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1.
Xinglong Yang Bin Liu Baiyuan Yang Shimei Li Fang Wang Kelu Li Fayun Hu Hui Ren Zhong Xu 《Neurological sciences》2018,39(11):1927-1934
Objective
Recent studies have shown an association between migraine and restless legs syndrome (RLS), but RLS prevalence among individuals with migraine differs substantially across studies. The present work aimed to comprehensively assess available evidence to estimate RLS prevalence among individuals with migraine and non-migraine controls.Method
Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched for observational and case-control studies of RLS prevalence among individuals with migraine. Eligible studies were meta-analyzed using Stata 12.0 software.Results
Pooled RLS prevalence in migraine was 19%, and the prevalence was lower in Asia (16%) than outside Asia (21%). Pooled RLS prevalence was 18.8% among individuals with migraine with aura, and 18.5% among individuals with migraine without aura; the RLS prevalence in migraine with aura (MA) was higher than that of migraine without aura (MO) (OR 1.17, 95%CI 1.01–1.34; p?=?0.037). Pooled RLS prevalence in a case-control study was significantly higher among individuals with migraine (17.9%) than among non-migraine controls (7.1%) (OR 2.65, 95%CI 2.26–3.10; p?<?0.001).Conclusion
Our meta-analysis provides the first reliable pooled estimate of RLS prevalence among individuals with migraine, and it provides strong evidence that RLS risk is higher among individuals with migraine than among controls.2.
Background
Although the sociomedical importance of epilepsies has been extensively investigated, data regarding social long-term outcome and quality of life of people with idiopathic generalized epilepsies (IGE) are lacking.Objectives
Predictors for the psychosocial outcome and the quality of life in patients with IGE are identified and discussed.Materials and methods
The findings of existing studies on the social outcome in patients with various IGE syndromes are analyzed and discussed.Results
Patients with absence epilepsy or juvenile myoclonic epilepsy (JME) are reported to have an unfavorable psychosocial outcome. While in JME a lower seizure frequency or remission of the epilepsy correlates with a favorable psychosocial outcome and a higher quality of life, remission of epilepsy is not predictive for a better social outcome among patients with absence epilepsy. Compared to other IGE syndromes, IGE with generalized, tonic–clonic seizures on awakening appears have a more favorable psychosocial outcome.Conclusion
Several predictors for the psychosocial outcome and the quality of life have been identified and may potentially increase the clinicians’ ability and confidence to recommend different treatment options to patients with IGE.3.
Introduction
Pediatric low-grade tumors are found in roughly 1–3 % of patients with childhood epilepsy; seizures associated with these tumors are often medically refractory and often present a significant morbidity, greater than the presence of the tumor itself.Discussion
The unique morbidity of the seizures often requires an epilepsy surgical approach over a standard oncologic resection to achieve a reduction in morbidity for the child. Multiple quality-of-life studies have shown that unless a patient is seizure-free, they remain disabled throughout their life; the best way to achieve this in our patient population is with a multidisciplinary team approach with treatment goals focusing primarily on the epilepsy.Conclusion
In those patients treated with gross total resection, roughly 80 % will have an Engel class I outcome and 90 % will achieve some reduction in seizure frequency with a significant improvement in quality of life.4.
Jonathan Rabner Alessandra Caruso David Zurakowski Lori Lazdowsky Alyssa LeBel 《Clinical autonomic research》2016,26(6):455-459
Purpose
To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache.Methods
A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5–18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS).Results
Higher frequencies of “insomnia,” “dizziness,” and “cold and clammy palms and soles” were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with “cold and clammy palms and soles” reaching significance (P < 0.001).Conclusions
The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.5.
Mustafa Ceylan Ahmet Yalcin Omer Faruk Bayraktutan Esra Laloglu 《Neurological sciences》2018,39(12):2135-2139
Purpose
Epileptic seizure is the result of uncontrollable neural excitation in the brain. The C-type natriuretic peptide is a member of natriuretic peptide hormone family and is synthesized by brain and blood vessels in CNS. NT-pro CNP is an amino-terminal fragment of C-type natriuretic peptide and is more stable compared to its predecessor. In this study, we aimed to evaluate the role of NT-pro CNP in psychogenic non-epileptic seizures, epileptic seizures, and normal subjects.Methods
Thirty-three patients with epilepsy and 43 patients with psychogenic non-epileptic seizures were enrolled in this study. The control group consisted of 28 healthy subjects. Post-ictal serum levels of NT-pro CNP were acquired from all participants. Statistically significant differences between patient groups and controls regarding serum levels of NT-pro CNP were sought.Results
NT-pro CNP levels were significantly lower in the epilepsy group than the psychogenic non-epileptic seizure group and control group with no significant difference between the psychogenic non-epileptic seizure and control group (p?<?0.05).Conclusion
Post-ictal serum NT-pro CNP levels were lower in epileptic seizures compared to psychogenic non-epileptic seizures as well as healthy controls. We think that such a difference is associated with C-type natriuretic peptide-related neural mechanisms such as altered microcirculation, increased brain-blood barrier permeability, and synaptic stabilization.6.
