The study encompassed insured individuals aged 0–17 years as of December 2018 who were registered at any point in 2018, for at least part of the year, in a Japanese health claims database spanning January—December 2018. Epilepsy was defined as a diagnosis of epilepsy based on the International Classification of Diseases, 10th Revision codes, and a claimed management fee for epilepsy or an anti-seizure medication (ASM) prescription for longer than 4 weeks. The prevalence of epilepsy, patient characteristics, including comorbidities, and management status, such as prescription of ASMs, were evaluated.</div></div><div><h3>Results</h3><div>Among 1528,905 registered children, 9279 were identified as having epilepsy. The prevalence of epilepsy was the lowest at 1.97 per 1000 population (95 % confidence interval [CI] 1.80–2.15) in the 0–2-year age group and increased with age to 9.34 per 1000 population (95 % CI 8.98–9.72) in the 15–17-year age group, with a significantly higher prevalence in boys than in girls in the ≥12-year age group. ASMs were prescribed to 88.3 %–91.9 % of the patients. Moreover, 27 (0.29 %) patients underwent epilepsy surgery. The frequency of claiming intravenous ASMs and long-term electroencephalogram fees increased with a decrease in age.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that young children receive more medical resources than adolescents and that epilepsy surgery is underutilized. Further investigations will help improve the management of and develop measures against epilepsy.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107455"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum matrix metallopeptidase-9 levels in infantile epileptic spasms syndrome of unknown etiology","authors":"Ryuki Matsuura ,&nbsp;Shin-ichiro Hamano ,&nbsp;Reiko Koichihara ,&nbsp;Rikako Takeda ,&nbsp;Hirokazu Takeuchi ,&nbsp;Yuko Hirata ,&nbsp;Kenjiro Kikuchi ,&nbsp;Akira Oka","doi":"10.1016/j.eplepsyres.2024.107454","DOIUrl":"10.1016/j.eplepsyres.2024.107454","url":null,"abstract":"<div><h3>Purpose</h3><div>Epileptic spasms are the primary symptom of infantile epileptic spasms syndrome (IESS); however, their direct impact on blood–brain barrier (BBB) function is unknown. Matrix metallopeptidase-9 (MMP-9), degrades type IV collagen, a key component of the blood-brain barrier, while tissue inhibitor of metalloproteinase-1 (TIMP-1) suppresses its activity, protecting BBB integrity. This study aimed to assess serum MMP-9 and TIMP-1 levels in patients with IESS of unknown etiology.</div></div><div><h3>Methods</h3><div>We prospectively assessed serum MMP-9 and TIMP-1 levels prior to administering vigabatrin or adrenocorticotropic hormone therapy in patients with IESS of unknown etiology at Saitama Children’s Medical Center between February 2012 and December 2023. We compared these biomarkers between patients with epileptic spasms and age-matched controls and performed a curve regression analysis between the biomarkers and the frequency of epileptic spasms. Additionally, we assessed whether MMP-9 and TIMP-1 levels were diagnostic predictors of IESS.</div></div><div><h3>Results</h3><div>This study included 22 patients with IESS (11 males) and 12 controls. Serum MMP-9 and MMP-9/TIMP-1 ratios were higher in patients with IESS than in controls (<em>p</em> &lt; 0.001 and <em>p</em> = 0.002, respectively). A high frequency of epileptic spasms also led to higher serum MMP-9 levels (y = 0.0871x² + 0.195x + 195.15, <em>R</em>² = 0.77, <em>p</em> &lt; 0.001). Using MMP &gt;188 ng/mL as the cutoff level, the sensitivity for diagnosing IESS was 95.5 %, the specificity was 75.0 %, the positive likelihood ratio was 3.82 (95 % confidence interval (CI) 1.43–10.22), and the relative risk was 8.75 (95 % CI 1.36–56.5).</div></div><div><h3>Conclusion</h3><div>Patients with IESS had elevated serum MMP-9 levels, suggesting an association between epileptic spasms and blood–brain barrier dysfunction. MMP-9 level measurement may be useful for diagnosing suspected patients.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107454"},"PeriodicalIF":2.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Face swapping in seizure videos for patient deidentification","authors":"Chin-Jou Li ,&nbsp;Jen-Cheng Hou ,&nbsp;Chien-Chen Chou ,&nbsp;Yen-Cheng Shih ,&nbsp;Stephane Dufau ,&nbsp;Po-Tso Lin ,&nbsp;Aileen McGonigal ,&nbsp;Hsiang-Yu Yu","doi":"10.1016/j.eplepsyres.2024.107453","DOIUrl":"10.1016/j.eplepsyres.2024.107453","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to test different AI-based face-swapping models applied to videos of epileptic seizures, with the goal of protecting patient privacy while retaining clinically useful seizure semiology. We hypothesized that specific models would show differences in semiologic fidelity compared to the original clinical videos.</div></div><div><h3>Methods</h3><div>Three open-source models, SimSwap, MobileFaceSwap and GHOST were adopted for face-swapping. For every model, an AI generated male and female image were used to replace the original faces. One representative seizure per patient from three patients with epilepsy was chosen (3 seizure videos x 3 AI models x 2 M/F swap) and remade to 18 transformed video clips. To evaluate the performance of the three models, we used both objective (AI-based) and subjective (expert clinician) evaluation. The objective assessment included four metrics for facial appearance and four metrics for facial expression changes. Four experienced epileptologists reviewed the clips and scoring according to deidentification and preservation of semiology. Kruskal-Wallis H test was used for statistical analysis among the models.