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Epilepsy & Behavior
Journal Prestige (SJR): 1.131
Citation Impact (citeScore): 2
Number of Followers: 12  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1525-5050 - ISSN (Online) 1525-5069
Published by Elsevier Homepage  [3168 journals]
  • Microgliosis is associated with visual memory decline in patients with
           temporal lobe epilepsy and hippocampal sclerosis: A clinicopathologic
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Eliana Cristina de Brito Toscano, Érica Leandro Marciano Vieira, Ana Carolina Diniz Carvalho Portela, Marcelo Vidigal Caliari, Joseane Aparecida Sousa Brant, Alexandre Varella Giannetti, Claudia Kimie Suemoto, Renata Elaine Paraizo Leite, Ricardo Nitrini, Milene Alvarenga Rachid, Antônio Lúcio TeixeiraAbstractHippocampal sclerosis (HS) is characterized by neuronal loss and gliosis. The intensity and distribution of these histopathological findings over the Cornu Ammonis (CA) subfields are important for the classification of HS and prognostication of patients with temporal lobe epilepsy (TLE). Several studies have associated the neuronal density reduction in the hippocampus with cognitive decline in patients with TLE. The current study aimed at investigating whether the expression of glial proteins in sclerotic hippocampi is associated with presurgical memory performance of patients with TLE. Before amygdalohippocampectomy, patients were submitted to memory tests. Immunohistochemical and morphometric analyses with glial fibrillary acidic protein (GFAP) for astrogliosis and human leucocyte antigen DR (HLA-DR) for microgliosis were performed in paraffin-embedded HS and control hippocampi. Sclerotic hippocampi exhibited increased gliosis in comparison with controls. In patients with TLE, the area and intensity of staining for HLA-DR were associated with worse performance in the memory tests. Glial fibrillary acidic protein was neither associated nor correlated with memory test performance. Our data suggest association between microgliosis, but not astrogliosis, with visual memory decline in patients with TLE.
  • Optimizing therapies for neurobehavioral comorbidities of epilepsy using
           chronic ambulatory electrocorticography
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Alexandra T. Issa Roach, Ganne Chaitanya, Kristen O. Riley, Wolfgang Muhlhofer, Sandipan PatiAbstractThere is an unmet need to improve therapy for neuropsychiatric comorbidities that are highly prevalent in persons with epilepsy (PWE). However, diagnosing and monitoring the neurobehavioral symptoms is challenging as their presentation can overlap with seizures. In this retrospective study, we report the advantage of chronic ambulatory electrocorticography (ECoG) from implanted Responsive Neurostimulator System (RNS®) in characterizing these psychosomatic paroxysms as a possible ictal, postictal, or interictal phenomenon and how the diagnosis guided the therapy choices. Five out of 21 patients with RNS had neuropsychiatric symptoms (panic attack, psychosis, conversion, and somatization disorders) that overlapped with their seizure semiology and were found to benefit from the use of RNS ECoG data by timely diagnosing and titrating targeted therapies. The cases illustrate the use of RNS ECoG data in diagnosing and improving the management of comorbidities in PWE. The ability to access RNS ECoG data and correlate it with patient symptoms is unique among available therapeutic options for PWE.
  • Impact of epilepsy on language and discourse: Two self-limited focal
           epileptic syndromes of childhood
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Merve Savaş, Aylin Müge Tunçer, Ayşe Özlem Çokar, Ahmet Veysi Demirbilek, Erdem TüzünAbstractSelf-limited focal epilepsy with centro-temporal spikes, also known as Rolandic epilepsy (RE), is a well-established focal epilepsy of childhood, characterized with language impairment. To investigate the relationship between language deficits and clinical parameters of self-limited focal epilepsies of childhood (SFEC), 21 patients with RE, 10 patients with childhood occipital epilepsy of Gastaut type (COE-G) (another SFEC that is not typically associated with language impairment), and 31 healthy controls were recruited. A broad panel of language tests also including narration sample was administered, and clinical features were documented. The language was significantly impaired in both RE and COE-G. Patients with COE-G showed worse scores than patients with RE in subtests measuring semantic functions. Clinical parameters were not associated with impaired language domains. Language impairment is experienced in different types of SFEC, emphasizing the broad representation of the language network. In SFEC, recent activity of epilepsy does not affect the severity of language dysfunction.
  • Epilepsy treatment gap and stigma reduction in Pakistan: A tested public
           awareness model
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Zarine Mogal, Hasan AzizAbstractHigh epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
  • Does the new Korean term for epilepsy reduce the stigma for Korean adults
           with epilepsy'
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Sang-Ahm Lee, Su-Hyun Han, Yang-Je Cho, Keun Tae Kim, Ji-Eun Kim, Dong Jin Shin, Jong-Geun Seo, Young-Soo Kim, Han Uk Ryu, Seo-Young Lee, Jung Bin Kim, Kyung-Wook Kang, Shinhye Kim, Soonhak Kwon, Joonsik Kim, Sunjun Kim, Hyo Jeong Kim, So-Hee Eun, Yun Jung Hur, Sun Ah ChoiAbstractPurposeThe purpose of this study was to evaluate differences in stigma, disclosure management of epilepsy, and knowledge about epilepsy between patients with epilepsy who recognized and did not recognize the new Korean term for epilepsy.MethodsThis was a cross-sectional, multicenter study. The Stigma Scale-Revised, the Disclosure Management Scale, the Patient Health Questionnaire-9, and a questionnaire assessing knowledge about epilepsy were used. The set of questionnaires had two versions, using either the old or new name for epilepsy. Multivariate logistic regression analyses were used.ResultsA total of 341 patients with epilepsy and 509 family members were recruited. Approximately 62% of patients felt some degree of epilepsy-related stigma. Mild stigma, severe concealment of epilepsy diagnosis, and increased knowledge about epilepsy were independently identified as factors associated with recognition of the new term in patients. Recognition of the new term was more prevalent in patients and family members with higher education, female family members, and family members having patients with younger age at seizure onset and shorter duration of epilepsy. There were no significant differences between the two types of questionnaires. About 81% of patients and 93% of family members had a positive attitude about renaming epilepsy.ConclusionThe use of the new Korean term for epilepsy (cerebroelectric disorder) increased knowledge about epilepsy but did not reduce stigma and concealment of epilepsy diagnosis in Korean adults with epilepsy. Higher education may be an important factor for knowing the new term in patients and family members.
  • Factors associated with obsessive–compulsive symptoms in people with
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Soo Jeong Kim, Sang-Ahm Lee, Han Uk Ryu, Su-Hyun Han, Gha-hyun Lee, Kwang-Deog Jo, Jung Bin KimAbstractPurposeObsessive–compulsive disorder (OCD) is a common but underrecognized psychiatric condition comorbid with epilepsy. We thus investigated clinical factors associated with obsessive–compulsive symptoms (OCS) in adults with epilepsy.MethodsThis was a cross-sectional multicenter study in Republic of Korea. Obsessive–compulsive symptoms were assessed using the Obsessive–Compulsive Inventory—Revised (OCI-R). Clinical factors that were assessed included age, sex, seizure-related variables, and the number and use of antiepileptic drugs (AEDs) prescribed. Data were analyzed by stepwise linear regression and adjusted according to anxiety and depressive symptoms as assessed by Hospital Anxiety Depression Scale (HADS).ResultsThe study population comprised 221 adults with epilepsy (42.1% male, 39.7 ± 11.9 years of age). The mean OCI-R score was 18.0 (standard deviation, 12.7), and an OCI-R score of ≥ 21 was obtained for 40.3% of the study sample. On a stepwise linear regression analysis, epilepsy severity, temporal lobe seizures, the use of topiramate, and the use of lamotrigine were identified as independent factors associated with OCI-R score after adjusting for anxiety according to the HADS. All factors except topiramate usage were positively associated with OCS. The total explained variance was 37.3%.ConclusionsObsessive–compulsive symptoms are common in persons with epilepsy and are associated with severe epilepsy, temporal lobe seizures, and the use of topiramate and lamotrigine. Specifically, the use of lamotrigine may aggravate OCS, whereas the use of topiramate may have beneficial effects on OCS.
  • Outcome of prolonged video-EEG monitoring in a new VA monitoring unit
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Ushtar Amin, Selim R. Benbadis, Alfred T. FronteraAbstractBackground and objectiveFor patients with refractory seizures or seizure-like activity, prolonged inpatient video-electroencephalography (EEG) (v-EEG) is standard of care to guide diagnosis and management. The purpose of this study was to describe the outcome of v-EEG in a new Veterans' Administration (VA) hospital epilepsy monitoring unit (EMU).MethodsWe reviewed all prolonged (> 24 h) inpatient v-EEGs performed in our EMU (2 beds) at the James A Haley VA in Tampa, FL over a five-and-a-half-year period (11/2013–07/2019). A total of 216 prolonged v-EEGs were performed. The patient population consisted of adult veterans (185 males, 31 females) ranging from 21 years to 89 years old (mean 52.5). The duration of monitoring ranged from 24 h to 9 days (mean 3.6 days).ResultsOf the 216 studies, 39 (18%) exclusively had epileptic seizures (ES). Of these, 37 (95%) had focal seizures, and 2 (5%) had generalized seizures. Of the 37 cases with focal seizures, all but 2 had clear ictal changes on EEG. Eighteen (8.5%) EEG studies revealed interictal epileptiform abnormalities without a clinical event. Sixty-eight (31.5%) of the v-EEGs had exclusively nonepileptic events (NEE). Of these, 27 (12.5%) were psychogenic nonepileptic seizures (PNES), and 41 (19%) were other NEE. Ninety-one (42%) of the studies were inconclusive, either because of lack of events captured (63) or because the events recorded were not the patient's typical episodes (27).SignificanceCompared to non-VA series, we found a lower proportion of PNES, and a higher proportion of inconclusive studies.
  • Differences in obsessive–compulsive symptom dimensions between patients
           with epilepsy with obsessive–compulsive symptoms and patients with OCD
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Esin Evren Kilicaslan, H.Sabiha Türe, Meltem İzci Kasal, Nebile Nur Çavuş, Dilek Altın Akyüz, Galip Akhan, Lutfullah BesirogluAbstractClinical correlates of obsessive–compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive–Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale–Brown Obsessive–Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive–compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group.As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS.This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD.
  • Praxis induction and its relationship with cognition in genetic
           generalized epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Belén Abarrategui, Beatriz Parejo-Carbonell, Maria Eugenia García García, Antonio Gil-Nagel, Irene García-MoralesAbstractIntroductionPraxis induction (PI) is a reflex trait defined as the precipitation of epileptic discharges (ED) or seizures by cognition-guided tasks that often involve visuomotor coordination and decision-making. This is a characteristic of genetic generalized epilepsy (GGE), and especially of juvenile myoclonic epilepsy (JME). Additionally, several studies have described dysexecutive traits in these patients. Our objective was to analyze PI in the different syndromes of GGE and explore the relationship between PI and cognitive performance.MethodsSixty-one adult patients with GGE underwent video-electroencephalograph (EEG) during which a neuropsychological activation protocol (NPAP) was performed: reading, writing, calculations, crosswords, and tangram. Praxis induction was defined by the presence of ED during the NPAP with a persistence of at least twice seen on the basal EEG. All patients also underwent a comprehensive cognitive evaluation.ResultsWe observed PI in 22 out of 61 patients (36%). Grouped by syndrome, PI was more frequent in adult patients with persistent childhood or juvenile absence epilepsy (JAE, 60%), followed by JME (42.1%) and in a lesser grade in patients with only tonic–clonic generalized seizures (9%). Patients classified as having PI did not obtain worse results in the cognitive evaluation. The presence of ED during the performance of a test was associated with a trend to lower results in that specific test.SignificanceOur study showed a relevant presence of PI in patients whose absence epilepsy persists into adulthood, and not only in JME, the syndrome classically associated with PI. According to our results, PI as a reflex trait does not imply necessarily a poorer cognitive phenotype, but the induction of frequent ED during the tasks could be associated with transient cognitive impairment.
  • Autonomic dysregulation in children with epilepsy with postictal
           generalized EEG suppression following generalized convulsive seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Kazuo Okanari, Shinsuke Maruyama, Hiroharu Suzuki, Takashi Shibata, Elizabeth Pulcine, Elizabeth J. Donner, Hiroshi OtsuboAbstractObjectivePostictal generalized electroencephalographic suppression (PGES) has been associated with sudden unexpected death in epilepsy (SUDEP) in adults. Decreased heart rate variability (HRV) is one clinical marker of SUDEP in adults with epilepsy. The objective of this study was to analyze the characteristics of HRV associated with generalized convulsive seizures (GCS) ± PGES in children.MethodsNine hundred and seventy-seven consecutive children who underwent prolonged scalp video-EEG (vEEG) and 1-lead electrocardiogram (ECG) monitoring at the Hospital for Sick Children, Toronto, Ontario, Canada were reviewed retrospectively from 2009 to 2011. Thirty-five children had GCS captured during their vEEG with or without PGES and met inclusion criteria. Children were subdivided into three age groups and compared with age-matched controls: 3–6 years; 7–12 years; and 13–18 years. Interictal HRV was measured at 5 min during N2 sleep. Preictal HRV was measured at 1 h prior to GCS onset, and postictal HRV was measured at 3 min post-GCS cessation. Low frequency (LF: ms2, 0.04–0.15 Hz) and high frequency (HF: ms2, 0.15–0.4 Hz) bands of heart rate oscillations were analyzed during the interictal and preictal periods. The root mean square of successive differences (RMSSDs) was analyzed during the following time points: interictal; preictal; and postictal.ResultsThirty-five children had GCS: 18 children with PGES [3–6 years (n = 2); 7–12 years (n = 6); 13–18 years (n = 10)] and 17 children without PGES [3–6 years (n = 6); 7–12 years (n = 5); 13–18 years (n = 6)]. Seventeen additional age-matched controls were identified [3–6 years (n = 3); 7–12 years (n = 5); 13–18 years (n = 9)]. Seventy-four GCS were captured consisting of 36 GCS + PGES and 38 GCS − PGES. There was no difference of interictal HRV among children with GCS ± PGES and controls. The preictal LF and HF in 36 GCS + PGES were significantly higher compared with 38 GCS − PGES (p 
  • Treatment with CCR2 antagonist is neuroprotective but does not alter
           epileptogenesis in the pilocarpine rat model of epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Maira Licia Foresti, Gabriel Maisonnave Arisi, James J. Campbell, Luiz E. MelloAbstractNeuroinflammation role on epileptogenesis has been the subject of increasing interest. Many studies showed elevation in cytokines and chemokines expression following seizures, such as, CCL2 protein (C-C motif ligand 2 chemokine) and its specific receptor, CCR2. In addition, recent studies manipulating the CCL2/CCR2 complex verified improved seizure outcome in different seizure models. In the present study, the effects of CCR2 antagonist was investigated using the pilocarpine rat model of epilepsy. Status epilepticus (SE) was induced by pilocarpine i.p. injection in adult rats. Daily oral treatment with CCR2 antagonist or vehicle was initiated 5 h following SE and lasted 5 or 10 days. Rats were euthanized 5 days after SE to evaluate neuronal damage and glial density or 30 days after SE to investigate spontaneous seizures development and seizure susceptibility to a second hit pentylenetetrazol (PTZ) test. Rats that received CCR2 antagonist presented less degenerating cells at hippocampal CA1 region. There was also a significant decrease in CA1 volume after SE that was not observed in treated rats. On the other hand, microglia cell density increased after SE regardless of CCR2 antagonist use. Treatment with CCR2 antagonist did not alter spontaneous seizure occurrence or later seizure susceptibility to PTZ in chronic rats. Additional rats were pretreated with CCR2 antagonist prior to SE induction, but this did not change SE progression. The data show that oral treatment with CCR2 antagonist is neuroprotective, but does not alter other epileptogenic factors, such as, neuroinflammation, or seizure development, after pilocarpine-induced SE in rats.