Comparative role of neuropsychological testing in the presurgical evaluation of children with medically intractable epilepsies 总被引：1，自引：0，他引：1
Cecília Souza-Oliveira Sara Escorsi-Rosset Marino Muxfeldt Bianchin Vera Cristina Terra Lauro Wichert-Ana Hélio Rubens Machado Américo Ceiki Sakamoto 《Child's nervous system》2009,25(7):875-880
Purpose
In the present study, we evaluated the preoperative demographic, clinical, and neuropsychological variables that could predict postoperative seizure outcome in a group of pediatric epileptic patients.Materials and methods
We studied 40 consecutive pediatric patients, ages ranging from 6 to 16 years, that underwent resective surgery for the treatment of medically intractable epilepsy at the Clinical Hospital of Ribeirão Preto School of Medicine. We performed ictal electroencephalography (EEG), interictal EEG, magnetic resonance imaging (MRI), and a preoperative neuropsychological assessment in the presurgical workup.Results
The following factors were correlated with seizure outcome: (1) duration of epilepsy, (2) surgery localization, (3) localized Neuropsychological (NPS) Evaluation, (4) ictal EEG, (5) interictal EEG, and (6) MRI. Mental retardation, NPS tests, and the other demographic variables failed to correlate with seizure reduction.Conclusions
The identification of predictor variables of epilepsy surgery outcome could improve the epileptic prognosis and guarantee the children's full potential development.7.
Long term effect of vagus nerve stimulation in pediatric intractable epilepsy: an extended follow-up
Ayse Serdaroglu Ebru Arhan Gökhan Kurt Atilla Erdem Tugba Hirfanoglu Kursad Aydin Erhan Bilir 《Child's nervous system》2016,32(4):641-646
Purpose
Over the past two decades, vagus nerve stimulation (VNS) has become an accepted and viable treatment modality for intractable epilepsy both in children and adults. Earlier studies have demonstrated short-term seizure outcomes, usually for up to 5 years; so far, none have reported an extended outcome in children. We aimed to assess long term seizure outcome in children with intractable epilepsy for more than 5 years.Methods
We identified patients who had VNS implantation for treatment of intractable epilepsy from March 2000 to March 2015 at our Epilepsy Center and collected data including demographic, age at epilepsy onset and VNS implantation, duration of epilepsy, seizure type, number of antiepilepsy drugs (AEDs), and monthly seizure frequency before VNS implantation and at the last clinic visit. Phone surveys were conducted with patients without recent clinic follow-up.Results
Fifty-six patients (aged 4–17 at the time of implant) are the subjects of the study. Seizure reduction of >50 % was achieved in 9.8 % (6th month), 24 % (2nd year), 46.4 % (3rd year), and 54 %(5th year), and overall 35 (62.5 %) of the 56 subjects had a greater than 50 % reduction in seizure frequency at the last follow-up. Eleven patients became seizure free. The results, once obtained, were maintained steadily or even improved over time without any loss of efficacy during the follow-up. The only parameter, significantly related with clinical response, was age at seizure onset. The most frequent adverse events were hoarseness, cough, sore throat, and anorexia, experienced by 13 patients. Two patients had local wound infections and lead to the removal of the stimulator. An improvement in alertness, attention, and psychomotor activity, independent of the efficacy of vagal nerve stimulation, was observed in 8 patients.Conclusion
To our knowledge, this is the first pediatric study evaluating seizure outcome over more than 5 years of follow-up, and demonstrates a favorable seizure outcome of >50 % seizure frequency in 62.5 % of patients and seizure freedom in 11 patients. It is well tolerated over an extended period of time.8.