</div></div><div><h3>Results</h3><div>In the reproduced videos, the swapped face cannot be recognized as the original face, with no significant difference in scores of deidentification either by objective or subjective assessment. Regarding semiology preservation, no significant differences between models were observed in the objective evaluations. The subjective evaluations revealed that the GHOST model outperformed the other two models (<em>p</em>=0.028).</div></div><div><h3>Conclusion</h3><div>This is the first study evaluating AI face swapping models in epileptic seizure video clips. Optimization of AI face-swapping models could enhance the accessibility of seizure videos for education and research while protecting patient privacy and maintaining semiology.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107453"},"PeriodicalIF":2.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0920121124001682/pdfft?md5=fdbd2e70e749c1faff0aabb208404bb7&pid=1-s2.0-S0920121124001682-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosis and schizophrenia among patients with epilepsy: A systematic review and meta-analysis","authors":"Sangharsha Thapa ,&nbsp;Mohammad Yazdan Panah ,&nbsp;Saeed Vaheb ,&nbsp;Krishna Dahal ,&nbsp;Prashanna Man Maharjan ,&nbsp;Sangam Shah ,&nbsp;Omid Mirmosayyeb","doi":"10.1016/j.eplepsyres.2024.107452","DOIUrl":"10.1016/j.eplepsyres.2024.107452","url":null,"abstract":"<div><h3>Background</h3><div>Prior research has indicated an association between epilepsy and psychosis. This review aimed to estimate the global prevalence rate of psychosis and schizophrenia in epilepsy and assess the odds of psychosis and schizophrenia among patients with epilepsy (PWE).</div></div><div><h3>Method</h3><div>A comprehensive literature search was carried out utilizing relevant keywords in PubMed/MEDLINE and Scopus, covering from January 1, 1990, to November 18, 2023. The meta-analysis was performed using R software employing a random-effect model to establish the overall prevalence and odds ratio (OR), with 95 % confidence intervals (95 % CI), of psychosis and schizophrenia in epilepsy.</div></div><div><h3>Result</h3><div>Eighty-one studies encompassing 970,497 PWE met the inclusion criteria. The meta-analysis revealed that the overall prevalence of psychosis and schizophrenia among PWE was 7.8 % (95 % CI: 6.3–9.2 %, I² = 100 %) and 3 % (95 % CI: 1.7–4.3 %, I² = 95 %), respectively. Moreover, epilepsy was associated with a threefold rise in the odds of psychosis (OR = 3.41, 95 % CI: 2.3–5.08, <em>p</em>-value &lt; 0.01, I² = 99 %, <em>p</em>-heterogeneity &lt; 0.01). Furthermore, epilepsy was found to be significantly correlated with a fivefold increased odds of schizophrenia (OR = 5.22, 95 % CI: 2.99–9.11, <em>p</em>-value &lt; 0.01, I² = 94 %, <em>p</em>-heterogeneity &lt; 0.01)</div></div><div><h3>Conclusion</h3><div>Epilepsy can increase the risk of developing psychosis and schizophrenia. Additional longitudinal research is warranted to elucidate the influence of epilepsy and its treatments on the risk of psychosis and schizophrenia, and also a comprehensive suite of confounding adjustments will be requisite.</div></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107452"},"PeriodicalIF":2.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracting seizure control metrics from clinic notes of patients with epilepsy: A natural language processing approach","authors":"Marta Fernandes ,&nbsp;Aidan Cardall ,&nbsp;Lidia MVR Moura ,&nbsp;Christopher McGraw ,&nbsp;Sahar F. Zafar ,&nbsp;M.Brandon Westover","doi":"10.1016/j.eplepsyres.2024.107451","DOIUrl":"10.1016/j.eplepsyres.2024.107451","url":null,"abstract":"<div><h3>Objectives</h3><p>Monitoring seizure control metrics is key to clinical care of patients with epilepsy. Manually abstracting these metrics from unstructured text in electronic health records (EHR) is laborious. We aimed to abstract the date of last seizure and seizure frequency from clinical notes of patients with epilepsy using natural language processing (NLP).</p></div><div><h3>Methods</h3><p>We extracted seizure control metrics from notes of patients seen in epilepsy clinics from two hospitals in Boston. Extraction was performed with the pretrained model RoBERTa_for_seizureFrequency_QA, for both date of last seizure and seizure frequency, combined with regular expressions. We designed the algorithm to categorize the timing of last seizure (“today”, “1–6 days ago”, “1–4 weeks ago”, “more than 1–3 months ago”, “more than 3–6 months ago”, “more than 6–12 months ago”, “more than 1–2 years ago”, “more than 2 years ago”) and seizure frequency (“innumerable”, “multiple”, “daily”, “weekly”, “monthly”, “once per year”, “less than once per year”). Our ground truth consisted of structured questionnaires filled out by physicians. Model performance was measured using the areas under the receiving operating characteristic curve (AUROC) and precision recall curve (AUPRC) for categorical labels, and median absolute error (MAE) for ordinal labels, with 95 % confidence intervals (CI) estimated via bootstrapping.</p></div><div><h3>Results</h3><p>Our cohort included 1773 adult patients with a total of 5658 visits with reported seizure control metrics, seen in epilepsy clinics between December 2018 and May 2022. The cohort average age was 42 years old, the majority were female (57 %), White (81 %) and non-Hispanic (85 %). The models achieved an MAE (95 % CI) for date of last seizure of 4 (4.00–4.86) weeks, and for seizure frequency of 0.02 (0.02–0.02) seizures per day.</p></div><div><h3>Conclusions</h3><p>Our NLP approach demonstrates that the extraction of seizure control metrics from EHR is feasible allowing for large-scale EHR research.</p></div>","PeriodicalId":11914,"journal":{"name":"Epilepsy Research","volume":"207 ","pages":"Article 107451"},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}