  • Facilitating ethical, legal, and professional deliberations to resolve
           dilemmas in daily healthcare practice: A case of driver with breakthrough
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Ramzi ShawahnaObjectiveThe present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures.MethodsA hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action.ResultsIn this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value 
  • Clinical characteristics of psychogenic nonepileptic seizures across the
           lifespan: An international retrospective study
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Tyson Sawchuk, Ali A. Asadi-Pooya, Lorna Myers, Kette D. Valente, Anilu Daza Restrepo, Luciana D' Alessio, Maryam Homayoun, Zahra Bahrami, Rudá Alessi, Angélica Aroni Paytan, Silvia Kochen, Firas Taha, Lorraine M. Lazar, Susannah Pick, Timothy R. Nicholson, Jeffrey BuchhalterAbstractPurposePrevious studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries.MethodsIn this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood).ResultsA total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [x¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x¯ = 24, sd = 36) or adult-onset groups (x¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010).ConclusionWhile PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES.
  • Exploring the genetic overlap between psychiatric illness and epilepsy: A
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Ciarán Campbell, Gianpiero L. Cavalleri, Norman DelantyAbstractThere is a long-documented epidemiological link between epilepsy and psychiatric disorders. People with epilepsy are at an increased risk for a variety of psychiatric illnesses, as are their family members, and people with epilepsy may experience psychiatric side effects because of their antiepileptic drugs (AEDs). In recent years, large-scale, collaborative international studies have begun to shed light on the role of genetic variation in both epilepsy and psychiatric illnesses, such as schizophrenia, depression, and anxiety. But so far, finding shared genetic links between epilepsy and psychiatric illness has proven surprisingly difficult. This review will discuss the prevalence of psychiatric comorbidities in epilepsy, recent advances in genetic research into both epilepsy and psychiatric illness, and the extent of our current knowledge of the genetic overlap between these two important neurobiological conditions.
  • Enhancing quality of life among epilepsy surgery patients: Interlinking
           multiple social and relational determinants
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Patti Shih, Emilie Francis-Auton, Armin Nikpour, Geoffrey Herkes, Andrew Bleasel, Frances RapportAbstractBackgroundAchieving seizure control through resective brain surgery is a major predictor of improved quality of life (QOL) among people with refractory (drug-resistant) epilepsy. Nevertheless, QOL is a comprehensive and dynamic construct, consisting of broad dimensions such as physical health, psychosocial well-being, level of independence, social relationships, and beyond. This study highlights the interlinkage and complementarity of these diverse dimensions, and how in practice, patients, clinicians, and others in a social support system can actively promote QOL among surgery patients.MethodTwenty-one qualitative in-depth interviews with patients with refractory epilepsy who are either undergoing presurgical assessment or postsurgery follow-up were conducted, to consider their perspective on QOL in relation to their experience of illness and surgical treatment. Data were thematically analyzed, resulting in three key thematic findings.Results(1) A myriad of QOL dimensions are highly interrelated and interdependent with mutual ‘spin-off’ effects: Uncontrolled seizures impacted beyond physical and cognitive health, disrupting important social identities such as being successful parents, spouses, and career professionals. The desire for good clinical outcomes from surgery was justified against the need to mitigate these social and personal concerns. (2) In postsurgery care, there were complementary effects of clinical interventions and social factors on patients' QOL. Psychosocial well-being was supported by a combination of improved physical health, self-confidence, psychological interventions, and social support from employers and educators who were sensitive to patients' specialized needs. (3) Engaging in education, employment, and government services influenced not only socioeconomic well-being, but also a sense of social inclusion. Advocacy made on behalf of patients by clinicians and family members has helped to better manage patients' eligibility for social services provision.ConclusionQuality of life is achieved through a comprehensive and interactive social process, and not simply an outcome measure of clinical treatment. The responses and interactions of many others within the patients' life and treatment process, including family members, clinicians, and social service workers, can culminate to influence QOL, highlighting the importance of a relational and social determinants perspective in patient care.
  • Patients' experience of wearing multimodal sensor devices intended to
           detect epileptic seizures: A qualitative analysis
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Sara Katherine Simblett, Andrea Biondi, Elisa Bruno, Dominic Ballard, Amanda Stoneman, Simon Lees, Mark P. Richardson, Til Wykes, for the RADAR-CNS consortiumAbstractBackgroundThe health management of patients with epilepsy could be improved by wearing devices that reliably detect when epileptic seizures happen. For the devices to be widely adopted, they must be acceptable and easy to use for patients, and their views are very important. Previous studies have collected feedback from patients on hypothetical devices, but very few have examined experience of wearing actual devices.PurposeThis study assessed the first-hand experiences of people with epilepsy using wearable devices, continuously over a period of time. The aim was to understand how acceptable and easy they were to use, and whether it is reasonable to expect that people will use them.Materials and methodsAdults with a diagnosis of epilepsy admitted routinely to a hospital epilepsy monitoring unit were asked to wear one, or more, wearable biosensor devices, tested for seizure detection. The devices are designed to continuously monitor and record signals from the body (biosignals). Participants completed semistructured interviews about their experiences of wearing the device(s). A systematic thematic analysis extracted themes from the interviews, focusing on acceptability and usability. Feedback was organized into (1) participants' experiences of the devices, any support they required and reasons for stopping wearing them; (2) their thoughts about using this technology outside a hospital setting.ResultsTwenty-one people with epilepsy wore one, or more, wearable devices for an average of 112.81 (SD = 71.83) hours. Participants found the devices convenient, and had no problem wearing them in hospital or sharing the data collected from them with the researchers and medical professionals. However, the presence of wires, bulky size, discomfort, and need for support, moderated experience. Participants' thoughts about wearing them in everyday life were strongly influenced by how visible and perceived accuracy. Willingness to use a smartphone app to complete questionnaires depended on the frequency, number of questions, and support.ConclusionsOverall, this work provides evidence about the feasibility and acceptability of using wearable devices to monitor seizure activity in people with epilepsy. Key barriers and facilitators to use while in hospital and hypothetical use in everyday life were identified and will be helpful for guiding future implementation.
  • Margiad Evans (1909–1958): A writer's epileptic experiences and
           their reflections in her work
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Peter WolfAbstractMargiad Evans, in the period 1930–1950, an acclaimed English writer, developed convulsive seizures at age 41 and died at age 50 from the tumor that had caused them. In her book “A Ray of Darkness”, she describes in profound analytic detail her seizure experiences, especially the isolated auras that had preceded her first convulsion by many years. Their ultimate strangeness echoed a long-standing fascination by the indescribable, which is a recurrent theme in her literary work. Another aspect of her poetry, a focus on the experience of the moment that cannot be retained is likewise reminiscent of the volatility of her aura experiences.Of three texts that are presently being published posthumously, one (“The Nightingale Silenced”) is a fragmentary continuation of her epileptic experience. She considered that she still had a lot to describe, contributing the inside of the “outside inside story” of epilepsy, clues on which neurology could work to obtain a deeper understanding. To have a focal motor seizure feels like being invaded by an alien force. An urge to run and heautoscopy are other recorded symptoms. Evans documents the experience of a long-lasting, predominantly nonconvulsive status epilepticus merging into aura continua where her earlier aura experiences appear transformed into a quasipsychotic state. But even in the account of “this appalling, this hellish condition”, she is careful to maintain her high literary standards. Together, the two reports on her disease seem to represent the only comprehensive inside case history of epilepsy, a most valuable legacy.
  • Psychological distress symptoms and illness perception in patients with
           epilepsy in Northwest Greece
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Eleftheria Siarava, Sofia Markoula, Sygkliti-Henrietta Pelidou, Athanassios P. Kyritsis, Thomas HyphantisAbstractObjectiveThe purpose of the present study was to compare psychological distress between patients with epilepsy and healthy controls and to evaluate potentially related factors to psychological distress in patients with epilepsy. Furthermore, we assessed how psychological distress and other potential factors mediate illness perception in patients with epilepsy in an urban area of Northwest Greece.Materials and methodsA case–control study was conducted in adult patients with epilepsy followed up at the University Hospital of Ioannina and in healthy controls. The Symptom Checklist—90 Revised (SCL-90R) for symptoms of psychological distress and the overall psychological distress Global Severity Index (GSI) evaluation, the brief illness perception questionnaire (B-IPQ), and the Adverse Event Profile (AEP) questionnaire for the antiepileptic drugs (AEDs) were used.ResultsSeventy patients with epilepsy and 70 controls were recruited in the study. Somatic, depression, and anxiety symptoms and the GSI were higher in patients than in controls. In patients with epilepsy, the AEP score was significantly associated with psychological distress.Illness perception was associated with the number and the total number of administered AEDs; the AEP score; somatic, obsessive, depressive, and anxiety symptoms; and the GSI. After regression analysis, epilepsy characteristics, AEDs, and psychological distress accounted for 11.7%, 28.7%, and 5.5% of variance in BIP-Q score, respectively.ConclusionScreening for psychological distress in patients with epilepsy is of high importance in clinical practice as somatic, depression, and anxiety symptoms and overall psychological distress are more severe in patients with epilepsy than in healthy controls. The symptoms of psychological distress are strongly associated with the adverse effects of AEDs. The epilepsy characteristics, the AEDs, and the psychological distress could determine a large part of illness perception in epilepsy, with the adverse effects of AEDs being the strongest predictor.
  • Considerations in developing a specialized epilepsy employment program: A
           sponsor's playbook
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Robert T. Fraser, Brian T. McMahon, Amber Wiggins, Aly Clift, Stephanie Hunter-BanksAbstractSpecialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.
  • Risk of readmission for injury in patients with epilepsy in the United
           States – A population-based study
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Churl-Su Kwon, Parul Agrawal, Jonathan Goldstein, Mandip Dhamoon, Madhu Mazumdar, Nathalie JettéAbstractObjectiveThe objective of this study was to determine the 30-day injury readmission risk among persons with epilepsy vs. without epilepsy using a nationally representative US database. Secondary objectives were to examine the factors associated with injury-related readmissions among those with epilepsy and identify specific causes of readmissions within 30 days of index admission.MethodsHospitalized individuals of all ages with epilepsy as the primary diagnosis were identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in the 2014 Nationwide Readmission Database (NRD). Primary outcome was 30-day readmission for an injury defined by ICD-9-CM diagnosis codes following discharge from index hospitalization. Subgroup differences in the groups with epilepsy and without epilepsy were estimated using standardized mean difference scores that are calculated with means and variances of the covariates. Multinomial logistic regressions were conducted to determine the 30-day injury readmission risk and examine the factors associated with injury-related readmissions.ResultsThere were 60,074 unique persons with epilepsy (mean age: 42.53 years, female: 49.32%) and 9,282,952 without epilepsy (mean age: 44.46 years, female: 59.43%). A higher proportion of persons with epilepsy (n = 215, 0.34%) vs. without epilepsy (n = 22,783, 0.22%) had a 30-day readmission due to an injury. After adjusting for covariates, persons with epilepsy had higher odds of 30-day readmission due to an injury (adjusted OR: 1.40, 95% CI: 1.20–1.62, p 
  • Investigation of knowledge and attitudes of military nurses about epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Esra Yildiz, Elif SaraçAbstractBackgroundThe knowledge and attitudes of military nurses are important for the quality of care of the individuals they care for.AimThis descriptive study aimed to determine the knowledge and attitudes of military nurses towards epilepsy.MethodAn introductory information form, an epilepsy knowledge scale, and an epilepsy attitude scale were used to collect data from 115 military nurses through social media.ResultsThe average score of the epilepsy knowledge scale was 14.04 ± 2.25, and that of the epilepsy attitude scale was 57.23 ± 4.39. While education, marital status, and having a relatives who are patients with epilepsy (PWE) did not affect knowledge and attitudes, encountering an epileptic seizure affected attitudes.ConclusionThe knowledge of military nurses regarding epilepsy was high, and their attitudes towards the illness were positive.
  • A patient-centered approach to understanding long-term psychosocial
           adjustment and meaning-making, 15 to 20 years after epilepsy surgery
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Honor Coleman, Anne McIntosh, Sarah J. WilsonAbstractObjectiveDifferent psychosocial trajectories have been identified following treatment with epilepsy surgery, as patients adjust to possible changes in seizure frequency and the subsequent impact on their psychosocial functioning. Qualitative research has been key to understanding this adjustment process, particularly in the short-term (2–5 years). Currently, however, there is a lack of qualitative research examining longer-term (> 15 years) outcomes, precluding the same rich, detailed understanding of longer-term psychosocial outcomes. Using a grounded theory approach, we explored how patients reflected on and made sense of their adjustment trajectories, 15 to 20 years after surgery. This included the impact of surgery on their sense of self and broader psychosocial functioning.MethodsWe recruited 40 adult patients who had undergone anterior temporal lobectomy (ATL) 15 to 20 years ago (24 females; 26 left-sided). Median age at habitual seizure onset was 9.7 years (Interquartile range; IQR = 13.8), and at surgery was 31 years (IQR = 12). Median length of follow-up was 18.4 years (IQR = 4.3). Comprehensive one-on-one interviews (median time = 86 min, IQR = 28) were used to elicit patient experiences of their surgery and subsequent psychosocial outcomes. Data were analyzed using a grounded theory inductive–deductive process.ResultsPatient narratives revealed a common process of psychosocial change and meaning-making triggered by surgery, which was often perceived as a major turning point in life. Patients reflected on moving through an early postsurgical period (
  • Negotiating the boundaries of the medical model: Experiences of people
           with epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Stephanie Kılınç, Carol Campbell, Alison Guy, Anna van WerschAbstractPeople with epilepsy (PWE) continually report dissatisfaction with the support they receive, particularly in regard to their psychological wellbeing. With its focus on optimal seizure control, epilepsy treatment is entrenched in the medical model of illness, despite growing evidence of the broader psychosocial impact of the condition. This study aimed to explore how PWE experience healthcare in the context of their lives.Semistructured interviews were conducted with thirty-nine adults with epilepsy from across the UK. An adapted version of interpretative phenomenological analysis (IPA) was conducted, and three superordinate themes were identified. Firstly, “negotiating the space between health and illness” identified how participants rejected the illness identity and struggled with a treatment regime, which reminded them of the longevity of their condition. Secondly, “tensions in adopting a biomedical perspective” considered how medical professionals overlooked the negative side effects medication had on participants' lives, in favor of optimal seizure control. Thirdly, “the need for broader support” highlighted the additional psychosocial support PWE require. The findings indicate the need to incorporate person-centered, psychological services within the care pathway for PWE, as well as training for health professionals to recognize the broader impact of epilepsy beyond seizure management.
  • Digital and technological opportunities in epilepsy: Toward a digital
           ecosystem for enhanced epilepsy management
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Ross Shegog, Lana Braverman, John D. HixsonAbstractThis commentary details the implications of a growing body of literature supporting several categories of supportive digital tools for the self-management of epilepsy. Although many prior review articles have focused on specific forms of digital epilepsy solutions, we propose the concept of an integrated self-management digital ecosystem. This would include categories of tools including self-management education programs, electronic diaries for self-monitoring, and automated wearables for seizure detection. Within these categories, individual interventions have been studied and made available to patients for years, but the evolution of a digital ecosystem promises the potential to integrate these tools in a manner that can meaningfully benefit patients' health. This commentary presents a discussion of the possible concerns that are preventing more widespread adoption of these digital health resources. Barriers are identified at multiple positions of the healthcare system, including the individual, the organizational, the community, and the policy levels.