L.B. Dehn 《Zeitschrift für Epileptologie》2015,28(2):140-147
Background
Epilepsy has an impact on not only the affected child, but also the whole family, especially the parents.Aim of the study
To give an overview of the psychosocial impact of a child’s epilepsy on his/her family.Methods
This overview is based on a selection of primary studies, which were mainly identified by a PubMed search.Results
Besides various worries, high support needs, and mental health problems on the part of the parents, the epilepsy of a child also leads to stress for their siblings and strains in the relationships within the family. Furthermore, there are several limitations both in everyday life and in the social activities of the affected families. The presence of additional behavioral or health problems in children has been found to be an important factor influencing the impact of epilepsy on families.Conclusion
In a comprehensive treatment approach for children and adolescents with epilepsy, the disease-related burdens of the family should be taken into account and psychosocial support should be provided.9.
Objective
In the present study we reviewed possible strategies and their success rates following primary therapy failure.Material and Methods
From all outpatients, we evaluated those children who had previously been treated unsuccessfully with two or more anticonvulsants, suffering from active epilepsy for at least one year and who had the last therapeutic intervention at least six months ago (n = 103). Regarding etiology, three groups were distinguished. The endpoint was seizure frequency. We distinguished between seizure freedom, seizure reduction by 75?% (responder) and no substantial improvement.Results
Of 103 patients, 45 were seizure-free, 45 were responder and 13 patients did not benefit.Discussion
An important advantage for patients that ultimately contributed significantly to the success of treatment was re-evaluation of the diagnosis and classification of the epilepsy. By correcting diagnosis and consequently changing treatment, some cases were successfully treated. All therapeutic options could be offered, including the full range of available anticonvulsants, surgical treatment and ketogenic diet. The majority of treatment success was achieved by consistent anticonvulsant pharmacotherapy regime. It was found that good therapeutic success was achieved most frequently with valproate and lamotrigine, without a significant difference regarding the epilepsy syndromes.10.
Purpose
In individuals with a comorbid autistic spectrum disorder and medically refractory epilepsy, vagus nerve stimulation may offer the potential of seizure control and a positive behavioral side effect profile. We aimed to examine the behavioral side effect profile using longitudinal and quantitative data and review the potential mechanisms behind behavioral changes.Methods
We present a case report of a 10-year-old boy with autistic spectrum disorder and epilepsy, who underwent vagus nerve stimulation subsequent to unsuccessful treatment with antiepileptic medication.Results
Following vagus nerve stimulation implantation, initial, if temporary, improvement was observed in seizure control. Modest improvements were also observed in behavior and development, improvements which were observed independent of seizure control.Conclusions
Vagus nerve stimulation in autistic spectrum disorder is associated with modest behavioral improvement, with unidentified etiology, although several candidates for this improvement are evident.11.
J. Stockinger M. Bacher V. Bernedo Paredes T. Intravooth R. Kornmeier C. Kurth P. Mahn A. M. Staack B. J. Steinhoff 《Zeitschrift für Epileptologie》2018,31(4):307-310
Background
In 2017, the International League Against Epilepsy (ILAE) published a new seizure and epilepsy classification. After this publication, there has been considerable doubt whether this classification can be translated into German and whether it is easy to apply in everyday clinical practice.Objectives
To investigate to what extent the new classification is employed in the doctors’ letters of our clinic.Materials and methods
We retrospectively analyzed the most recent doctors’ letters before 01 December 2017 and examined whether the new classification was applied and what kind of changes were especially frequently not adopted. Furthermore, our clinic’s physicians anonymously answered our questions about knowledge, appreciation and use of the new classification.Results
The new classification was entirely applied in 28 of 76 letters (37%). The most common reason for not implementing the new classification correctly was using prior seizure denominations, as bilateral convulsive seizures (n?=?15), dyscognitive seizures (n?=?9) and aura (n?=?6). Only with regard to generalized epilepsy syndromes were there no difficulties in adopting the new classification.Conclusions
In our specialised centre, physicians applied the new classification only in one third of all cases, despite subjective predominantly good knowledge of the new classification. The acceptance of the new ILAE version was diverging in our physician staff. It seems likely that some officially abolished terms which have proven their worth by being comprehensible and feasible will persist in our vocabulary.12.
