Seizure-European Journal of Epilepsy最新文献

{"title":"Deep brain stimulation targets in drug-resistant epilepsy: Systematic review and meta-analysis of effectiveness and predictors of response","authors":"Ahmed Yassin , Leen Al-Kraimeen , Aref Qarqash , Hassan AbuShukair , Obada Ababneh , Salma Al-Aomar , Mohammad Abu-Rub , Khalid Alsherbini","doi":"10.1016/j.seizure.2024.09.017","DOIUrl":"10.1016/j.seizure.2024.09.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Anterior nucleus of the thalamus (ANT) is the only deep brain stimulation (DBS) target that is approved by the FDA for treatment of drug-resistant epilepsy (DRE). Hippocampus (HC) and centromedian nucleus (CMN) have been reported as potential DBS targets for DRE. This study aimed to assess the effectiveness and predictors of response among DRE patients treated with DBS in general and among ANT, HC and CMN DBS-targets.</div></div><div><h3>Methods</h3><div>A systematic search was executed on PubMed, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases between Jan 1, 2000 and June 29, 2020. Patients with DRE who underwent DBS treatment with at least three months of follow-up were included. Individual patient data (IPD) meta-analysis was conducted on DBS studies with available IPD. Response was defined as ≥50 % reduction in seizures frequency. Responders group was compared with non-responders group in terms of demographics, epilepsy/seizure characteristics, MRI findings, and DBS targets and duration of use. Subsequently, predictors of response to different DBS targets were investigated.</div></div><div><h3>Results</h3><div>Thirty-nine studies with a total of 296 patients (ANT: 69 %, HC: 11 %, CMN: 21 %) were included. The responders group constituted of 209 patients (70.6 %). The response was significantly higher in patients with generalized seizures compared to those with focal seizures (93.2% vs 63.9 %; <em>p</em> < 0.001). Response was significantly higher with CMN (83.9 %) and HC (77.4 %) compared with ANT (65.5 %) as DBS targets (<em>p</em> = 0.014). Response was also significantly associated with longer duration of DBS use (<em>p</em> = 0.008). The responder rate was higher among the patients with lesional MRIs (76.7 %) than those with non-lesional MRIs (66.7 %), but with no statistically significant difference (<em>p</em> = 0.134). Age, gender, epilepsy etiology, onset zone of focal seizures, and previous use of VNS had no significant differences between the responders and non-responders. A binary logistic regression including the seizure type, MRI findings, DBS targets, and DBS duration showed, after controlling for confounders, that the duration of DBS use was the only significant predictor of response (adjusted OR 1.061; 95 % CI 1.019–1.106; <em>p</em> = 0.005). Regarding DBS targets, the response rate in patients with symptomatic etiology was significantly higher with HC or CMN targets than the ANT (<em>p</em> = 0.003). In patients with non-lesional MRI, response rate was significantly higher with the CMN target compared to the other two targets (<em>p</em> = 0.008).</div></div><div><h3>Conclusion</h3><div>DBS proves to be effective in DRE, with progressive success upon longer treatment and possibility of improving quality of life. In addition to focal seizures, DBS has potential for treating generalized seizures as well. While the ANT stands as the most utilized and only","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 144-152"},"PeriodicalIF":2.7,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445746","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":"Unraveling the shared genetics of common epilepsies and general cognitive ability","authors":"Naz Karadag ,&nbsp;Espen Hagen ,&nbsp;Alexey A. Shadrin ,&nbsp;Dennis van der Meer ,&nbsp;Kevin S. O'Connell ,&nbsp;Zillur Rahman ,&nbsp;Gleda Kutrolli ,&nbsp;Nadine Parker ,&nbsp;Shahram Bahrami ,&nbsp;Vera Fominykh ,&nbsp;Kjell Heuser ,&nbsp;Erik Taubøll ,&nbsp;Torill Ueland ,&nbsp;Nils Eiel Steen ,&nbsp;Srdjan Djurovic ,&nbsp;Anders M. Dale ,&nbsp;Oleksandr Frei ,&nbsp;Ole A. Andreassen ,&nbsp;Olav B. Smeland","doi":"10.1016/j.seizure.2024.09.016","DOIUrl":"10.1016/j.seizure.2024.09.016","url":null,"abstract":"<div><h3>Purpose</h3><div>Cognitive impairment is prevalent among individuals with epilepsy, and increasing evidence indicates that genetic factors can underlie this relationship. However, the extent to which epilepsy subtypes differ in their genetic relationship with cognitive function, and information about the specific genetic variants involved remain largely unknown.