  • Psychiatric aspects of posttraumatic epilepsy: A still unexplored area
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Marco MulaAbstractTraumatic brain injury (TBI) represents one of the most common causes of death and disability in young people, and posttraumatic epilepsy (PTE) accounts for 10% to 20% of all symptomatic epilepsies. However, PTE is still a relatively underappreciated condition. This paper aimed at reviewing current knowledge about psychiatric comorbidities of PTE, looking in particular at the nature of the relationship between TBI, psychiatric problems, and epilepsy, at the phenomenology of psychiatric disorders in PTE, and how to manage them. Data on psychiatric comorbidities of PTE are almost nonexistent, and this is a paradox considering that TBI itself is burdened by a number of cognitive and psychiatric sequelae, which can profoundly affect the everyday life of these patients. Preliminary data seem to suggest that the bidirectional relationship between epilepsy and psychiatric disorders is maintained in TBI and people with a psychiatric condition at the time of the TBI, or as a consequence of it, are at increased risk of developing PTE and vice versa. However, a number of questions are still unanswered concerning the genetic and environmental contributors, the phenomenology of psychiatric disorders in PTE, and how to prevent and address them properly. Further research in this area is urgently needed in order to provide the best possible care to people with PTE.Special Issue: Epilepsy & Behavior's 20th Anniversary.
  • Can we and should we use animal models to study neurobehavioral
           comorbidities of epilepsy'
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Andrey MazaratiAbstractAnimal systems have been widely used to examine mechanisms of neurobehavioral comorbidities of epilepsy and to help in developing their effective therapies. Despite the progress made in the field, animal studies have their limitations stemming both from issues with modeling neuropsychiatric disorders in the laboratory and from drawbacks of animal models of epilepsy themselves. This review discusses advantages and weaknesses of experimental paradigms and approaches used to model and to analyze neurobehavioral comorbidities of epilepsy, from the perspectives of their needs, interpretation, ways of improvement, and clinical relevance. Developmental studies are required to adequately address age-specific aspects of the comorbidities. The deployment of preclinical Common Data Elements (pCDEs) for epilepsy research should facilitate the standardization and the harmonization of studies in question, while the application of Research Domain Criteria (RDoC) to characterize neurobehavioral disorders in animals with epilepsy should help in closing the bench-to-bedside gap.Special Issue: Epilepsy & Behavior's 20th Anniversary.
  • Reply to Czarnota, Wiglusz, and Cubaƚa
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Heidi M. Munger Clary, Jay Salpekar
  • Current behavioral health and cognitive screening practices in pediatric
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Janelle L. Wagner, Avani C. Modi, Shanna M. Guilfoyle, Katherine F. Junger, Chelsea Weyand, Gigi Smith, Millie Griffin, Grace MucciAbstractPurposeInitiatives such as the Epilepsy Learning Healthcare System continue to advocate for standardized care and shared outcome data. Therefore, the current project aim was to gather information from epilepsy healthcare professionals, behavioral health professionals in particular, regarding their behavioral health and cognitive screening practices in pediatric patients with epilepsy. Information obtained will be used to assist in the development of new educational programs and platforms in the American Epilepsy Society (AES) and to inform the development of guidelines for behavioral healthcare of patients with pediatric epilepsy.Survey informationTwenty-five AES members representing 25 unique epilepsy programs across the United States participated in the survey. Findings are described in terms of three focus areas: (1) Systems, (2) Assessment, and (3) Intervention. Over 80% of respondents surveyed reported that they do conduct formal screenings, most commonly to determine if further evaluation is indicated (81%), inform treatment decisions (57.1%), and for developmental surveillance (33.3%). Assessment methods were fairly evenly split between nonstandardized informal questions (50%) and evidence-based broadband measures, with the Behavior Assessment System for Children (BASC), 2nd or 3rd Editions (40%) most commonly used. If behavioral health concerns are identified, referrals are often made for psychotherapy (48% in-house; 80% community-based), psychiatry (68% in-house; 48% community-based), and cognitive testing (88% neuropsychological testing; 36% for psychoeducational testing). Thirty-two percent refer for psychotropic medication management.ConclusionAccording to this survey, a number of epilepsy centers and clinics incorporate behavioral health screening; however, there is significant variability in assessments/measures used, who is administering them, and their purpose in the trajectory of treatment. These findings emphasize the need for standardization across centers in order to most effectively provide comprehensive care for youth with epilepsy.
  • Editorial on “Current behavioral health screening practices in pediatric
           epilepsy, by Wagner et al. (this issue)”
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Jana E. Jones
  • Interaction of GABAA and GABAB antagonists after status epilepticus in
           immature rats
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Pavel Mareš, Hana KubováAbstractAmong neurotransmitter systems affected by status epilepticus (SE) in adult rats are both GABAergic systems. To analyze possible changes of GABAA and GABAB systems in developing rats lithium-pilocarpine SE was induced at postnatal day 12 (P12). Seizures were elicited by a GABAA antagonist pentylenetetrazol (PTZ) 3, 6, 9, and 13 days after SE (i.e., in P15, P18, P21, and P25 rats), and their possible potentiation by a GABAB receptor antagonist CGP46381 was studied. Pilocarpine was replaced by saline in control animals (lithium-paraldehyde [LiPAR]).Pentylenetetrazol in a dose of 50 mg/kg s.c. elicited generalized seizures in nearly all 15-day-old naive rats and in 40% of 18-day-old ones but not in older animals. After SE, PTZ no longer elicited seizures in these two younger groups, i.e., sensitivity of GABAA system was diminished. The GABAB antagonist exhibited proconvulsant effect in P15 and P18 SE as well as LiPAR rats returning the incidence of PTZ-induced seizures to values of control animals. A decrease in the incidence of minimal clonic seizures was seen in P21 LiPAR animals; these seizures in the oldest group were not affected. Change of the effect from proconvulsant to anticonvulsant (or at least to no action) took place before postnatal day 21.Both SE and LiPAR animals exhibited similar changes but their intensity differed, effects in LiPAR controls were usually more expressed than in SE rats.
  • Cognitive and functional status in late-onset Lennox–Gastaut syndrome:
           Variation on a classic phenotype
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Nitish Chourasia, Atul Maheshwari, Giridhar KalamangalamAbstractLennox–Gastaut syndrome (LGS) denotes a refractory epileptic encephalopathy of childhood onset with the triad of generalized slow spike–wave (GSSW) on interictal scalp electroencephalogram (EEG), multiple seizure types, and intellectual impairment. The neurobiology of LGS is said to sustain abnormal patterns of brain activity and connectivity that ultimately impair normal cerebral developmental mechanisms. However, we describe eight patients from our combined practice who presented with electroclinical findings consistent with LGS but without significant cognitive impairment. All patients fulfilled the other criteria of LGS with multiple seizure types (three or more of generalized tonic–clonic, atonic, tonic, myoclonic, and atypical absence) and GSSW activity on EEG. Four subjects completed high school, two completed some college, two acquired college degrees, and all performed basic and instrumental activities of daily living (ADL) independently. Magnetic resonance imaging (MRI) was normal in all patients. We speculate that a variation of the classic phenotype of LGS can present with preserved cognitive and functional status, often with onset in the second decade of life, and associated with normal brain imaging.
  • Evaluation of the prognostic factors in school age children who
           experienced neonatal seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Edibe Pembegul Yıldız, Burak Tatlı, Melis Ulak Ozkan, Emine Erarslan, Nur Aydınlı, Mine Çalışkan, Meral ÖzmenAbstractBackgroundThis prospective study aimed to evaluate long-term neurodevelopmental outcomes and risk factors of the previously reported cohort, at their school age.MethodWe included neonates whose seizures were directly observed by the child neurologist or neonatologist based on clinical observations. They were assessed for cognitive and neurological outcomes at the age of 9–11 years. The test battery included a neurological examination, the Wechsler Intelligence Scale for Children—Revised (WISC-R) test, and patients with the diagnosis of cerebral palsy (CP) were graded according to the Gross Motor Function Classification System (GMFCS). The primary outcome of this study was to determine risk factors for the long-term prognosis of neonatal seizures.ResultsFor the long-term follow-up, 97 out of 112 patients of the initial cohort were available (86.6%). We found that 40 patients (41%) have the normal prognosis, 22 patients (22.7%) have the diagnosis of CP, and 30 patients (30.9%) were diagnosed as having epilepsy. Twelve out of 22 patients with CP had the diagnosis of epilepsy. The WISC-R full-scale IQ scores were  85 points in 40 patients (41.2%). According to GMFCS, 10 patients were classified as levels 1–2, and 12 patients were classified as levels 3–5. In multivariate regression analyses, 5-min APGAR score
  • Moral injury in Veterans with nonepileptic seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): W. Curt LaFrance, Peter Vo, Grayson Baird, Rotunda East, Nathan R. SteinAbstractObjectiveOver 40% of combat Veterans report exposure to at least one type of morally injurious experience (MIE). While moral injury (MI) is described among Veterans with posttraumatic stress disorder (PTSD), MI has not been studied in Veterans with psychogenic nonepileptic seizures (PNES). We sought to identify MI in a clinical sample of Veterans with PNES and describe differences between those with MI and those without.MethodsWe conducted a retrospective cross-sectional study of 82 male and female Veterans with video-electroencephalography (EEG)-confirmed PNES consecutively seen in a Veterans Administration neuropsychiatry clinic. Identification of MI (witnessed or experienced events that conflict with one's moral compass) was made based by an independent observer using a survey of MIEs. Comorbidities, trauma history, and symptom scales were compared among those with and without MI.ResultsTwelve of 82 Veterans with PNES had MI. Those with MI reported higher guilt, depression symptoms and were of younger average age. There were no significant differences for categorical PTSD diagnosis, abuse history, or other demographic variables between those with and without MI.SummaryIn this sample of Veterans with PNES, MI was present in 14.6%. Those with MI had more guilt and depressive symptoms than those without. An increased understanding of this condition may aid in the development of diagnostic screenings and therapy options for those with PNES.
  • Contribution of autobiographic memory impairment to subjective memory
           complaints in focal epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Genevieve Rayner, Benjamin Siveges, James Allebone, Jessamae Pieters, Sarah J. WilsonAbstract“My memory is terrible!” is a common refrain among people with epilepsy, but such complaints are not reliably linked to poor performances on standard tests of memory. Negative affect like depression and anxiety are the most robust predictor of these complaints; however, neither do they entirely account for the phenomenon. The contribution of autobiographic memory impairment to subjective memory complaints in focal epilepsy has not been well-explored despite autobiographic memory impairments being common in patients with epilepsy, and the face validity of relating day-to-day memory failings to such a personally relevant form of memory. The current study sought to clarify whether autobiographic memory dysfunction contributes to subjective complaints in epilepsy, above and beyond negative affect, objective memory impairment, and epileptological factors in a large sample of patients with drug-resistant focal epilepsy relative to healthy controls (N = 135). Patients were stratified into groups with mesial temporal (MT; n = 40) versus nonmesial temporal (NMT; n = 46) foci. Compared to controls (n = 46), both patient groups reported more bitter subjective memory complaints (p 
  • Sleep quality and related clinical features in patients with epilepsy: A
           preliminary report
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Aslı Ece Çilliler, Bülent GüvenAbstractObjectiveThe relationship between sleep and epilepsy is complex and involves multiple mechanisms. Patients with epilepsy (PWE) often report fatigue and daytime sleepiness, and are often diagnosed with comorbid sleep disorders that are thought to be a direct corollary of seizures, adverse effects of antiepileptic drugs (AEDs), or a combination of these two factors. The emergence of depressive symptomatology in PWE can also lead to decreases in quality of life. The aim of this study was to investigate the relationship between sleep quality, clinical characteristics, excessive daytime sleepiness (EDS), fatigue, and depression in PWE.MethodsSeventy-five consecutive PWE were included in the study. Demographic data, type and frequency of seizures, treatment regimens, number of seizures in the last 12 months, and relationship between seizures and sleep quality were recorded. Sleep quality, fatigue, daytime sleepiness, and depression symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI), respectively.ResultsPatients (43 females, 32 males) had a mean age of 31.3 ± 11 years, a mean age of epilepsy onset of 18 ± 11.4 years, and a mean disease duration of 13.2 ± 9.9 years. Thirty-two (42.7%) patients had poor sleep quality, while 44 (58.7%) had fatigue, 18 (24%) had daytime sleepiness, and 56 (74.7%) had depression. The FSS, ESS, and BDI scores of the patients with PSQI ≥ 5 were significantly higher (p = 0.048, p = 0.018, p 
  • Patient phenotypes and clinical outcomes in invasive monitoring for
           epilepsy: An individual patient data meta-analysis
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Madison Remick, George M. Ibrahim, Alireza Mansouri, Taylor J. AbelAbstractObjectiveInvasive monitoring provides valuable clinical information in patients with drug-resistant epilepsy (DRE). However, there is no clear evidence indicating either stereoelectroencephalography (SEEG) or subdural electrodes (SDE) as the optimal method. Our goal was to examine differences in postresection seizure freedom rates between SEEG- and SDE-informed resective epilepsy surgeries. Additionally, we aimed to determine potential clinical indicators for SEEG or SDE monitoring in patients with drug-resistant epilepsy.MethodsA systematic literature review was performed in which we searched for primary articles using keywords such as “electroencephalography”, “intracranial grid”, and “epilepsy.” Only studies containing individual patient data (IPD) were included for analysis. A one-stage IPD meta-analysis was performed to determine differences in rates of seizure freedom (International League Against Epilepsy (ILAE) guidelines and Engel classification) and resection status between SEEG and SDE patients. A Cox proportional-hazards regression was performed to determine the effect of time on seizure freedom status. Additionally, a principal component analysis was performed to investigate primary drivers of variance between these two groups.ResultsThis IPD meta-analysis compared differences between SEEG and SDE invasive monitoring techniques in 595 patients from 33 studies. Our results demonstrate that while there was no difference in seizure freedom rates regardless of resection (p = 0.0565), SEEG was associated with a lower rate of resection compared with SDE (82.00% SEEG, 92.74% SDE, p = 0.0002). Additionally, while SDE was associated with a higher rate of postresection seizure freedom (54.04% SEEG, 64.32% SDE, p = 0.0247), the difference between seizure freedom rates following SEEG- or SDE-informed resection decreased with long-term follow-up. A principal component analysis showed that cases resulting in SEEG were associated with lower risk of morbidity than SDE cases, which were strongly collinear with multiple subpial transections, anterior temporal lobectomy, amygdalectomy, and hippocampectomy.SignificanceIn this IPD meta-analysis of SEEG and SDE invasive monitoring techniques, SEEG and SDE were associated with similar rates of seizure freedom at latest follow-up. The former was associated with lower rates of resection. Furthermore, the clinical phenotypes of patients undergoing SEEG monitoring was associated with lower rates of complications. Future long-term prospective registries of IPD are promising options for clarifying the differences in these intracranial monitoring techniques as well as the unique patient phenotypes that may be associated with their indication.
