Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials

Introduction: Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents. Method: Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD–RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively. Results: Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = ?0.13, 95% CI [?0.25, ?0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01). Conclusion: Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.     

The efficacy and safety of lamotrigine for absence seizures in children and adolescents: A systematic review and meta-analysis

AimsThis systematic review and meta-analysis of randomized controlled trials (RCTs) systematically explored the effectiveness and safety of lamotrigine for absence seizures in children and adolescents.MethodsKeywords searches were conducted in Pubmed Embase Cochrane Central Register of Controlled Trials Wanfang CNKI from inception through March 2019. The RCTs comparing lamotrigine with other drugs and/or placebo for the treatment of absence seizures in children and adolescents were considered in this study. The study was conducted adhering to PRISMA guidelines.ResultsEight RCTs (n = 787) were included in our study. Among these studies, one study (N = 45 patients) used placebo as a control and seven studies (N = 742 patients) used positive drug controls. For effectiveness, there was significant difference between lamotrigine and valproate [OR = 0.42, 95%CI (0.28–0.63), I² = 0%] or ethosuximide [OR = 0.34, 95%CI (0.22–0.53), I² = 0%]. For adverse effects (AEs), there was no significant difference between lamotrigine and valproate [OR = 1.17, 95%CI (0.59, 2.32), I² = 0%] or ethosuximide [OR = 0.75, 95%CI (0.47, 1.19), I² = 92%], and the most common adverse effects of lamotrigine were Rash (7.88%), Fatigue (6.50%) and Headache (6.50%).ConclusionsAccording to current evidence, LTG is less effective than VPA and ESM, however, based on its relative safety, LTG might be reasonably tried as initial therapy in children and adolescents at risk of significant adverse effects from VPA and ESM, and future well-designed studies are needed to confirm our findings.     

Associations between specific technologies and adolescent sleep quantity,sleep quality,and parasomnias

ObjectiveWe tested the hypothesis that weekday bedtime use of six technologies would be significantly associated with eight sleep parameters studied relating to sleep quantity, sleep quality, and parasomnias.MethodsIn our cross-sectional study, we previously administered validated age-appropriate questionnaires (School Sleep Habits Survey, Technology Use Questionnaire). Participating adolescents (n = 738; 54.5% boys) were aged 11–13 years and were from the Midlands region of the United Kingdom in 2010.ResultsFrequent use of all technology types was significantly inversely associated with weekday sleep duration (hours). Frequent music listeners and video gamers had significantly prolonged sleep onset (β = 7.03 [standard error {SE}, 2.66]; P < .01 and β = 6.17 [SE, 2.42]; P < .05, respectively). Frequent early awakening was significantly associated with frequent use of all technology types. The greatest effect was observed in frequent television viewers (odds ratio [OR], 4.05 [95% confidence interval {CI}, 2.06–7.98]). Difficulty falling asleep was significantly associated with frequent mobile telephone use, video gaming, and social networking, with music listeners demonstrating the greatest effect (OR, 2.85 [95%CI, 1.58–5.13]). Music listeners were at increased risk for frequent nightmares (OR, 2.02 [95%CI, 1.22–3.45]). Frequent use of all technologies except for music and mobile telephones was significantly associated with greater cognitive difficulty in shutting off. Frequent television viewers were almost four times more likely to report higher sleepwalking frequency (OR, 3.70 [95% CI, 1.89–7.27]).ConclusionsFrequent weekday technology use at bedtime was associated with significant adverse effects on multiple sleep parameters. If confirmed in other samples and longitudinally, improving sleep hygiene through better management of technology could enhance the health and well-being of adolescent populations.     