</div></div><div><h3>Methods</h3><div>We investigated the genetic relationship between epilepsies and general cognitive ability (COG) using complementary statistical tools, including linkage disequilibrium score (LDSC) regression, MiXeR and conjunctional false discovery rate (conjFDR). We analyzed genome-wide association study data on COG (<em>n</em> = 269,867) and common epilepsies (<em>n</em> = 27,559 cases, 42,436 controls), including the broad phenotypes ‘all epilepsy’, focal epilepsies and genetic generalized epilepsies (GGE), as well as specific subtypes. We functionally annotated the identified loci using several biological resources and validated the results in independent samples.</div></div><div><h3>Results</h3><div>Using MiXeR, COG (11.2k variants) was estimated to be almost four times more polygenic than ‘all epilepsy’, GGE, juvenile myoclonic epilepsy (JME), and childhood absence epilepsy (CAE) (2.5k – 2.9k variants). The other epilepsy phenotypes were insufficiently powered for MiXeR analysis. We quantified extensive genetic overlap between COG and epilepsy types, but with varying negative genetic correlations (-0.23 to -0.04). COG was estimated to share 2.9k variants with both GGE and ‘all epilepsy’, and 2.3k variants with both JME and CAE. Using conjFDR, we identified 66 distinct loci shared between COG and epilepsies, including novel associations for GGE (27), ‘all epilepsy’ (5), JME (5) and CAE (5). The implicated genes were significantly expressed in multiple brain regions. The results were validated in independent samples (COG: <em>p</em> = 3.62 × 10^–7; ‘all epilepsy’: <em>p</em> = 2.58 × 10^–3).</div></div><div><h3>Conclusion</h3><div>Our study further dissects the substantial genetic basis shared between epilepsies and COG and identifies novel shared loci. An improved understanding of the genetic relationship between epilepsies and COG may lead to the development of novel comorbidity-targeted epilepsy treatments.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 105-112"},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401760","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":"Functional seizure semiology and classification in a public and private hospital","authors":"Gabriele Vilyte ,&nbsp;James Butler ,&nbsp;Victoria Ives-Deliperi ,&nbsp;Chrisma Pretorius","doi":"10.1016/j.seizure.2024.09.020","DOIUrl":"10.1016/j.seizure.2024.09.020","url":null,"abstract":"<div><h3>Purpose</h3><div>Our understanding of potential differences in seizure semiology among patients with functional seizures (FS), also known as psychogenic non-epileptic seizures (PNES), across socioeconomic contexts is currently limited. By examining the differences in seizure manifestations between different socioeconomic groups, we aim to enhance the understanding of how socioeconomic factors may influence FS presentation. This study aimed to describe FS semiology in patients from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa.</div></div><div><h3>Methods</h3><div>The study included patients with FS confirmed through video-electroencephalography (video-EEG) and without comorbid epilepsy. For this retrospective case-control study, data on seizure semiology was gathered from digital patient records, beginning with the earliest available record for each hospital.</div></div><div><h3>Results</h3><div>A total of 305 patients from a private hospital and 67 patients from a public hospital were eligible for the study (<em>N</em> = 372). The private hospital tended to report more akinetic and subjective seizure types when compared to the public hospital. Additionally, patients at the public hospital had higher odds of reporting emotional seizure triggers (aOR=2.57, 95% CI [1.03, 6.37]), loss of consciousness or awareness (aOR=2.58, 95% CI [1.07, 6.24]), and rapid post-event recovery (aOR=6.01, 95% CI [2.52, 14.34]). At the same time, they were less likely to report both short (&lt;30 s) (aOR=0.21, 95% CI [0.08, 0.55]) and long (&gt;5 min) seizures (aOR=0.73, 95% CI [0.13, 0.56]), amnesia for the event (aOR=0.19, 95% CI [0.09, 0.43]), ictal aphasia (aOR=0.33, 95% CI [0.14, 0.76]) or falls and drop attacks (aOR=0.43, 95% CI [0.18, 0.996]), when compared to the private hospital patients.