  • Cognitive control deficits in pediatric frontal lobe epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Lydia van den Berg, Al de Weerd, Marieke Reuvekamp, Jaap van der MeereAbstractExecutive dysfunction and behavioral problems are common in children with epilepsy. Inhibition and shifting, both aspects of cognitive control, seem related to behavior problems and are thought to be driven mainly by the frontal lobes. We investigated if inhibition and shifting deficits are present in children with frontal lobe epilepsy (FLE). Secondly, we studied the relationship between these deficits and behavior problems. Thirty-one children were administered the Stroop Color Word Test and a digital version of the Wisconsin Card Sorting Test (WCST). Parents completed the Behavioral Rating Inventory for Executive Function (BRIEF) and the Achenbach scale (Child Behavior Checklist (CBCL)). About 20% of the children displayed significant low results on the Stroop Effect. About 60% showed shifting problems on the WCST. Parents reported cognitive control and behavioral deficits in about a third of the children. Also, behavioral problems and deficits in inhibition and shifting in daily life (BRIEF) seem to be related. There were no correlations between questionnaires and the Stroop and the WCST. Only in the group of children with many perseverative errors there were especially high correlations between Inhibit of the BRIEF.
  • Management of status epilepticus in adults. Position paper of the Italian
           League against Epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Fabio Minicucci, Monica Ferlisi, Francesco Brigo, Oriano Mecarelli, Stefano Meletti, Umberto Aguglia, Roberto Michelucci, Massimo Mastrangelo, Nicola Specchio, Stefano Sartori, Paolo TinuperAbstractSince the publication of the Italian League Against Epilepsy guidelines for the treatment of status epilepticus in 2006, advances in the field have ushered in improvements in the therapeutic arsenal. The present position paper provides neurologists, epileptologists, neurointensive care specialists, and emergency physicians with updated recommendations for the treatment of adult patients with status epilepticus. The aim is to standardize treatment recommendations in the care of this patient population.
  • The effect of zonisamide on memory processes — A preclinical study
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Agata Krupa-Burtnik, Ewa Zwierzyńska, Bogusława PietrzakAbstractObjectiveZonisamide is an antiepileptic drug with a perspective of a broader use. Although it is regarded as a relatively safe drug, zonisamide might cause disorders of the central nervous system. The study assessed the influence of zonisamide on spatial and emotional memory in adult Wistar rats.MethodsMorris water maze test was used to examine the effect of zonisamide administered p.o. as single dose (50 mg/kg or 100 mg/kg) or repeatedly (50 mg/kg) on spatial memory. The impact of zonisamide administered as above on emotional memory was assessed in the Passive avoidance test.ResultsZonisamide mainly in a high acute dose impaired the spatial memory, whereas when administered repeatedly, its effect was observed only in the initial phase of the study. Emotional memory disturbances were noted only during repeated administration of zonisamide.ConclusionZonisamide may impair memory and learning processes in rats but the results are varied and depend on the type of memory.
  • Comparison of psychiatric comorbidities and impact on quality of life in
           patients with epilepsy or psychogenic nonepileptic spells
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Caroline Abe, David Denney, Alexander Doyle, Munro Cullum, Jessica Adams, Ghazala Perven, Hina Dave, Marisara Dieppa, Ryan Hays, Mark Agostini, Kan DingAbstractObjectivesPsychiatric comorbidity is common in people with epilepsy (PWE) and psychogenic nonepileptic spells (PNES). These comorbidities can be detrimental to quality of life (QOL) and are often underdiagnosed and undertreated. Some types of epilepsy, such as focal temporal lobe epilepsy (TLE), have been associated with higher rates of psychiatric comorbidity. This study examined the impact of psychiatric comorbidity on QOL in patients admitted to two level 4 epilepsy monitoring units (EMUs).MethodsIn this prospective observational study, 200 patients admitted to two level 4 EMUs completed standardized surveys including the Quality of Life in Epilepsy (QOLIE-31-P), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Beck Depression Inventory-II (BDI-II). Hierarchal multiple regression was performed to assess impact on QOL.ResultsOf the 200 participants, 113 had a diagnosis of epilepsy, 36 had a diagnosis of PNES, and 51 were excluded for nondiagnostic evaluation or dual diagnosis. Of those with epilepsy, 65 had TLE, 28 had focal extratemporal lobe epilepsy (ETLE), and 20 had nonfocal epilepsy. Patients with PNES had higher self-reported anxiety and depression levels (GAD-7: p = 0.04, PHQ-9: p 
  • PNESSE 1: Psychogenic status and status epilepticus: Could they be
           distinguished retrospectively' A survey among neurologists
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Hélène Kholi, Alexandre Bellier, Laurent VercueilAbstractObjectiveThe aim of this study was to evaluate neurologists' reliability in recognizing retrospectively a diagnosis of psychogenic status and status epilepticus (SE) based solely on clinical semiology, as reported in medical charts.MethodsThis is a retrospective analysis of medical records of patients with suspected SE, diagnosed with psychogenic status and SE, proven by video-electroencephalography (EEG) monitoring, over a two-year period, from January 1st 2012 to December 31st 2013. Eight additional patients outside this time frame were included in this series because they had video-EEG proven psychogenic status, and they met all the inclusion criteria. The group with SE was divided into symptomatic SE (SSE) if a precipitating factor was identified, and undetermined SE (USE) if none were identified. Twenty-two neurologists from the CHU de Grenoble-Alpes were asked to fill out a survey where they were asked to score, for each patient, their agreement, using Likert scales, for the respective diagnoses of psychogenic status and SE. Their opinions were based on a provided written sheet summarizing the clinical description of the event and patients' clinical context. Neurologists were blinded to video-EEG monitoring results and final diagnosis. The level of agreement, disagreement, and the homogeneity of neurologist's responses according to the final diagnosis were then calculated. Finally, clinical data, as provided in the event's clinical description and context, considered as highly relevant by neurologists to establish an accurate diagnosis were gathered.ResultsEighteen neurologists completed the survey for 48 patients, including 11 diagnosed with psychogenic status and 37 with SE (30 with SSE and 7 with USE). For patients diagnosed with SE, the presence of a precipitating factor increased the likelihood and the homogeneity among neurologists of a diagnosis of SE (77%), with a specificity (Sp) of 96% and a positive predictive value of 95%. The lack of a precipitating factor significantly decreased the diagnosis likelihood of SE (55%) with a predictive value of 82%. For patients diagnosed with psychogenic status, most of neurologists agreed with the diagnosis of psychogenic status (69%) with a predictive value of 82%, although heterogeneity in the diagnosis was found. According to neurologists participating in this study, most significant terms, found in the medical charts, helping to distinguish SE from psychogenic status were “stereotypical movements”, “limb myoclonus”, “epilepsy”, and “vigilance alteration”. To differentiate psychogenic status from SE, most relevant terms used by neurologists were “resistance to eyes opening”, “anarchic movements”, “prolonged motor manifestations”, “limb tremor” and “opisthotonus”. However, analysis of the distribution of the terms among the different groups (SSE, USE, and psychogenic status) showed no significant difference.SignificanceThis study is in line with previous literature highlighting the difficulty in retrospectively differentiating SE from psychogenic status based on clinical events description recorded in the medical chart.
  • A description of verbal and gestural communication during postictal
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Alexia Fasola, F.-Xavier Alario, Marion Tellier, Bernard Giusiano, Carlo Alberto Tassinari, Fabrice Bartolomei, Agnès TrébuchonAbstractPatients suffering from drug-resistant temporal lobe epilepsy show substantial language deficits (i.e., anomia) during their seizures and in the postictal period (postictal aphasia). Verbal impairments observed during the postictal period may be studied to help localizing the epileptogenic zone. These explorations have been essentially based on simple tasks focused on speech, thus disregarding the multimodal nature of verbal communication, particularly the fact that, when speakers want to communicate, they often produce gestures of various kinds. Here, we propose an innovative procedure for testing postictal language and communication abilities, including the assessment of co-speech gestures. We provide a preliminary description of the changes induced on communication during postictal aphasia.We studied 21 seizures that induced postictal aphasia from 12 patients with drug-refractory epilepsy, including left temporal and left frontal seizures. The experimental task required patients to memorize a highly detailed picture and, briefly after, to describe what they had seen, thus eliciting a communicative meaningful monologue. This allowed comparing verbal communication in postictal and interictal conditions within the same individuals. Co-speech gestures were coded according to two categories: “Rhythmic” gestures, thought to be produced in support of speech building, and “illustrative” gestures, thought to be produced to complement the speech content.When postictal and interictal conditions were compared, there was decreased speech flow along with an increase of rhythmic gesture production at the expense of illustrative gesture production. The communication patterns did not differ significantly after temporal and frontal seizures, yet they were illustrated separately, owing to the clinical importance of the distinction, along with considerations of interindividual variability.A contrast between rhythmic and illustrative gestures production is congruent with previous literature in which rhythmic gestures have been linked to lexical retrieval processes. If confirmed in further studies, such evidence for a facilitative role of co-speech gestures in language difficulties could be put to use in the context of multimodal language therapies.
  • The management of epilepsy in clinical practice: Do the needs manifested
           by the patients correspond to the priorities of the caring physicians'
           Findings from the EPINEEDS Study
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Giorgia Giussani, Gabriele Enia, Elisa Bianchi, Oriano Mecarelli, Ettore Beghi, Patrizia Pulitano, Claudia Cagnetti, Sara Baldinelli, Angela La Neve, Maria Tappatà, Teresa Francavilla, Giovanni De Maria, Vito Sofia, Loretta Giuliano, Greta Mainieri, Daniela Fatuzzo, Vincenzo Belcastro, Maurizio Elia, Giuseppe D'Orsi, Alessandra LallaAbstractPurposeThe purpose of this study was to assess the priorities of patients with epilepsy and caring physicians and the correspondence between these priorities.MethodsIn this multicenter cross-sectional study, patients with epilepsy attending 21 Italian epilepsy centers and their caring physicians filled anonymously questionnaires on the needs and priorities in the management of the disease. Included were questions on patients' demographics, diagnosis, treatment, and outcome of epilepsy. The concordance between patients and their physicians was assessed on various aspects of the diagnosis and care of the disease. Patients' satisfaction with communication, services, and patient–doctor relationship was also assessed.ResultsIncluded were 432 women and 355 men aged 15 to 88 years (median: 41 years). Disease duration ranged from 6 months to 75 years. A structural/metabolic etiology predominated (52.7%), followed by a (presumed) genetic etiology (33.0%). Seizure remission was present in 56.5% of cases. Comorbidities requiring chronic treatment were present in 27.5%, and comorbidities affecting self-sufficiency in 9.5%. Psychiatric comorbidity was present in 35.0%. Patients' priorities included discovery of the cause (89.1%), use of right drug (98.7%), use of a drug without chronic side effects (94.0%), and a life without restrictions (90.4%). Physicians' priorities included choice of right drug (83.5%) and use of drugs without chronic side effects (86.8%). Priorities varied with patients' age, sex, education, and occupation. Patient–doctor relationships were at least good in most cases. The information imparted was considered unsatisfactory by 21–44% of cases on seizure circumstances and complications, side effects of drugs, limitations of daily activities, and management of physiologic or pathologic conditions. Patients declared overall satisfaction, except for appointments (21.5%) and emergencies (30.8%).ConclusionPatients and physicians' priorities in the management of epilepsy overlap only in part. Patients are satisfied with their caring physicians and less satisfied with communication and management of routine and emergency problems.
  • First do no harm: Preventing harm and optimizing care in psychogenic
           nonepileptic seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Clark Johnsen, Helen T. DingAbstractPsychogenic nonepileptic seizures (PNES) are challenging clinical occurrences consisting of any combination of altered movement, sensation, or awareness that resemble epileptic seizures (ES) but do not coincide with electrographic ictal discharges and are presumed to be neuropsychiatric–neurobehavioral in origin. Securing the PNES diagnosis is a crucial first step and is best confirmed by recording events on video-electroencephalogram (v-EEG) and finding an absence of ictal EEG changes and the presence of normal awake EEG rhythms before, during, and after the event. However, obstacles to timely diagnosis and referral to psychiatric treatment frequently occur, placing these patients at risk for harm from unnecessary medications and procedure as well as placing high burden on medical systems. Although providers across all disciplines share the responsibility by maintaining high suspicion of PNES in relevant clinical settings and engaging swiftly and empathically in securing and sharing the diagnosis with patients and families, psychiatric and neurologic providers are uniquely positioned to help lead patients towards safe and effective long-term care through a cohesive approach that is rooted in therapeutic alliance, interdisciplinary collaboration, and realistic treatment goals.
  • Long-term effects of status epilepticus during infancy in male rats:
           Sexual behavior and brain response upon exposure to sexually receptive
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Florencia Chena-Becerra, Genaro Alfonso Coria-Avila, Luis Beltrán-Parrazal, Jorge Manzo, María Leonor López-MerazAbstractPrevious research in female rats showed that induction of status epilepticus (SE) during infancy impairs proceptive sexual behavior at the long run in adulthood but temporarily, since full proceptivity is recovered after four mating trials. In male rats, such equivalent effects have not been explored yet. Thus, SE was experimentally induced by injecting lithium chloride (3 mEq/kg, i.p.) in thirteen-day-old (P13) male pups and then, on P14, pilocarpine hydrochloride (100 mg/kg, s.c.). Controls received the same volume of saline. For Experiment 1, at P90, we analyzed c-Fos immunoreactivity (c-Fos-IR) as a measure of unconditioned brain activity after exposing them to sexually receptive females, but without physical contact. For Experiment 2, a different group of males was tested for locomotor activity, and their sexual behavior was assessed during five trials. Then, serum testosterone and corticosterone levels were measured. Our results showed that a lower proportion of SE males performed mounts, intromissions, and ejaculations, and repeated training did not improve their behavior. The levels of testosterone in SE males were reduced, but corticosterone, c-Fos-IR, and locomotion were similar to controls. These results suggest that SE during infancy impairs adult sexual behavior by reducing testosterone.
  • Effect of rutin on anxiety-like behavior and activity of
           acetylcholinesterase isoforms in specific brain regions of
           pentylenetetrazol-treated mice
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Maria Anesti, Natalia Stavropoulou, Korina Atsopardi, Fotini N. Lamari, Nikolaos T. Panagopoulos, Marigoula MargarityAbstractThe aim of the present study was to investigate the effect of rutin administration (100 mg/kg/day) to pentylenetetrazol (PTZ)-treated Balb-c mice (60 mg/kg/day), with respect to anxiety-like behavior using both open-field and elevated plus-maze (EPM) tests, and acetylcholinesterase (AChE) activity in salt-soluble (SS) fraction and detergent-soluble (DS) fraction of the cerebral cortex, hippocampus, striatum, midbrain, and diencephalon. Our results demonstrated that the administration of PTZ in 3 doses and the induction of seizures increased significantly anxiety behavior of mice and reduced significantly DS-AChE activity in all brain regions examined, while the reduction in the SS fraction was brain region-specific. Rutin administration to normal mice did not affect their behavior, while it induced a brain region-specific reduction in SS-AChE and a significant decrease in DS-AChE in all brain regions. We demonstrated for the first time that pretreatment of PTZ-mice with rutin (PTZ + Rutin group) prevented the manifestation of anxiety and induced interestingly a further significant reduction on the SS- and DS-AChE activities only in the cerebral cortex and striatum, in comparison with PTZ group. Our results show that rutin exhibits an important anxiolytic effect and an anticholinesterase activity in specific brain areas in the seizure model of PTZ.