Objective
In this study, we aimed to investigate restless legs syndrome, depression, frequency of fibromyalgia and possible causes of its frequencies, and the relationships among these synergies and migraine’s prodrome, aura, pain, and postdrome symptoms in patients with migraine.Subjects and methods
The study group included 200 patients previously or recently diagnosed with definite migraine and according to International Headache Society criteria and 200 healthy volunteers. All subjects underwent a medical interview to confirm restless legs syndrome and fibromyalgia, and they were asked to complete Beck Depression and Anxiety Inventory and “severity of restless legs syndrome inventory.”Results
The frequencies of depressive symptoms and fibromyalgia in the patients with migraine were higher than those of the control group. The mean age of the migraine patients with restless legs syndrome was also higher, and this group had migraine headache for a longer time. There was a statistically significant difference with regard to only generalized anxiety and traveler’s distress, which were features of the migraine, between migraine patients with and without restless legs syndrome. Restless legs syndrome was more common in migraine patients with and without aura and in those with nonspecific white matter lesions in the cranial MRI.Conclusions
In our study, the greater frequency of restless legs syndrome, depressive symptoms, and fibromyalgia in the patients with migraine supports the role of dopamine, which is common to all three disorders. Interviews focused on these problems among migraine patients may help to decide on the best available treatment modality.13.
Background
Brain imaging is one of the most important diagnostic methods for evaluating headache during pregnancy. In this study, we aimed to identify anamnestic and clinical predictors for pathological brain imaging findings in pregnant women suffering from acute headache.Methods
We conducted a retrospective chart review of 151 pregnant women with acute headache between 2010 and 2016. We screened the medical records of these patients and analyzed radiological variables, including brain imaging frequency and modality, delay to imaging and imaging findings. In patients with brain imaging, we compared several anamnestic and clinical features between those with and without symptomatic pathological findings.Results
Half of the patients (50.3%) underwent brain imaging, mainly magnetic resonance imaging (MRI) including venography (53.9%) or MRI including both venography and arteriography (31.6%). Symptomatic pathological results could be observed in 27.6% of the patients with a brain scan. Patients in the first trimester with acute headache had a statistically higher risk for a symptomatic pathological imaging finding (p?=?0.024). Strong pain intensity, a reduced level of consciousness and seizures were significantly associated with a symptomatic pathological imaging outcome across all stages of pregnancy.Conclusion
Brain imaging may reveal a secondary headache etiology in more than 25% of pregnant women presenting with acute headache. In particular, when the acute headache is of severe intensity, and the headache is accompanied by seizures or a change in consciousness, brain imaging is required.14.
Background
For many people with epilepsy, consumption of stimulants such as alcohol, nicotine and cannabis contributes to high quality of life.Objectives
We have assessed consumer behaviour of people with epilepsy in regard of alcohol, nicotine and cannabis. Furthermore, the question if consumption of these substances is proconvulsant, i.e. if occurrence of epileptic seizures is facilitated, was addressed.Materials and methods
A total of 310 patients with epilepsy who were treated in the outpatient clinic of the Charité – Universitätsmedizin Berlin responded to a semi-structured interview asking detailed questions on consumption of alcohol, nicotine and cannabis.Results and conclusion
Patients with epilepsy handle consumption of alcohol in a responsible manner; in fact, two thirds consume alcohol at least once per year, but three quarters of those patients consume a rather low amount of alcohol. Independent predictor for seizure manifestation within 24 h after alcohol consumption is idiopathic generalized epilepsy. But even in this vulnerable group of patients, seizures occur only after consumption of – commonly sporadic – large amount of alcohol. Use of nicotine and cannabis was no risk factor for increased epileptogenicity. These data indicate that just due to epilepsy patients do not need to be categorically advised to refrain from the mentioned stimulants.15.
Purpose of Review
A paradigm shift in contemporary epileptology has been the reframing of both epilepsy and its comorbid memory disorders as the product of diseased brain networks. The current review discusses some of the clinical and theoretical implications that stem from this shift.Recent Findings
Some implications of a network conceptualisation of epilepsy include a need for more widespread cognitive phenotyping in epilepsy; recognition that memory disorders in epilepsy can be multi-determined, including by non-structural factors; deeper consideration given to the neurodevelopmental context in which memory problems emerge; the utility of new methods to characterise memory impairments in epilepsy; and a call for greater recognition of the close interrelationships between memory comorbidities and psychiatric symptoms in epilepsy.Summary
Memory disorder significantly worsens the quality of life of people with epilepsy, underscoring the importance to patient wellbeing of giving due consideration to the up-to-date neuropsychological practises outlined in this review.16.