</div></div><div><h3>Conclusion</h3><div>While the seizure manifestations were largely consistent across the two socioeconomic cohorts of patients with FS, some subtle differences were observed and warrant further investigation.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 71-79"},"PeriodicalIF":2.7,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382168","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":"Advancing epilepsy diagnosis: A meta-analysis of artificial intelligence approaches for interictal epileptiform discharge detection","authors":"Jordana Borges Camargo Diniz ,&nbsp;Laís Silva Santana ,&nbsp;Marianna Leite ,&nbsp;João Lucas Silva Santana ,&nbsp;Sarah Isabela Magalhães Costa ,&nbsp;Luiz Henrique Martins Castro ,&nbsp;João Paulo Mota Telles","doi":"10.1016/j.seizure.2024.09.019","DOIUrl":"10.1016/j.seizure.2024.09.019","url":null,"abstract":"<div><h3>Introduction</h3><div>Interictal epileptiform discharges (IEDs) in electroencephalograms (EEGs) are an important biomarker for epilepsy. Currently, the gold standard for IED detection is the visual analysis performed by experts. However, this process is expert-biased, and time-consuming. Developing fast, accurate, and robust detection methods for IEDs based on EEG may facilitate epilepsy diagnosis. We aim to assess the performance of deep learning (DL) and classic machine learning (ML) algorithms in classifying EEG segments into IED and non-IED categories, as well as distinguishing whether the entire EEG contains IED or not.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Web of Science following PRISMA guidelines. We excluded studies that only performed the detection of IEDs instead of binary segment classification. Risk of Bias was evaluated with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Meta-analysis with the overall area under the Summary Receiver Operating Characteristic (SROC), sensitivity, and specificity as effect measures, was performed with R software.</div></div><div><h3>Results</h3><div>A total of 23 studies, comprising 3,629 patients, were eligible for synthesis. Eighteen models performed discharge-level classification, and 6 whole-EEG classification. For the IED-level classification, 3 models were validated in an external dataset with more than 50 patients and achieved a sensitivity of 84.9 % (95 % CI: 82.3–87.2) and a specificity of 68.7 % (95 % CI: 7.9–98.2). Five studies reported model performance using both internal validation (cross-validation) and external datasets. The meta-analysis revealed higher performance for internal validation, with 90.4 % sensitivity and 99.6 % specificity, compared to external validation, which showed 78.1 % sensitivity and 80.1 % specificity.</div></div><div><h3>Conclusion</h3><div>Meta-analysis showed higher performance for models validated with resampling methods compared to those using external datasets. Only a minority of models use more robust validation techniques, which often leads to overfitting.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 80-86"},"PeriodicalIF":2.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382167","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":"Epileptic variant in the spectrum of Alzheimer's disease - practical implications.","authors":"Benjamin Cretin","doi":"10.1016/j.seizure.2024.09.015","DOIUrl":"https://doi.org/10.1016/j.seizure.2024.09.015","url":null,"abstract":"<p><p>Alzheimer's disease (AD) is known to be associated with an increased risk of epilepsy, which is not exclusively related to the late stage of the disease - when a major cognitive impairment is observed, previously known as the dementia stage - but also to its prodromal stage (mild cognitive impairment). Moreover, published case reports and cohorts have shown that epilepsy may occur even earlier, at the preclinical stage