  • Effect of perampanel on aggression in patients with refractory focal
           epilepsy: A 6-month longitudinal study
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Sang-Ahm Lee, Ji Ye Jeon, Hyun-Woo KimAbstractPurposeClinical trials have demonstrated the efficacy of perampanel for the treatment of epilepsy. However, patients treated with this and other antiepileptic drugs often exhibit aggressive behaviors. We investigated the clinical factors contributing to aggression in patients with refractory focal epilepsy during 6 months of adjunctive perampanel treatment.MethodsThis was a single-center longitudinal study involving patients treated with perampanel (starting dose, 2 mg/day; maximal dose, 12 mg/day). Patients were assessed with an aggression questionnaire (Korean version of Aggression Questionnaire [AQ-K]) and the hospital anxiety depression scale (HADS) at the beginning of the study and after receiving treatment for 6 months. Paired t-tests were used to compare AQ-K and HADS scores at the beginning of the study with those recorded at the end, and stepwise linear regression models were applied to identify predictive factors.ResultsThirty-two patients (mean age, 42.4 ± 10.3 years) successfully completed the 6-month study. The AQ-K and HADS scores increased after 6 months of adjunctive perampanel treatment (p 
  • Attention and inhibitory control deficits in patients with genetic
           generalized epilepsy and psychogenic nonepileptic seizure
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Leila Simani, Mehrdad Roozbeh, Mohammad Rostami, Hossein Pakdaman, Mahtab Ramezani, Marjan AsadollahiAbstractThis study aimed to evaluate the attention and inhibitory control functions in patients with genetic generalized epilepsy (GGE) and psychogenic nonepileptic seizure (PNES) and compare the results with the healthy control subjects. A total of 30 patients with GGE, 30 patients with PNES, and 32 healthy control subjects were included in the study. The severity of attention and inhibitory control deficit, general intelligence status, and psychopathology screening in all subjects were respectively investigated with the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), the Wechsler Adult Intelligence Scale (WAIS), and the Symptoms Checklist 90-revised (SCL-90-R). Patients with PNES had severe impairments in all performed tasks compared with the control group and the group with GGE (p 
  • The impact of cerebrovascular risk factors on postoperative memory decline
           in patients with left temporal lobe epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Anny Reyes, Sanam J. Lalani, Erik Kaestner, Kiera Hooper, Austin Chen, Anna Christina Macari, Brianna M. Paul, Bruce P. Hermann, Carrie R. McDonaldAbstractCerebrovascular risk factors (CVRFs) and comorbid cardiovascular and metabolic disease have been linked to accelerated cognitive aging and dementia in the general population; however, the contribution of these comorbidities to the risk of post anterior temporal lobectomy (ATL) memory decline has been unexamined. We explored the effects of CVRFs on postoperative verbal memory decline in a cohort of 22 patients with left temporal lobe epilepsy (LTLE) who completed pre- and one-year postsurgical neuropsychological testing. Diagnoses of interest included preoperative cardiovascular and metabolic disorders, as well as CVRFs [pulse pressure proxy, body mass index (BMI), and fasting glucose]. Twenty-three percent of patients had a history of cardiovascular disease, 9% of metabolic disorders, and 38% had a BMI indicating overweight or obese status. Higher preoperative BMI and glucose were associated with greater decline in verbal memory. The association between BMI and memory decline remained significant after controlling for age and left hippocampal volume. These findings suggest that modifiable health-related risk factors, including CVRFs, may impact the risk of postoperative cognitive decline, and that BMI in particular could be an important factor to consider and/or target for intervention early in clinical care to protect cognitive health.
  • Cognitive-emotion processing in psychogenic nonepileptic seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Rachael Rosales, Barbara Dworetzky, Gaston BasletAbstractBackgroundPrevious literature suggests that cognitive-emotion processing contributes to the pathogenesis of psychogenic nonepileptic seizures (PNES). Characterization of alterations in cognitive-emotion processing in PNES could inform treatment.MethodsIn this descriptive, cross-sectional study, 143 patients with video electroencephalogram (EEG) confirmed PNES were prospectively recruited. Patients completed self-report questionnaires on emotion perception (Trait Meta-Mood Scale (TMMS) attention and clarity subscales) and coping style (Affective Styles Questionnaire [ASQ] concealing, adjusting, and tolerating subscales) at the time of their initial evaluation for PNES. Demographic, clinical data and measures of psychopathology severity were also obtained. The TMMS and ASQ subscale scores were compared to available normative data and between PNES subgroups (based on presence of trauma-related factors). Correlation coefficients were obtained to evaluate associations between subscale scores and measures of psychopathology.ResultsMean scores on both TMMS subscales (attention 47.0 [SD 7.4] and clarity 37.5 [SD 8.0]) and the ASQ adjusting subscale (22.2 [SD 6.3]) were significantly lower than available normative data (p 
  • Health-related quality of life and the burden of prolonged seizures in
           noninstitutionalized children with epilepsy
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Fenella J. Kirkham, Federico Vigevano, Miquel Raspall-Chaure, Bernd Wilken, Dawn Lee, Corinne Le Reun, Tamara Werner-Kiechle, Lieven LagaeAbstractObjectiveThis study aimed to provide information on the burden of illness and health-related quality of life (HRQoL) in children with epilepsy who experience prolonged acute convulsive seizures (PACS) in the community setting, and to investigate factors that may predict poor HRQoL in this population.MethodsNoninstitutionalized children (aged 3–16 years) who had experienced at least one PACS within the past year and had currently prescribed PACS rescue medication were enrolled in a cross-sectional study in Germany, Italy, Spain, and the United Kingdom (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3 [PERFECT-3]). Clinicians, parents/guardians, and patients completed web-based questionnaires regarding clinical characteristics, PACS frequency, and day-to-day impairment. Patients' HRQoL was rated by clinicians, parents/guardians, and patients themselves using the 5-dimension EuroQol questionnaire (EQ-5D) and summarized as a utility score. Potential predictors of poor HRQoL were tested in individual univariate generalized linear models and a global multivariable model.ResultsEnrolled children (N = 286) had experienced 1–400 PACS (median: 4) in the past year. Clinicians reported that 216/281 patients (76.9%) had learning disabilities of varying severity. Mean EQ-5D utility scores rated by clinicians (n = 279), parents (n = 277), and patients (n = 85) were 0.52 (standard deviation: 0.41), 0.51 (0.39), and 0.74 (0.29), respectively. Increasing PACS frequency, increasing severity of learning disability, and specialist school attendance were significantly associated with decreasing EQ-5D utility score. In the multivariable model, having learning disabilities was the best predictor of poor HRQoL.SignificanceHealth-related quality of life was very poor in many children with epilepsy whose PACS were managed with rescue medication in the community, with learning disability being the most powerful predictor of patients' HRQoL. Mean EQ-5D utility scores were lower (worse) than published values for many other chronic disorders, indicating that optimal treatment should involve helping children and their families to manage learning disabilities and day-to-day impairments, in addition to preventing seizures.
  • Are patients ready for integrated person-centered care' A qualitative
           study of people with epilepsy in Ireland
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Robert Power, John-Paul Byrne, Rachel Kiersey, Jarlath Varley, Colin P. Doherty, Veronica Lambert, Emma Heffernan, A. Jamie Saris, Mary FitzsimonsAbstractThe National Clinical Programme for Epilepsy (NCPE) in Ireland aims to deliver a holistic model of integrated person-centered care (PCC) that addresses the full spectrum of biomedical and psychosocial needs of people with epilepsy (PwE). However, like all strategic plans, the model encompasses an inherent set of assumptions about the readiness of the environment to implement and sustain the actions required to realize its goals. In this study, through the lens of PwE, the Irish epilepsy care setting was explored to understand its capacity to adopt a new paradigm of integrated PCC. Focus groups and semi-structured one-to-one interviews were employed to capture the qualitative experiences of a sample of Irish PwE (n = 27) in the context of the care that they receive. Participants were from different regions of the country and were aged between 18 and 55 years with 1 to 42 years since diagnosis (YSD). Highlighting a gap between policy intent and action on the ground, findings suggest that patient readiness to adopt a new model of care cannot be assumed. Expectations, preferences, behaviors, and values of PwE may sustain the more traditional constructions of healthcare delivery rather than the integrated PCC goals of reform. These culturally constituted perceptions illustrate that PwE do not instinctively appreciate the goals of healthcare reform nor the different behavior expected from them within a reformed healthcare system. Recalibrating deep-rooted patient views is necessary to accomplish the aspirations of integrated PCC. Patient engagement emphasizing the meaningful role that they can play in shaping their healthcare services is vital.
  • Psychoanalytical concepts of epilepsy
    • Abstract: Publication date: Available online 13 November 2019Source: Epilepsy & BehaviorAuthor(s): Simon ShorvonAbstractAs part of the anniversary issue of Epilepsy & Behavior looking back as aspects of the history of epilepsy, this article reviews psychoanalytical concepts of the pathogenesis of seizures and the so-called epileptic personality (epileptic constitution). It addresses the question whether these theories are completely invalid or do they have insights that are worth rediscovering.Special Issue: Epilepsy & Behavior's 20th Anniversary
  • Effects on executive functions of antiepileptic monotherapy in pediatric
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Francesca Felicia Operto, Grazia Maria Giovanna Pastorino, Roberta Mazza, Marco Carotenuto, Michele Roccella, Rosa Marotta, Carlo di Bonaventura, Alberto VerrottiAbstractObjectivesCognitive abilities and executive functions in children and adolescents are important indicators of quality of life as well as academic and social achievements. Cognitive and executive functioning are often impaired in patients with epilepsy and can be exacerbated by seizures and antiseizure drugs. The aim of our observational retrospective study was to assess executive functioning in patients with pediatric epilepsy, currently taking a single antiseizure medication.Materials and methodsRecords of 172 children and adolescents aged between 6 and 18 years (mean age = 12 ± 3.4 years) with newly diagnosed epilepsy who had not yet commenced an antiepileptic treatment were included in the study. Longitudinal changes in executive functioning were assessed using the EpiTrack Junior test at baseline, before the introduction of antiepileptic monotherapy, and at 3-month, 6-month, and 9-month follow-up visits. All patients commenced a single antiepileptic treatment (levetiracetam n = 54; valproic acid n = 52; ethosuximide n = 20; oxcarbazepine n = 22; carbamazepine n = 24). Age, sex, seizure types, and seizure baseline frequency were also recorded.ResultsRelative to baseline, Epitrack Junior mean scores deteriorated at the 9-month follow-up visit for patients taking valproic acid, ethosuximide, and carbamazepine, but this was only statistically significant for patients taking carbamazepine. In contrast, mean scores improved for subjects taking levetiracetam and oxcarbazepine at the 9-month follow-up visit relative to baseline, but this was only statistically significant for patients taking levetiracetam.ConclusionsLevetiracetam was the only antiseizure medication that led to slight improvements in executive functioning; whereas carbamazepine led to deteriorations in cognitive functioning. Further research using double-blinded, placebo-controlled trials are needed to confirm these results.
  • Efficacy and adverse event profile of cannabidiol and medicinal cannabis
           for treatment-resistant epilepsy: Systematic review and meta-analysis
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Renandro de Carvalho Reis, Kelson James Almeida, Luciano da Silva Lopes, Cíntia Maria de Melo Mendes, Edson Bor-Seng-ShuAbstractThis paper aimed to systematically examine the efficacy and adverse event (AE) profile of cannabidiol and medicinal cannabis by analyzing qualitative and meta-analytic data. We used the terms (“Cannabidiol” OR “Cannabis”) AND “Epilepsy” AND (“Treatment” OR “Therapeutics”) as keywords to retrieve studies indexed on PubMed, ScienceDirect, and CENTRAL databases. The inclusion criteria were as follows: clinical studies with a longitudinal observational design and intervention using cannabinoid derivatives, especially cannabidiol and medicinal cannabis, whereby some results involved the frequency of epileptic seizures. We used Cochrane Collaboration's Review Manager software (RevMan 5.1.6) for the meta-analysis and dichotomized the articles to a confidence interval of 95%. From 236 articles, we selected 16 for descriptive analysis; we selected only 4 for the meta-analysis. According to the results, a statistically meaningful effect of cannabidiol compared with placebo was observed (p 
  • A transcranial sonography study of brainstem and its association with
           depression in idiopathic generalized epilepsy with tonic–clonic seizures
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Jie Shen, Dong-Lin Li, Xiu-Xiu Tan, Wei-Wei Tao, Cheng-Juan Xie, Xue-Gong Shi, Yu WangAbstractBrainstem raphe (BR) hypoechogenicity in transcranial sonography (TCS) has been depicted in patients with depression. But, up to date, the association of BR alterations in TCS with depression in patients with epilepsy has never been reported. This study was to investigate the possible role of BR examination via TCS in patients with idiopathic generalized epilepsy with tonic–clonic seizures (IGE-TCS) and depression. Forty-six patients with IGE-TCS and 45 healthy controls were recruited. Echogenicity of the caudate nuclei (CN), lentiform nuclei (LN), substantia nigra (SN), and BR and widths of the lateral ventricle (LV) frontal horns and the third ventricle (TV) were assessed via TCS. The determination of depression was based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and depression severity measured by Chinese version Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E) and Beck Depression Inventory—II (BDI-II). The width of TV in patients with epilepsy was found significantly larger than that in healthy controls (p = 0.001), but there was no significant difference in TV width between patients with IGE-TCS with and without depression. There were no significant differences between patients with IGE-TCS and healthy controls in LV frontal horn width, as well as in SN, CN, LN, and BR echogenicity. Here, it seems that patients with IGE-TCS were detected with smaller SN echogenic area compared with controls though they had no statistical significance. Patients with IGE-TCS with hypoechogenic BR had significantly higher C-NDDI-E and BDI-II scores than those with normal BR signal, and most patients with IGE-TCS with depression exhibited hypoechogenic BR, but few patients with IGE-TCS without depression exhibited hypoechogenic BR. In conclusion, BR echogenic signal alterations in TCS can be a biomarker for depression in epilepsy, but it might not be associated with epilepsy itself. The alterations of SN echogenic area and TV width in TCS may reflect a potential role of SN and diencephalon structure in the pathogenesis of epilepsy, which needs to be further elucidated.
  • Cognitive performances in patients affected by late-onset epilepsy with
           unknown etiology: A 12-month follow-up study
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Claudio Liguori, Cinzia Costa, Flaminia Franchini, Francesca Izzi, Matteo Spanetta, Elena Nardi Cesarini, Simona Di Santo, Natalia Manfredi, Lucia Farotti, Michele Romoli, Alessandro Lanari, Nicola Salvadori, Lucilla Parnetti, Paolo Calabresi, Nicola Biagio Mercuri, Fabio PlacidiAbstractIntroductionEpilepsy has a growing frequency, particularly in the elderly. Several triggers may cause late-onset epilepsy; however, more than 20% of epilepsies, manifesting in the elderly, has an unknown etiology. Although cognition is frequently altered in patients affected by epilepsy, there is a paucity of studies specifically evaluating cognition in patients affected by late-onset epilepsy. The aim of the present study was to assess the cognitive profile of patients affected by late-onset epilepsy with an unknown etiology and followed for 12 months.MethodsPatients affected by diagnosed late-onset epilepsy with unknown etiology were included in this observation. All patients were evaluated at the time of diagnosis (baseline) and at follow-up (12 months later). We distributed patients in subgroups based on seizure type (focal seizures [FS], secondarily generalized seizures [SGS], primarily generalized seizures [GS]) and antiepileptic drug (AED) regimen (mono- vs. polytherapy). Cognition was evaluated through standardized neuropsychological testing.ResultsFifty-eight patients were included in this observation and distributed in three groups: 29 affected by FS, 14 affected by SGS, 15 affected by GS. Forty-five patients were in monotherapy, and 13 in polytherapy. The most frequent treatments were levetiracetam (n = 12), valproic acid (VPA) (n = 9), carbamazepine (n = 9), and oxcarbazepine (n = 7). We documented a significant decrease of Mini-Mental State Examination (MMSE) and memory scores at follow-up in the whole group. Verbal learning decreased exclusively in VPA users.ConclusionPatients affected by late-onset epilepsy with unknown etiology showed a significant decline of cognition at follow-up, independently from number and efficacy of AEDs received. These results deserve verification in larger longitudinal cohorts.