Background
Ictal electroencephalogram (EEG) source imaging has both advantages and disadvantages compared with source imaging of interictal epileptiform discharges. Ictal source imaging estimates the seizure onset zone directly. However, the rapid propagation of the ictal activity and the low signal-to-noise ratio impose additional challenges on ictal source imaging. Several methods have been developed to circumvent these challenges.Objectives
To summarize and explain in plain terms the methods of ictal EEG source imaging and to review the published evidence on its accuracy.Materials and methods
We systematically searched Medline for studies of ictal EEG source imaging. In addition, we summarize our clinical experience with ictal EEG source imaging and we present illustrative examples for the analysis process.Results
Pooled data from 77 operated patients, from four clinical studies, showed that ictal EEG source imaging had a sensitivity of 83.3% (95% confidence interval: 69.8–92.5%) and specificity of 72.4% (95% confidence interval: 52.8–87.3%).Conclusion
Ictal EEG source imaging is accurate and it should be added to the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy.17.
Purpose of Review
Migraine is a common disorder causing attacks of neurological dysfunction and pain. Treatment ranges from pharmacological to lifestyle changes to improve both frequency and severity of attacks. Focus on lifestyle changes, especially diet, is often discussed during clinical visits in the care of migraine patients.Recent Findings
Diet may play a role in triggering migraine, but available evidence on migraine and diet is limited. When advising patients on dietary changes to improve migraine, it is important to acknowledge the limits in evidence and the larger role that diet may play in lifestyle changes.Summary
This review will focus on current evidence on the effect of diet and migraine and use a case to illustrate how to approach diet changes in a patient with migraine.18.
Purpose of Review
This review explores different treatment modalities for immune-mediated epilepsy, including epilepsy caused by autoantibodies as well as epilepsy in the context of systemic autoimmune disease.Recent Findings
Autoimmune epilepsy is an increasingly recognized entity. Conventional treatments for epilepsy, such as antiseizure medications and epilepsy surgery, are less successful in treating epilepsy caused by autoimmune disease. Immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin, and plasma exchange are generally more successful in treating immune-mediated epilepsy than conventional epilepsy therapies.Summary
Autoimmune epilepsy should be considered as a possible etiology for patients with frequent seizures of unknown etiology. The response to immunotherapies is often promising, particularly in patients with antibodies to neuronal cell surface antigens.19.
R. Kreidenhuber G. Demarchi G. Kalss M. Leitinger P. A. Winkler E. Trinka S. Rampp 《Zeitschrift für Epileptologie》2018,31(3):179-184
Background
About 23 million people worldwide suffer from medically refractory epilepsy. Surgery might be the best treatment option with a reasonable chance of seizure freedom. Surgical success depends on the exact definition of the epileptogenic zone (EZ). Magnetoencephalography (MEG) is one of the newer additions to the noninvasive presurgical work-up.Objectives
This study gives an overview of the impact of MEG on the management of epilepsy patients, focusing on (1) the influence on presurgical evaluation, (2) the identification of patients with the greatest benefit, and (3) possible surgical outcome predictors.Methods
An extensive Medline literature search was conducted for studies published from 1990.Results
MEG is in clinical use in the presurgical evaluation of epilepsies for the identification of the EZ and outcome prediction. In cases of failed surgery, it serves as a means to locate the remaining epileptogenic cortex. The usefulness of MEG has been reported for a wide range of localizations including challenging areas like the insula. In cases of multiple possible culprit lesions, MEG can mark the epileptogenic lesion, whereas in cases of nonlesional magnetic resonance imaging (MRI) findings, MEG can pinpoint a lesional or nonlesional epileptogenic cortex area. The role of MEG in the presurgical evaluation of epilepsy was shown with rates of modified approaches in 20–35% of cases. This holds true especially for cases with extratemporal epilepsy.Discussion
The value of MEG source localization is highest in extratemporal epilepsy, in MRI-negative or multilesional cases, if other modalities yield contradictory or inconclusive results, or in cases of suspected multifocal epilepsy. There is clear evidence that MEG yields nonredundant information and influences the therapeutic course of patients. Various patient groups likely to benefit from MEG were identified. Considering the poor chances of seizure freedom with continued medical treatment, these patients should not be denied source localization, which could result in surgery with favorable outcomes.20.
Yuhan Zhu Yanyan Liu Jing Zhao Qingqing Han Lei Liu Xiaoxu Shen 《Neurological sciences》2018,39(12):2097-2106