of AD: Epileptic seizures may therefore be the sole objective manifestation of the disease. Such a situation is called the epileptic variant of AD (evAD). EvAD is one of the etiologies of late-onset epilepsy, which means that it carries a risk of later progression to dementia and that it can only be diagnosed by assessing amyloid and tau biomarkers. However, evAD is a window of therapeutic opportunity that is probably optimal for preventing, through antiseizure medication treatment, the accelerated cognitive decline associated with AD-related brain hyperexcitability (manifested by seizures or interictal epileptiform activities).</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331055","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":"Associations between epilepsy, respiratory impairment, and minor ECG abnormalities in children","authors":"See Wai Chan ,&nbsp;Angela Chun ,&nbsp;Linh Nguyen ,&nbsp;Beth Bubolz ,&nbsp;Anne E. Anderson ,&nbsp;Yi-Chen Lai","doi":"10.1016/j.seizure.2024.09.011","DOIUrl":"10.1016/j.seizure.2024.09.011","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to examine the effects of acute seizures and respiratory derangement on the cardiac electrical properties reflected on the electrocardiogram (ECG); and to analyze their potential interactions with a diagnosis of epilepsy in children.</div></div><div><h3>Methods</h3><div>Emergency center (EC) visits with seizure or epilepsy diagnostic codes from 1/2011–12/2013 were included if they had ECG within 24 h of EC visit. Patients were excluded if they had pre-existing cardiac conditions, ion channelopathy, or were taking specific cardiac medications. Control subjects were 1:1 age and gender matched. Abnormal ECG was defined as changes in rhythm, PR, QRS, or corrected QT intervals; QRS axis or morphology; ST segment; or T wave morphology from normal standards. We identified independent associations between clinical factors and abnormal ECG findings using multivariable logistic regression modeling.</div></div><div><h3>Results</h3><div>Ninety-five children with epilepsy presented to the EC with seizures, respiratory distress, and other concerns. Three hundred children without epilepsy presented with seizures. There was an increased prevalence of minor ECG abnormalities in children with epilepsy (49 %) compared to the control subjects (29 %) and those without epilepsy (36 %). Epilepsy (OR: 1.61, 95 %CI: 1.01–2.6), need for supplemental oxygen (OR 3.06, 95 % CI: 1.45–6.44) or mechanical ventilation (OR: 2.5, 95 % CI: 1.03–6.05) were independently associated with minor ECG abnormalities. Secondary analyses further demonstrated an independent association between level of respiratory support and ECG abnormalities only in the epilepsy group.</div></div><div><h3>Significance</h3><div>Independent association of increased respiratory support with minor ECG abnormalities suggests a potential respiratory influence on the hearts of children with epilepsy.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 39-44"},"PeriodicalIF":2.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320367","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":"Prediction begins with diagnosis: Estimating seizure recurrence risk in the First Seizure Clinic","authors":"Suyi Ooi ,&nbsp;Chris Tailby ,&nbsp;Naoto Nagino ,&nbsp;Patrick W. Carney ,&nbsp;Graeme D. Jackson ,&nbsp;David N. Vaughan","doi":"10.1016/j.seizure.2024.09.013","DOIUrl":"10.1016/j.seizure.2024.09.013","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the feasibility of using a seizure recurrence prediction tool in a First Seizure Clinic, considering (1) the accuracy of initial clinical diagnoses and (2) performance of automated computational models in predicting seizure recurrence after first unprovoked seizure (FUS).</div></div><div><h3>Methods</h3><div>To assess diagnostic accuracy, we analysed all sustained and revised diagnoses in patients seen at a First Seizure Clinic over 5 years with 6+ months follow-up (‘accuracy cohort’, n = 487).</div><div>To estimate prediction of 12-month seizure recurrence after FUS, we used a logistic regression of clinical factors on a multicentre FUS cohort (‘prediction cohort’, n = 181), and compared performance to a recently published seizure recurrence model.