  • Characteristics of the knowledge and attitudes of medical students about
    • Abstract: Publication date: January 2020Source: Epilepsy & Behavior, Volume 102Author(s): Halise Akça, Ayşegül Neşe Çıtak KurtAbstractEpilepsy is one of the most common neurological diseases in the world. False knowledge and attitudes related to epilepsy both complicate the social lives of patients and adversely affect their academic development. The aim of this study was to investigate the knowledge and attitudes of the medical students about epilepsy. Seven hundred twenty-three students participated in the study. A questionnaire including demographic information and Epilepsy Knowledge and Attitude Scales was given to the students. The first 3 years students were accepted as preclinical group, and the last 3 years were accepted as clinical group. Previously, the rate of hearing about epilepsy was 87.8%, and the reading rate was 69%. Both hearing and reading rates were higher in the clinical group. The total knowledge score was higher in all groups who had heard and read about epilepsy, witness an epileptic seizure, and know someone with epilepsy. The total attitude score did not change with witness an epileptic seizure and know someone with epilepsy. Though total knowledge score was similar between genders, total attitude score was higher in males. Although the total knowledge score was higher in the clinical group, the total attitude score was similar.
  • The visuospatial pattern of temporal lobe epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Giulia Maria Tallarita, Annalisa Parente, Anna Rita GiovagnoliAbstractPurposeUnlike temporal lobe lesions, temporal lobe epilepsy (TLE) has no definite effects on visuospatial functions. This retrospective study evaluated these functions in patients with TLE, aiming to clarify their relationships to TLE laterality and magnetic resonance imaging (MRI)-detected brain lesions.MethodsThe Raven Colored Progressive Matrices (RCPM), Attentive Matrices (AM), Trail Making Test A (TMTA), Street Completion Test (SCT), Rey Complex Figure Copying (RCFC) and Delayed Reproduction (RCFDR), and Corsi Blocks Span (CBS) and Supraspan Learning (CBSSL) were used to assess different visuospatial functions in 198 patients with TLE and 90 healthy subjects.ResultsIn 169 patients (83 left), MRI revealed focal temporal lobe lesions [unilateral mesial temporal lobe sclerosis (MTLS) in 88 cases]. The patients with left or right TLE obtained normal scores on the RCPM, AM, TMTA, SCT, and RCFC, but their scores were significantly low on the CBS, CBSSL, and RCFDR. The patients with MTLS obtained lower scores in comparison with the controls and the patients without lesions, whereas those with other lesions obtained low scores only on the CBSSL and those without lesions performed normally.ConclusionsTemporal lobe epilepsy does not affect nonmemory visuospatial functions but significantly impairs visuosopatial memory and learning. This pattern is independent of TLE laterality, in keeping with a modality-specific memory model. On the contrary, the type of temporal lobe lesion is relevant to the severity of impairment.
  • Source localization of high-frequency activity in tripolar
           electroencephalography of patients with epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Christopher Toole, Iris E. Martinez-Juárez, John N. Gaitanis, Sridhar Sunderam, Lei Ding, John DiCecco, Walter G. BesioAbstractObjectiveThe objective of the study was to localize sources of interictal high-frequency activity (HFA), from tripolar electroencephalography (tEEG), in patient-specific, realistic head models.MethodsConcurrent electroencephalogram (EEG) and tEEG were recorded from nine patients undergoing video-EEG, of which eight had seizures during the recordings and the other had epileptic activity. Patient-specific, realistic boundary element head models were generated from the patient's magnetic resonance images (MRIs). Forward and inverse modeling was performed to localize the HFA to cortical surfaces.ResultsIn the present study, performed on nine patients with epilepsy, HFA observed in the tEEG was localized to the surface of subject-specific, realistic, cortical models, and found to occur almost exclusively in the seizure onset zone (SOZ)/irritative zone (IZ).SignificanceHigh-frequency oscillations (HFOs) have been studied as precise biomarkers of the SOZ in epilepsy and have resulted in good therapeutic effect in surgical candidates. Knowing where the sources of these highly focal events are located in the brain can help with diagnosis. High-frequency oscillations are not commonly observed in noninvasive EEG recordings, and invasive electrocorticography (ECoG) is usually required to detect them. However, tEEG, i.e., EEG recorded on the scalp with tripolar concentric ring electrodes (TCREs), has been found to detect narrowband HFA from high gamma (approximately 80 Hz) to almost 400 Hz that correlates with SOZ diagnosis. Thus, source localization of HFA in tEEG may help clinicians identify brain regions of the epileptic zone. At the least, the tEEG HFA localization may help determine where to perform intracranial recordings used for precise diagnosis.
  • Neurofeedback impacts cognition and quality of life in pediatric focal
           epilepsy: An exploratory randomized double-blinded sham-controlled trial
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Leon Morales-Quezada, Diana Martinez, Mirret M. El-Hagrassy, Ted J. Kaptchuk, M. Barry Sterman, Gloria Y. YehAbstractObjectiveChildren with epilepsy experience cognitive deficits and well-being issues that have detrimental effects on their development. Pharmacotherapy is the standard of care in epilepsy; however, few interventions exist to promote cognitive development and to mitigate disease burden. We aimed to examine the impact of two different modalities of neurofeedback (NFB) on cognitive functioning and quality-of-life (QOL) measurements in children and adolescents with controlled focal epilepsy. The study also explored the effects of NFB on clinical outcomes and electroencephalography (EEG) quantitative analysis.MethodsParticipants (n = 44) with controlled focal epilepsy were randomized to one of three arms: sensorimotor rhythm (SMR) NFB (n = 15), slow cortical potentials (SCP) NFB (n = 16), or sham NFB (n = 13). All participants received 25 sessions of intervention. The attention switching task (AST), Liverpool Seizure Severity Scale (LSSS), seizure frequency (SF), EEG power spectrum, and coherence were measured at baseline, postintervention, and at 3-month follow-up.ResultsIn children and adolescents with controlled focal epilepsy, SMR training significantly reduced reaction time in the AST (p = 0.006), and this was correlated with the difference of change for theta power on EEG (p = 0.03); only the SMR group showed a significant decrease in beta coherence (p = 0.03). All groups exhibited improvement in QOL (p = 
  • Comparison of the relapse rates in seizure-free patients in whom
           antiepileptic therapy was discontinued and those in whom the therapy was
           continued: A meta-analysis
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Jingjing Wang, Pin Huang, Zhi SongAbstractAbout 70% of patients with epilepsy can be seizure-free with an appropriate treatment. When the seizures are under control, discontinuation of the antiepileptic drugs (AEDs) can help avoid their side effects; however, it may increase the risk of relapse. Some studies have compared the relapse rates between patients in whom AEDs have been continued and those in whom AEDs have been discontinued. However, it is not clear whether AED discontinuation causes a higher seizure recurrence rate. This meta-analysis aimed mainly to determine whether the seizure recurrence rate was different between seizure-free patients in whom AEDs were continued and those in whom AEDs were discontinued. The I2 value was used for assessing the heterogeneity; the Mantel–Haenszel test was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs). Seven cohort studies and randomized controlled trials (RCTs) met the inclusion criteria. The study quality evaluation was performed respectively using the Newcastle–Ottawa Scale and the Jadad scale. A total of 1253 patients were included. The relapse rate was higher in patients in whom AEDs were discontinued than in those in whom the AED treatment was continued.Furthermore, we also compared the epilepsy recurrence rates after AED discontinuation between seizure-free patients who were on monotherapy with different AEDs (carbamazepine, phenytoin, sodium valproate, and phenobarbitone/primidone). Four studies and 625 patients were included in this analysis. The epilepsy recurrence rates did not significantly differ between the patients on different AED treatment.
  • Using artwork to understand and address the psychosocial challenges facing
           children and adolescents with epilepsy
    • Abstract: Publication date: Available online 9 November 2019Source: Epilepsy & BehaviorAuthor(s): Carl E. StafstromAbstractArtwork is a valuable and underutilized technique for exploring the self-esteem and psychological challenges facing children and adolescents with epilepsy and other chronic diseases. Having children with epilepsy draw a picture of their seizure correlates reliably with seizure type, provides insight into the child's developmental level, and allows expression of inner feelings such as helplessness, vulnerability, and self-concept. Art therapy focus groups are beneficial in helping children with epilepsy express their feelings nonverbally and get to know peers facing similar challenges. On the occasion of Epilepsy and Behavior's 20th anniversary, this article reviews the usefulness of art for exploring the self-concept of patients with epilepsy and acknowledges the journal's support of this informative, inexpensive, and empowering adjunctive technique."Special Issue: Epilepsy & Behavior's 20th Anniversary"
  • Temporal lobe surgery and memory: Lessons, risks, and opportunities
    • Abstract: Publication date: Available online 9 November 2019Source: Epilepsy & BehaviorAuthor(s): Kristie Bauman, Orrin Devinsky, Anli A. LiuAbstractCareful study of the clinical outcomes of temporal lobe epilepsy (TLE) surgery has greatly advanced our knowledge of the neuroanatomy of human memory. After early cases resulted in profound amnesia, the critical role of the hippocampus and associated medial temporal lobe (MTL) structures to declarative memory became evident. Surgical approaches quickly changed to become unilateral and later, to be more precise, potentially reducing cognitive morbidity. Neuropsychological studies following unilateral temporal lobe resection (TLR) have challenged early models, which simplified the lateralization of verbal and visual memory function. Diagnostic tests, including intracarotid sodium amobarbital procedure (WADA), structural magnetic resonance imaging (MRI), and functional neuroimaging (functional MRI (fMRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT)), can more accurately lateralize and localize epileptogenic cortex and predict memory outcomes from surgery. Longitudinal studies have shown that memory may even improve in seizure-free patients. From 70 years of experience with epilepsy surgery, we now have a richer understanding of the clinical, neuroimaging, and surgical predictors of memory decline—and improvement—after TLR."Special Issue: Epilepsy & Behavior's 20th Anniversary"
  • Commemorating the 20th Anniversary of Epilepsy & Behavior
    • Abstract: Publication date: Available online 7 November 2019Source: Epilepsy & BehaviorAuthor(s): Bruce Hermann
  • Bridging the divide between epilepsy and mental health to drive solutions
    • Abstract: Publication date: Available online 6 November 2019Source: Epilepsy & BehaviorAuthor(s): Rosemarie Kobau, Ron Manderscheid, Steven Owens, W. Curt LaFrance, Martha SajatovicAbstractSince its establishment in 2000, Epilepsy & Behavior has published more than 1000 papers on mental health issues among people with epilepsy, including about 200 reviews. These studies on prevalence, treatment, and guidance for future research are important contributions to the field, and they offer great promise. Yet these papers and the multitude published in other journals over the years have failed to result in systematic, scaled changes in how the epilepsy field in the United States addresses mental health issues. The mental health assessment and management gap is especially notable given decades-old, as well as more recent, recommendations from national initiatives on epilepsy, consensus statements, and other expert appeals to reduce psychiatric burden. Selected or comprehensive elements of emerging models and latest approaches from behavioral health (e.g., peer support) and public health (e.g., community-clinical linkages) highlight current opportunities to engage multiple community partners and sectors to bridge the epilepsy and behavioral health fields to implement solutions for improved mental healthcare for people with epilepsy. In honor of the 20th anniversary of Epilepsy & Behavior and its contribution to the literature and the field, we seek to build public health roadmaps to bridge the epilepsy and behavioral health divide—with new epilepsy partners who can expand community-based partnerships that may help facilitate systematic changes to close mental health treatment gaps.Special Issue: Epilepsy & Behavior's 20th Anniversary.
  • Network connectivity separate from the hypothesized irritative zone
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Elliot G. Neal, Long Di, AmberRose Reale-Caldwell, Stephanie Maciver, Mike R. Schoenberg, Fernando L. ValeAbstractIntroductionSurgery remains an essential option for the treatment of medically intractable temporal lobe epilepsy (TLE). However, only 66% of patients achieve postoperative seizure freedom, perhaps attributable to an incomplete understanding of brain network alterations in surgical candidates. Here, we applied a novel network modeling algorithm and measured key characteristics of epileptic networks correlated with surgical outcomes and objective measures of cognition.MethodsTwenty-two patients were prospectively included, and relevant demographic information was attained. Resting state functional magnetic resonance imaging (rsfMRI) and electroencephalography (EEG) data were recorded and preprocessed. Using our novel algorithm, patient-specific epileptic networks were mapped preoperatively, and geographic spread was quantified. Global functional connectivity was also determined using a volumetric functional atlas. Neuropsychological pre- and postsurgical raw and standardized scores obtained blinded to epileptic network status. Key demographic data and features of epileptic networks were then correlated with surgical outcome using Pearson's product–moment correlation.ResultsAt an average follow-up of 18.4 months, 15/22 (68%) patients were seizure-free. Connectivity was measured globally using a functional 3D atlas. Higher mean global connectivity correlated with worse scores in preoperative neuropsychological testing of executive functioning (Ruff Figural Fluency Test [RFFT]-ER; R = 0.943, p = 0.005). A higher ratio of highly correlated connections between regions of interest (ROIs) in the hemisphere contralateral to the seizure onset correlated with impairment in executive functioning (RFFT-ER; R = 0.943, p = 0.005). Higher numbers of highly correlated connections between ROIs in the contralateral hemisphere correlated with impairment in both short- and long-term measures of verbal memory (Rey Auditory Verbal Learning Test Trials 6, 7 [RAVLT6, RAVLT7]; R = − 0.650, p = 0.020, R = − 0.676, p = 0.030). Epilepsy networks were modeled in each patient, and localization of the epilepsy network in the bitemporal lobes correlated with lower scores in neuropsychological tests measuring verbal learning and short-term memory (RAVLT6; R = − 0.671, p = 0.024). Higher rates of seizure recurrence correlated with localization of the epilepsy network bitemporally (R = − 0.542, p = 0.014), with the stronger correlation found with localization to the contralateral temporal lobe from side of surgery (R = − 0.530, p = 0.016).ConclusionIncreased connectivity contralateral to seizure onset and epilepsy network spread in the bitemporal lobes correlated with lower measures of executive functioning and verbal memory. Epilepsy network localization to the bitemporal lobes, in particular, the contralateral temporal lobe, is associated with higher rates of seizure recurrence. These findings may reflect network-level disruption that has infiltrated the contralateral hemisphere and the bitemporal lobes contributing to impaired cognition and relatively worse surgical outcomes. Further identification of network parameters that predict patient outcomes may aid in patient selection, resection planning, and ultimately the efficacy of epilepsy surgery.
  • Validation of a Georgian version of the Neurological Disorders Depression
           Inventory for Epilepsy (NDDI-E)
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Ketevan Silagadze, Sofia Kasradze, Teimuraz Silagadze, Giorgi LomidzeAbstractIntroductionThis study aimed to validate a Georgian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). The distribution of psychiatric disorders was assessed among patients with epilepsy.MethodsOne hundred and thirty consecutive adult patients with epilepsy completed the NDDI-E and the Beck Depression Inventory (BDI). All patients were further assessed by a qualified psychiatrist.ResultsIn 31 (23.8%) patients, a diagnosis of major depression was revealed. The internal consistency of the NDDI-E was 0.695. Receiver operating characteristics (ROC) showed an area under the curve of 0.975. A cutoff score of ≥ 16 resulted in a sensitivity of 0.90 and a specificity of 0.939. The screening questionnaire showed a significantly positive correlation with BDI scores (Spearman's rho — 0.684), indicating good concurrent validity.DiscussionThe Georgian version of the NDDI-E is a reliable tool for the detection of depressive disorders in individuals with epilepsy.
  • Complementary and integrative medicine in epilepsy: What patients and
           physicians perceive
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Ali A. Asadi-Pooya, Maryam Homayoun, Samira SharifiAbstractPurposeThe purpose of the current study was to investigate the extent to which people with epilepsy (PWE) use complementary and integrative medicine (CIM) to treat their illness and to assess their perceptions. We also investigated the perceptions of their treating physicians.MethodsIn this cross-sectional study, all adult patients with epilepsy, who had the illness for at least one year, were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from January 2019 until March 2019. A questionnaire was designed for this survey. We also designed a similar questionnaire to investigate perceptions of the physicians in the same region.ResultsOne hundred and one patients participated. Seventy-one patients (70%) believed that CIM would be helpful in treating seizures; the most commonly reported CIM therapies were prayers, exercise, and herbs. Sixteen patients (16%) had actually used CIM to treat their seizures, but only one patient perceived that CIM was more effective than antiepileptic drugs to bring her seizures under control. Thirty-one neurologists participated in the study. Seventeen neurologists (55%) believed that CIM would be helpful in treating epileptic seizures. The most commonly reported CIM therapies were meditation, yoga, and exercise.ConclusionComplementary and integrative medicine is considered and used by many PWE to treat epileptic seizures. Cultural issues probably play an important role in having faith in CIM. Physicians involved in the care of PWE should provide appropriate information regarding the safety and efficacy of various CIM treatments for PWE.
  • Parents' view of the cognitive outcome one year after pediatric epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Christian Hoppe, Izabela Porębska, Kassandra Beeres, Robert Sassen, Stefan Kuczaty, Ulrike Gleissner, Michael Lendt, Christian E. Elger, Christoph Helmstaedter ObjectivesThe cognitive outcome of pediatric epilepsy surgery has mainly been examined on the basis of standardized tests. Here, we analyzed the outcome in six cognitive domains from the parents' view.MethodsIncluded were consecutive surgical pediatric patients whose parents filled-in a comprehensive questionnaire on cognitive problems in children and adolescents (Kognitive Probleme bei Kindern und Jugendlichen (KOPKIJ); Gleissner et al. 2006) at the preoperative baseline (T1) as well as twelve months thereafter (T2). All children also underwent standard neuropsychological assessments at T1 and T2.ResultsParents of 96 patients provided pre- and postoperative KOPKIJ data. Overall, 80% of the children became seizure-free at the follow-up. Group means indicated a strong positive effect of time on KOPKIJ and neuropsychological performance. We found postoperative improvements in five out of six cognitive domains (language, memory, executive functions, attention, school; unchanged: visuospatial abilities). Individually, improvements were twice as likely as declines. However, 33 patients (35%) experienced significant decline in at least one cognitive domain. Later onset of epilepsy resulted in better performance but had no effect on change scores. Seizure-free status, lower antiseizure drug load, and stronger drug reduction after surgery contributed to postoperative cognitive improvements as perceived by the parents; no other effects of clinical factors were obtained (e.g., localization/lateralization). Despite their similar outcome patterns, change scores as derived from parental ratings and neuropsychological assessment were not correlated.ConclusionsParents acknowledged the overall positive neurocognitive development after pediatric epilepsy surgery as previously shown by standardized tests. Seizure freedom and lower antiseizure drug load contributed to the beneficial cognitive outcome. Even if cognitive improvements outweighed declines, a risk for cognitive decline with impact on everyday functioning does exist.
  • Psychogenic nonepileptic seizures: Comparing what South African healthcare
           providers communicate to patients at the point of diagnosis against
           international guidelines
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Louise Hartwig, Chrisma PretoriusAbstractThe process of communicating a diagnosis of psychogenic nonepileptic seizures (PNES) has been widely studied internationally and found to be an important factor in the reduction of symptoms as well as promoting the uptake of treatment. To date, no research has focused on diagnosis communication in the South African context. This study used applied thematic analysis to explore the content addressed by a sample of 11 South African healthcare providers (HCPs) when presenting a diagnosis of PNES to a patient. The purpose was to investigate the areas of alignment between the international guidelines and what is done in practice and to identify other elements communicated by South African HCPs that were not addressed in the guidelines.The key communication elements described in five international guidelines were grouped into nine main themes, and coding frequencies were used to identify areas of alignment. In general, the practices of the participants aligned closely to the international guidelines. There was close alignment between the guidelines and the practices of HCPs in respect of six themes, namely: that the diagnosis was not epilepsy; how the diagnosis was made; that PNES was a real, debilitating condition; an explanation of possible causes and maintaining factors; that antiepileptic drugs are not effective in treating PNES; and a description of appropriate treatment. Participants suggested four additional subthemes that may be included when presenting a diagnosis: what to do in the event of future seizures; that further investigations are not helpful; enquiry into the link between stressors and seizures; and a discussion about comorbid conditions.Participants noted the value of utilizing a guideline as a means to ensure that all HCPs involved with a patient communicate a consistent message. They emphasized that diagnosis presentation must be relevant to the South African population and discussed the need to tailor explanations for the patient's home language and level of education. Cross-cultural barriers and different cultural health beliefs may require a specially tailored communication approach grounded in a clear cultural understanding.
  • Attention-deficit hyperactivity disorder in adults with epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Nahid Ashjazadeh, Ali Sahraeian, Iman Sabzgolin, Ali A. Asadi-PooyaAbstractPurposeWe investigated the prevalence of attention-deficit hyperactivity disorder (ADHD) in adult people with epilepsy (PWE). We hypothesized that ADHD is common among adult PWE and, some clinical factors may be associated with ADHD.MethodsIn this cross-sectional study, 200 adult PWE referred to our neurology clinic at Shiraz, Iran were recruited (consecutively sampled). Validated Persian versions of Adult ADHD Self-Report Scale (ASRS v1.1) and Addenbrooke's Cognitive Examination-Revised (ACE-R) tests were used. We performed univariate analyses and also a logistic regression analysis.ResultsEighty-two patients (41%) were male, and 118 (59%) were female. Seventy patients (35%) had a positive screen for ADHD. There was a significant association between cognitive function and the prevalence of positive screening for ADHD in the whole group; 19 (18%) of the patients with a normal cognition, 23 (42%) of those with mild impairment, and 28 (70%) of those with severe cognitive impairment screened positive for ADHD (p = 0.0001). One hundred and five patients had normal cognition and were studied separately. Nineteen patients (18%) had screened positive for ADHD. Attention-deficit hyperactivity disorder was not associated with any of the tested variables in these patients.ConclusionAbout one-fifth of adults with epilepsy and normal cognitive function may have a positive screen for ADHD. Routine screening of all PWE for early detection and appropriate management of ADHD would be a reasonable approach.
  • Validation of the Chinese version of the Scale for Suicide Ideation-Worst
           in adult patients with epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Xueying Li, Siqi Ding, Jiahe Lin, Yingjie Hua, Feirong Dong, Yanru Du, Jingzan Shen, Niange Xia, Zhenguo Zhu, Xinshi Wang, Rongyuan Zheng, Huiqin XuAbstractObjectiveThe aim of this study was to validate the Chinese version of the Scale for Suicide Ideation-Worst (SSI-W) for screening suicide ideation in Chinese adult patients with epilepsy (PWE).MethodA consecutive sample of Chinese adult PWE from a tertiary hospital completed the SSI-W and the suicidality module of the Chinese version of the Mini International Neuropsychiatric Interview (MINI) Plus 5.0.0.ResultsA total of 269 PWE completed the scales. According to the MINI, 59 patients (21.9%) had suicidal ideation. The Cronbach's α coefficient for the SSI-W was 0.96. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) for the SSI-W was 0.957 (95% confidence interval [CI] = 0.935–0.980). With a cutoff score of 2 points, the SSI-W demonstrated the best psychometric properties: a sensitivity of 95.8%, a specificity of 87.3%, a positive predictive value (PPV) of 56.7%, and a negative predictive value (NPV) of 99.0%. The scores for items 11 (Reason for attempt) and 18 (Final acts) were not significantly different (p > 0.05) in patients with suicidal ideation, while the scores for the other items were significantly different between these groups of patients.ConclusionThe Chinese version of the SSI-W proved to be a reliable and effective assessment tool for screening suicidal ideation in Chinese adult PWE.
  • Genetic backgrounds have unique seizure response profiles and behavioral
           outcomes following convulsant administration
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Nycole Ashley Copping, Anna Adhikari, Stela Pavlova Petkova, Jill Lynn SilvermanAbstractThree highly utilized strains of mice, common for preclinical genetic studies, were evaluated for seizure susceptibility and behavioral outcomes common to the clinical phenotypes of numerous psychiatric disorders following repeated low-dose treatment with either a gamma-aminobutyric acid (GABA) receptor antagonist (pentylenetetrazole (PTZ)) or a glutamate agonist (kainic acid (KA)). Effects of strain and treatment were evaluated with classic seizure scoring and a tailored behavior battery focused on behavioral domains common in neuropsychiatric research: learning and memory, social behavior, and motor abilities, as well as seizure susceptibility and/or resistance. Seizure response was induced by a single daily treatment of either PTZ (30 mg/kg, intraperitoneally (i.p.)) or KA (5 mg/kg, i.p.) for 10 days. Pentylenetetrazole-treated FVB/NJ and C57BL/6NJ strains of mice showed strong, clear seizure responses. This also resulted in cognitive and social deficits, and increased susceptibility to a high dose of PTZ. Kainic acid-treated FVB/NJ and C57BL/6NJ strains of mice had a robust seizure response, which resulted in hyperactivity. Pentylenetetrazole-treated C57BL/6J mice demonstrated mild hyperactivity, while KA-treated C57BL/6J displayed cognitive deficits and resistance to a high dose of KA but no social deficits. Overall, a uniquely different seizure response profile was detected in the C57BL/6J strain with few observable instances of seizure response despite repeated convulsant administration by two mechanisms. This work illustrated that differing background genetic strains have unique seizure susceptibility profiles and distinct social and cognitive behavior following PTZ and/or KA treatment and that it is, therefore, necessary to consider strain differences before attributing behavioral phenotypes to gene(s) of interest during preclinical evaluations of genetic mouse models, especially when outcome measures are focused on cognitive and/or social behaviors common to the clinical features of numerous neurological disorders.
  • Diagnosis of psychiatric comorbidities in epilepsy — The role of
           screening tools
    • Abstract: Publication date: Available online 6 November 2019Source: Epilepsy & BehaviorAuthor(s): Małgorzata Czarnota, Mariusz S. Wiglusz, Wiesław J. Cubała
  • Effectiveness of eslicarbazepine acetate in dependency of baseline
           anticonvulsant therapy: Results from a German prospective multicenter
           clinical practice study
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Florian Weissinger, Florian Losch, Yaroslav Winter, Silvia Brecht, Dirk Lendemans, Edgar KockelmannAbstractEslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved as monotherapy for partial-onset seizures in adults and as adjunctive therapy in patients aged above 6 years in the European Union (EU). The prospective observational Zebinix Effects in DEpendency of BAseline Conditions (ZEDEBAC) study aimed at investigating the effectiveness of ESL in clinical practice, with ESL being administered as monotherapy (mono group), as only add-on to a current monotherapy (1 + group), or as add-on to ≥ 2 baseline AEDs (≥ 2 + group). In total, 237 patients were included, 35 in the mono group, 114 in the 1 +, and 88 in the ≥ 2 + group. Six-month retention rates were 93.9%, 78.0%, and 75.3% in the mono, 1 +, and ≥ 2 + group. There were 90.5%, 77.6%, and 48.3% of patients in the mono, 1 +, and ≥ 2 + groups who were responders (patients with a ≥ 50% reduction in seizure frequency at follow-up vs. baseline). Seizure freedom rates were 81.5%, 47.9%, and 23.4%, respectively. Adverse drug reactions (ADRs) occurred in 11.4% of patients of the mono, 19.3% of the 1 +, and 28.4% of patients of the ≥ 2 + group. Hyponatremia was reported as ADR in 3.4% of all patients. Although baseline variables differed considerably, with most elderly patients with tumor-related and vascular etiologies in the mono group and most patients with refractory epilepsies with pronounced use of concomitant sodium channel blockers (SCBs) in the ≥ 2 + group, retention as a measure of real-life effectiveness turned out not to be substantially different and favorable in all groups.
  • Pre- and postoperative verbal memory and executive functioning in frontal
           versus temporal lobe epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Florian J. Bremm, Hendriks Marc P.H, Christian G. Bien, Philip GreweAbstractThere is accumulating evidence for considerable overlap in preoperatively affected cognitive functions in patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The current study investigated whether it is possible to differentiate between patients with FLE and TLE prior to surgery, based on measures of verbal memory and executive functioning. Furthermore, the postoperative cognitive development was compared. Pre- and postoperative data from 109 patients with FLE and 194 patients with TLE were retrospectively analyzed. Preoperatively, there were no differences in verbal memory, and postoperatively, no distinctive cognitive change was found between patients with FLE and TLE. However, patients with FLE performed worse on a cognitive switching task. Notably, irrespective of localization, patients with a presumed epileptogenic area in the language-dominant hemisphere performed worse than patients with seizures that originated in the nonlanguage-dominant hemisphere on measures of verbal memory, both pre- and postoperatively. In sum, the results suggest that verbal memory scores may be less valuable for differentiation between TLE and FLE, while measures of executive functioning may help identify patients with FLE. Additionally, rather than the localization, epilepsy lateralization critically impacts the evaluation of verbal memory functioning in both TLE and FLE. The results are discussed in light of the current frameworks of functional disturbances in epileptic networks.
  • Verbal associative memory outcomes in pediatric surgical temporal lobe
           epilepsy: Exploring the impact of mesial structures
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Ashley N. Danguecan, Mary Lou SmithAbstractObjectiveWe examined verbal associative memory outcomes in children with left- or right-sided temporal lobe epilepsy (TLE) who received combined lateral and mesial resections versus lateral resections sparing mesial structures. We hypothesized that children who underwent left-sided resections including mesial structures would show the greatest verbal associative memory declines following surgery.MethodWe retrospectively analyzed neuropsychology assessment results from a sample of 65 children with TLE who completed pre- and postoperative evaluation at the Hospital for Sick Children in Toronto, Canada. We examined verbal associative memory score changes between groups by laterality (left versus right) and resection type (lateral only versus lateral and mesial resection). We also explored potential associations between certain epilepsy-related characteristics and verbal associative memory changes.ResultsPostoperative decline was found in children with left-sided resections, but not those with right-sided resections. In children who received left-sided resections, there was some suggestion of verbal associative memory decline in those who had both lateral and mesial tissues excised, but not in those with lateral resections only. Notably, there was also a language dominance (typical versus atypical) by resection type interaction. Specifically, for the typical language group, children with left lateral plus mesial resections (but not mesial sparing resections) showed postoperative verbal associative memory declines, whereas the opposite was true for the atypical language group.SignificanceThese data contribute to our growing understanding of verbal memory outcomes following TLE in childhood, with consideration of the extent of resection to mesial structures. Our findings also highlight the importance of language laterality when interpreting neuropsychological assessment findings and making predictions regarding risk of functional loss following surgery.