</div></div><div><h3>Results</h3><div>Initial diagnosis was sustained over 6+ months follow-up in 69% of patients in the ‘accuracy cohort’. Misdiagnosis occurred in 5%, and determination of unclassified diagnosis in 9%. Progression to epilepsy occurred in 17%, either following FUS or initial acute symptomatic seizure.</div><div>Within the ‘prediction cohort’ with FUS, 12-month seizure recurrence rate was 41% (95% CI [33.8%, 48.5%]). Nocturnal seizure, focal seizure semiology and developmental disability were predictive factors. Our model yielded an Area under the Receiver Operating Characteristic curve (AUC) of 0.60 (95% CI [0.59, 0.64]).</div></div><div><h3>Conclusions</h3><div>High clinical accuracy can be achieved at the initial visit to a First Seizure Clinic. This shows that diagnosis will not limit the application of seizure recurrence prediction tools in this context. However, based on the modest performance of currently available seizure recurrence prediction tools using clinical factors, we conclude that data beyond clinical factors alone will be needed to improve predictive performance.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 87-95"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394717","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":"Real-world effectiveness and safety of perampanel for children and adolescents with epilepsy: A meta-analysis with at least 1-year follow-up","authors":"Yijun Weng,&nbsp;Bihong Ma,&nbsp;Xi Lin","doi":"10.1016/j.seizure.2024.09.014","DOIUrl":"10.1016/j.seizure.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Perampanel, the first third-generation anti-seizure medication targeting the AMPA receptor, has been used in the treatment of patients with focal seizures, with or without secondary generalized seizures, and primary generalized tonic-clonic seizures. This study focused on the effectiveness and safety of perampanel for pediatric patients with at least 1-year follow-up in real-world settings.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, EMBASE, and Web of Science for real-world studies published before April 27, 2024. The data of interest were extracted and analyzed using the R software (version 4.2.1).</div></div><div><h3>Results</h3><div>From 1181 retrieved citations, 25 records involved a total of 2985 individuals were included in the meta-analysis. The 50 % responder rate pooled from the 22 studies yielded an overall 55.0 % (95 % CI: 46.1–63.8 %), with significant evidence of between-study heterogeneity (I² = 93 %, <em>P</em> &lt; 0.01, τ² = 0.038). The seizure-free rate pooled from 22 studies yielded an overall rate of 28.9 % (95 % CI: 19.6–39.1 %). Twenty studies reported the retention rate of perampanel treatment with a pooled proportion was 71.1 % (95 % CI: 61.1–80.2 %). The estimate of the adverse events incidence rate pooled from the 23 studies yielded an overall 29.0 % (95 % CI: 23.4–34.9 %). Subgroup analyses were conducted based on follow-up time (12 months or ≥ 24 months).</div></div><div><h3>Conclusion</h3><div>Perampanel is generally well tolerated and effective in the treatment of epilepsy in children and adolescents with mid-long-term follow-up. The 50 % responder rate in children and adolescents improved with time. The retention rate and the seizure-free rate during at least 24 months of follow-up were not as sustained as those in 12 months of follow-up. Adverse events, particularly psychiatric and behavioral, should be monitored during clinical practice administration.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 96-104"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394718","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":"Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome.","authors":"Mary Nyakato, Shubaya Kasule Naggayi, Pamela Rosemary Akun, Sam Ononge, Alfred Odong, Erias Adams Baguma, Hellen Nansiiro, Dennis Kalibbala, Simple Ouma, Innocent Besigye, Richard Idro","doi":"10.1016/j.seizure.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.seizure.2024.09.012","url":null,"abstract":"<p><strong>Introduction: </strong>Nodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour.</p><p><strong>Objectives: </strong>The study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome.</p><p><strong>Methods: </strong>A comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes.</p><p><strong>Results: </strong>Overall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted.</p><p><strong>Conclusion: </strong>Children whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.</p>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331056","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":"Preliminary observation on clinical outcome and safety of surgery in early infants (<12 months) with drug-resistant epilepsy","authors":"Yi-Di Liu ,&nbsp;Feng-Jun Zhu ,&nbsp;Yan Chen ,&nbsp;Lin Li ,&nbsp;Hua-Fang Zou ,&nbsp;Yang Sun ,&nbsp;Chun Lin ,&nbsp;Cong Li ,&nbsp;Ze-Shi Tan ,&nbsp;Xiao-Fan Ren ,&nbsp;De-Zhi Cao","doi":"10.1016/j.seizure.2024.09.009","DOIUrl":"10.1016/j.seizure.2024.09.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To investigate the clinical outcomes and safety of surgery in infants (&lt; 12 months of age) with drug-resistant epilepsy, clarify surgical indications, and select appropriate surgical methods.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This was a retrospective analysis of infants with drug-resistant epilepsy who underwent epilepsy surgery and were followed up for &gt; 6 months at the Epilepsy Center of Shenzhen Children's Hospital. Clinical data included etiology, seizure type, surgical procedure, preoperative auxiliary examinations, pathological findings, and intraoperative and postoperative complications. Clinical outcomes were assessed based on postoperative seizure frequency, antiseizure medicines (ASMs) use, and neurocognitive development. Intraoperative blood loss, operative duration, postoperative complications, and duration of intensive care were evaluated to assess the safety of epilepsy surgery. Univariate and logistic analyses were performed to explore the factors influencing prognosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Epilepsy surgery was performed on 44 infants with drug-resistant epilepsy, including 7 patients who underwent two operations. The age of seizure onset ranged from 1 day to 11 months (median: 1 month, interquartile range (IQR): 0.1–3.8), the disease course was 1–11 months (median: 4 months, IQR: 2–7), and the age at surgery was 6.9 ± 3.6 months. Twenty-three patients underwent hemispherectomy (52.3 %), and two underwent subtotal hemispherectomy. Five patients underwent multilobar disconnection, five underwent frontal lobotomy, and the remaining nine underwent focal resection. The surgical duration was 7.5 ± 2 h. Intraoperative blood loss ranged from 50 to 1800 ml (median: 275 ml, IQR: 200–500), with all patients receiving an intraoperative blood transfusion of 0.5–6 U (median: 1.5 U, IQR: 1.5–3). The intensive care unit stay was 1–4 days (median: 1 day, IQR: 1–2). The postoperative complication rate was 13.6 % (6/44; two cases of hydrocephalus with intracranial infection, two isolated hydrocephalus, and two subdural hematomas). Excluding one child who died of severe lung infection approximately one year after surgery and one child lost to follow-up after surgery, all other cases were regularly followed up for 10 –49 months (median: 30 months, IQR: 16.5–36). After surgery, patients were treated with 0–3 ASMs (median: 1 ASM, IQR: 0–2); 27.9 % (12/43) stopped taking ASMs and 51.2 % (22/43) had reduced number of ASMs. Engel I was achieved in 76.7 % (33/43) of the patients at the last follow-up. In 17 cases with complete developmental quotient follow-up data, the preoperative and postoperative developmental quotient means were 28.8 ± 21 and 43.2 ± 20.1, showing statistically significant differences (&lt;em&gt;p&lt;0.05&lt;/em&gt;)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Significance&lt;/h3&gt;&lt;div&gt;Epilepsy surgery in infants under 12 months of age is safe and effective. Early preoperative evaluation is crucial for identifying structural","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"122 ","pages":"Pages 165-171"},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511657","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}