  • Dissociation between decision making under ambiguity and risk in patients
           with juvenile myoclonic epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Maria L. Paiva, Patricia Rzezak, Bernardo Santos, Ellen M. Lima, Sylvie P. Moschetta, Silvia Vincentiis, Rudá Alessi, Melanie Mendoza, Kette D. ValenteAbstractIntroductionDecision making (DM) is one aspect of impulsivity that can be defined by the ability to decide between two or more options in a given situation. To date, there are at least two types of DM that differ in the level of uncertainty, and how much information about consequences is provided. In this study, we aimed to evaluate the two domains of DM — under risk and ambiguous — with a comprehensive evaluation in a group of patients with juvenile myoclonic epilepsy (JME), and correlate with patients' characteristics, clinical variables, and neuropsychological evaluation for executive functions.MethodsWe evaluated 35 patients with JME and 39 healthy controls using the Iowa Gambling Task for DM under ambiguity and the Game Dice Task for DM under risk. We assessed the performance in Iowa Gambling Task and Game Dice Task through net scores, safe and risky choices, besides the type of decisions across time.ResultsPatients with JME had a higher number of risky choices compared to controls in the Game Dice Task. There was no significant difference between patients and controls in the Iowa Gambling Task. However, patients with higher seizure frequency had worse scores on decks C and D (safe choices) from the Iowa Gambling Task.ConclusionPatients with JME have worse performance on DM under risk. The same was not observed for DM under ambiguity. Epilepsy-related factors and the presence of psychiatric disorders, but not executive dysfunction, were associated with a lower tendency for safe choices. These findings showed a dissociation between DM processes in patients with JME and a tendency to make disadvantageous decisions with measurable risks.
  • Ethnicity and health outcomes among people with epilepsy participating in
           an epilepsy self-management RCT
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Neha Kumar, Michelle Aebi, Elaine Lu, Christopher Burant, Martha SajatovicAbstractPeople with epilepsy (PWE) may experience negative health events (NHEs) such as seizures, emergency room visits, and hospitalizations, with ethnic and racial minorities disproportionately affected. Epilepsy self-management may reduce NHEs; however, few reports examine self-management outcomes in racial minorities. Using data from a longitudinal 6-month randomized controlled trial (RCT) of 120 PWE, this analysis compared African–American and Whites at baseline, 10 weeks and 24 weeks after receiving the “Self-management for people with epilepsy (SMART) and a history of NHEs” self-management program. The primary RCT outcome was number of NHEs. At baseline, compared to Whites, African–Americans had less education (p = 0.02) and greater depressive severity (p = 0.04). Both African–American and Whites generally improved with SMART, and there were no racial differences in NHE counts or other outcomes' responses. Given known racial disparities in epilepsy care, it may be particularly important to reach out to minority PWE with self-management programs.
  • New-onset seizure survey of epilepsy centers in the United States
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Luda M. Sorin, Kelly G. Knupp, Anne T. BergAbstractObjectivesChildren presenting with new-onset seizures have variable access to resources and may not receive timely and adequate treatment. Some may experience adverse consequences when not evaluated in a timely manner by appropriate medical providers. Consequences can be especially severe for children under the age of two and for children who have psychiatric, cognitive, and behavioral comorbidities. There are no published data on how children with new-onset seizure are evaluated and treated across the US. Our goal was to gain insight into how different epilepsy centers across the country evaluate and treat children with new-onset seizures.MethodsWe conducted a survey of Epilepsy Centers in the US that are part of the Pediatric Epilepsy Research Consortium (PERC) and focused on children presenting with new-onset seizures; PERC is a group of pediatric epilepsy providers and researchers who participate in collaborative multicenter research in pediatric epilepsy with the goal of improving outcomes in children with pediatric epilepsy. The questionnaire was developed by the authors of this study. It was designed to provide a descriptive assessment of the consistency and variability in how patients with new-onset seizure are evaluated and treated at epilepsy sites across the country. The questionnaire was designed to assure all points of interest were explored. The questions were aimed at describing access to care, how care is delivered, whether centers prioritize based on clinical presentation and/or age, and availability of resources. The survey was sent to 80 epileptologists at 42 different Epilepsy Centers that are part of PERC.ResultsRespondents included 29 pediatric epileptologists representing 24 unique centers. In the cases where there were multiple respondents from each center, response of the most senior epileptologist was used. It is possible that the senior epileptologist may have not known about the center as much as a junior epileptologist, but this was used to establish consistencies among centers with multiple respondents. Results showed that 30% of centers had a dedicated new-onset seizure clinic. The median time for children to be seen was two to four weeks, and 12% reported that it takes more than five weeks until the patient is seen. There was a trend toward centers with new-onset seizure clinic having less wait times. Most centers identified lack of adequate care based on insurance coverage, resources, long wait times, and long travel times.SignificanceMost centers (70%) do not have a dedicated new-onset seizure clinic. Children presenting with new-onset seizures often do not receive timely and comprehensive care because of limitations in resources and lack of established standard of care. Standardizing care for patients presenting with new-onset seizures has not yet occurred in the US. Many centers do not have a screening process and employ staff other than physicians or nurses for screening and triaging patients. This study shows that having a neurologist or epileptologist in charge of triaging does not reduce wait times. This survey revealed that there is substantial variability in how these patients are evaluated. Although this study shows a trend for epilepsy centers with new-onset seizure clinic having less wait times, even when there is a new-onset seizure clinic, wait times can be greater than five weeks. Overall, however, a new-onset seizure clinic may be an effective way to improve access to timely and efficient care for these patients.
  • Clinical profile and comparison of scoring tools for the prediction of
           in-hospital mortality in convulsive status epilepticus in elderly
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Archana Verma, Kiran K, Alok KumarAbstractPurposeThe present study was aimed to study the clinical profile, etiologies, and outcome of convulsive status epilepticus (CSE) in elderly patients and also to compare the predictive accuracy of the Status Epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus — etiology, age, level of consciousness (EMSE-EAL) score for in-hospital mortality.MethodsEighty-five elderly patients (≥ 60 years of age) with a diagnosis of CSE were consecutively enrolled. The distinction between the score performances was determined by comparing the means area under the receiver operating characteristic curve (AUC).ResultsThe mean age of respondents was 66.3 ± 7.4 years; the most common etiology of CSE was stroke (acute and remote symptomatic) in 48.2% of cases. In-hospital mortality was 16.5% in our series, and on multivariate analysis, variables significantly related with mortality were lack of response to first-line drugs (odds ratio (OR) = 43.05, 95% confidence interval (CI) = 4.7–386.8; p = .001) and higher EMSE-EAL score (OR = 0.08, 95% CI = 0.015–0.47; p = .005). On comparison, STESS with the cutoff value of ≥ 3 has AUC of 0.678 (95%CI = 0.54–0.81), whereas ESME-EAL with the cutoff value of ≥ 40 showed AUC of 0.901 (95% CI = 0.83–0.97).ConclusionsMost frequent cause of CSE in elderly in our series was stroke and was also associated with high mortality. For the prediction of in-hospital mortality in elderly, EMSE-EAL-40 score is superior to STESS-3, which can be easily applied in resource-poor sectors with limited diagnostic facilities especially where continuous video-electroencephalogram (EEG) monitoring is unavailable.
  • Factors associated with social anxiety in South Korean adults with
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Su-Hyun Han, Keun Tae Kim, Han Uk Ryu, Sang-Ahm Lee, Yang-Je Cho, Jee Hyun Kim, Kyung-Wook Kang, Dong Jin Shin, Gha Hyun Lee, Kyoung Jin Hwang, Young-Soo Kim, Jung Bin Kim, Ji-Eun Kim, Seo-Young Lee, Jong-Geun SeoAbstractPurposeThe aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors.MethodThis was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used.ResultsOf a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥ 9 and SIAS-6 scores ≥ 12, respectively. In logistic regression analysis, SPS-6 scores ≥ 9 were independently associated with SS-R scores of 4–9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515–29.587, p = .001), SS-R scores 1–3 (OR: 5.496, 95% CI: 1.757–17.197, p = .003), and PHQ-9 scores ≥ 10 (OR: 4.092, 95% CI: 1.823–9.185, p = .001). In contrast, SIAS-6 scores ≥ 12 were related only to PHQ-9 scores ≥ 10 (OR: 8.740, 95% CI: 3.237–23.599, p 
  • First evidence of the clinical impact of a general practitioner with a
           special interest in epilepsy
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Ian. Minshall, Aidan. NeliganAbstractPurposeThe purpose of the study was to review the clinical outcomes of people with epilepsy (PWE) attending a primary care-based specialist epilepsy service.MethodThe case notes of 355 people attending the service and subsequent follow-up from 2005 to 2013 were reviewed.ResultsThere had been 37 deaths (all nonattributable to epilepsy), and 38 people had left the area, leaving 280 people who completed the audit. Positive outcomes could be attributed in 94% still attending the service at the end of follow-up. Seventy-five percent of people on treatment, referred with poor seizure control, achieved seizure remission with antiepilepsy drug (AED) changes initiated by the service.ConclusionThis study suggests that the majority of people who attended the service had a positive outcome and provides the first evidence for the clinical effectiveness of a general practitioner (GP) with special interest in epilepsy (GPwSIe) and provides support for the recommendations in earlier government reports to promote the use of such a service. Clinical Commissioning Groups (CCGs) and Government should consider investment in this intermediate tier of care as a means to both improving the quality of care and potentially reducing costs.
  • Impact of resective surgery for pediatric drug-resistant epilepsy on
           emotional functioning
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Natalie L. Phillips, Elysa Widjaja, Mary Lou SmithAbstractObjectiveThe objective of the study was to evaluate emotional functioning following surgical and medical treatment in children with drug-resistant epilepsy (DRE; i.e., uncontrolled seizures despite treatment with ≥ 2 antiepileptic drugs [AED]).MethodThis prospective, longitudinal, multicenter study involved 128 children and adolescents (8–18 years) with DRE who were assessed for surgical candidacy; 48 went on to have surgery and 80 continued medical treatment. Participants completed child-validated self-report measures of anxiety and depression at baseline, 6, and 12 month follow-up. Standardized z-scores were calculated with higher scores indicative of greater symptoms.ResultsAt baseline, 16% and 22% of all patients reported elevated symptoms of depression and anxiety, respectively (i.e., z ≥ 1.00). Seizure freedom was higher in the surgical, compared with the medical, group at 6 (64 vs. 11%) and 12 month (77 vs. 24%) follow-up. Linear mixed effects models controlling for age found a main effect of time for both depression and anxiety; scores decreased over time for all patients. A main effect of seizure outcome was found for depression, but not anxiety; seizure freedom was associated with lower scores overall. There were no main effects of treatment or significant interactions. Multiple regression analyses found baseline mood predicted outcomes at 6 and 12 month follow-up; higher anxiety and depression scores at baseline were associated with higher scores at follow-up. Older age and greater number of AEDs at baseline was associated with higher depression scores at 12 month follow-up.ConclusionOverall, patients reported a reduction in anxiety and depressive symptoms over the first 12 months, irrespective of treatment, and baseline level of functioning was the best predictor of outcome. Despite more children achieving seizure freedom with surgery compared with medical treatment, surgery was not associated with better outcomes over time. It may be that changes in anxiety and depression require a longer time to emerge postsurgery; however, being seizure-free is associated with fewer depressive symptoms, irrespective of treatment type.
  • Disrupted functional network in patients with temporal lobe epilepsy with
           impaired alertness
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Jinping Liu, Xia Zhou, Zhao Zhang, Lu Qin, Wei Ye, Jinou ZhengAbstractCognitive impairment is common in patients with temporal lobe epilepsy (TLE). Alertness is an important subfunction of cognition, but it is poorly understood in TLE. We hypothesized that disruptions to underlying brain networks may affect alertness in patients with TLE. Patients with unilateral TLE were grouped into low-alertness and high-alertness groups, and they were matched with healthy controls (HCs) (n = 20 each). Functional magnetic resonance imaging (fMRI) was used to construct functional brain networks, and graph theory was used to identify topological parameters of the networks. At the global level, patients with low alertness had networks with less small-worldness and less normalized clustering than HCs. At the nodal level, patients with low alertness exhibited decreased centrality of the bilateral parahippocampal gyrus compared with HCs and increased centrality of the right postcentral gyrus compared with patients with high alertness. This study reveals a decreased separation, tending toward randomization, of the functional network in patients with TLE with impaired alertness. Our results also suggest that the parahippocampal gyrus may contribute to impaired alertness and the right postcentral gyrus plays an important role in the modulation of alertness in patients with TLE.
  • History of dietary treatment from Wilder's hypothesis to the first open
           studies in the 1920s
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Sophie Höhn, Blandine Dozières-Puyravel, Stéphane AuvinAbstractIn the ketogenic diet (KD) history, Wilder is often mentioned as the first author to report on the use of KD for patients with epilepsy.Our article aimed to understand how Wilder formulated the hypothesis of the KD effectiveness for patients with epilepsy, and how the KD was used and spread in the 1920s.In 1921, Wilder published two articles on the effects of ketonemia on epilepsy. He first reported on the interest of fasting for patients with epilepsy, suggesting that the benefits of fasting on seizures might be dependent on ketonemia. He then hypothesized that equally good results could be obtained with a KD, very rich in fat and very low in carbohydrate, which would provoke ketogenesis, and observed the effects of this diet on three patients for the first time.Following the publication of Wilder articles, 9 papers on KD were published during the 1920s, involving more than 400 patients with epilepsy.Ketogenic diet therapies (KDT) are now evidence-based treatments of epilepsy. Available experimental data do not confirm the role of ketosis as the unique mechanism of the KD. The KD is still explored to understand all the underlying mechanisms.
  • Modulatory effect of opioid ligands on status epilepticus and the role of
           nitric oxide pathway
    • Abstract: Publication date: December 2019Source: Epilepsy & Behavior, Volume 101, Part AAuthor(s): Shahab Meskinimood, Nastaran Rahimi, Hedyeh Faghir-Ghanesefat, Mahdi Gholami, Mohammad Sharifzadeh, Ahmad Reza DehpourAbstractEpilepsy is a chronic disorder that causes unprovoked, recurrent seizures. Status epilepticus (SE) is a medical emergency associated with significant morbidity and mortality. Morphine has been the cornerstone of pain controlling medicines for a long time. In addition to the analgesic and opioid responses, morphine has also revealed anticonvulsant effects in different epilepsy models including pentylenetetrazole (PTZ)-induced seizures threshold. Some authors suggest that nitric oxide (NO) pathway interactions of morphine explain the reason for its pro or anticonvulsant activities. To induce SE, injection of a single dose of lithium chloride (127 mg/kg, intraperitoneal (i.p.)) 20 h before pilocarpine (60 mg/kg, i.p.) was used. Administration of morphine (15 mg/kg, i.p.) inhibited the SE and decreased the mortality in rats when injected 30 min before pilocarpine. On the other hand, injection of L-NG-nitro arginine methyl ester (L-NAME, a nonselective NO synthase (NOS) blocker; 10 mg/kg, i.p.), 7-nitroindazole (7-NI, a neuronal NOS (nNOS) blocker; 30 mg/kg, i.p.), and aminoguanidine (AG, an inducible NOS (iNOS) blocker; 50 mg/kg, i.p.) 15 min before morphine, significantly reversed inhibitory effect of morphine on SE. Subsequently, measurement of nitrite metabolite levels in the hippocampus of SE-induced rats displayed high levels of nitrite metabolite for the control group. However, after injection of morphine in SE-induced rats, nitrite metabolite levels reduced. In conclusion, these findings demonstrated that NO pathway (both nNOS and iNOS) interactions are involved in the anticonvulsant effects of morphine on the SE signs and mortality rate induced by lithium–pilocarpine in rats.
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