El insomnio y la pobre calidad de sueño se asocian a un mal control de crisis en pacientes con epilepsia

ObjectivesThis study aimed to assess the presence of sleep disorders in patients with epilepsy and to analyse their association with seizure control.MethodsWe performed a cross-sectional study of patients with epilepsy, recruited consecutively between September 2017 and December 2018. Patients were classified as having good seizure control (no seizures in the last 4 weeks) or poor seizure control (at least one seizure in the last 4 weeks). We performed intergroup comparisons for demographic and clinical data, insomnia (Insomnia Severity Index [ISI]), excessive daytime sleepiness (Epworth Sleepiness Scale [ESS]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression (Beck Depression Inventory-II [BDI-II]), and quality of life (Quality of Life in Epilepsy Inventory-10 [QOLIE-10]).ResultsThe sample included a total of 123 patients, of whom 31.7% had excessive daytime sleepiness (ESS ≥ 10), 50.4% had insomnia (ISI ≥ 10), and 53.6% had poor sleep quality (PSQI ≥ 5). According to our multivariate analysis, presence of seizures was associated with unemployment (odds ratio [OR] = 4.7; 95% confidence interval [CI], 1.36-19.2; P = .02), a higher number of antiepileptic drugs (OR = 5.87; 95% CI, 1.81-27.1; P < .001), insomnia (OR = 1.9; 95% CI, 1.1-9.3; P = .04), and poor sleep quality (OR = 2.8; 95% CI, 1.9-10.32; P = .01).ConclusionsSleep disorders are common in patients with epilepsy. Insomnia and poor sleep quality were associated with poor seizure control. These findings support the hypothesis that sleep disorders constitute a significant comorbidity of epilepsy, especially in patients with poor seizure control.     

Environmental factors,sleep duration,and sleep bruxism in Brazilian schoolchildren: a case-control study

ObjectiveThe purpose of our study was to evaluate the association between environmental factors, sleep duration, and sleep bruxism (SB) in schoolchildren.MethodsA case-control study was performed. Individuals participating in the study were randomly chosen from public and private schools in Belo Horizonte, Brazil. A total of 120 children with bruxism and 240 without bruxism (mean age, 8 years) participated in our study. A questionnaire for parents was used to collect data based on criteria taken from the American Academy of Sleep Medicine. Conditional binary logistic regression statistical tests and χ² tests were used for analysis.ResultsThe final logistical model found that children with a median sleep time ⩽8 h per night (odds ratio [OR], 2.561 [95% confidence interval {CI}, 1.480–4.433]), who did not enjoy a good night’s sleep (OR, 3.253 [95% CI, 1.600–6.615]), who slept with noise in the room (OR, 2.699 [95% CI, 1.645–4.429]), and who had the light on (OR, 2.370 [95% CI, 1.446–3.884]), were more likely to have SB.ConclusionChildren who sleep for less than 8 h a night are more likely to have SB. Light and noise in the room were two predisposing factors for the occurrence of SB.     

Absence of small study effects in neurosurgical meta-analyses: A meta-epidemiological study

BackgroundSmall studies are prone to lower methodological quality and publication bias, and are more likely to report greater beneficial effects. A meta-epidemiological study was undertaken to investigate and quantify the impact of small study effects on meta-analyses in the neurosurgical literature.MethodsA PubMed search was used to procure meta-analyses from Journal of Neurosurgery, Neurosurgery, Spine, Acta Neurochirurgica and Journal of Neurotrauma. Outcome data were extracted from meta-analyses the effect of study size was estimated by calculating the ratio of odds ratios (RORs) between small and large studies.Results16 meta-analyses of 229 primary studies and 90,629 patients were included. All but two included pooled outcomes were significantly different from 1. On average small studies did not demonstrate greater beneficial effects, with an estimated pooled ROR of 1.32 (95% CI, 0.89 to 1.75). Stratification by meta-analysis effect size and heterogeneity yielded similar findings.ConclusionsThe absence of small study effects in meta-analyses of neurosurgical studies may reflect widespread poor quality of the neurosurgical literature affecting both large and small studies, rather than an absence of publication bias.     

Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs

After reviewing the negative effects of antiepileptic drugs (AEDs) on general health and quality of life, the Commission on Outcome Measurement from the International League Against Epilepsy (ILAE) recommended incorporating reliable and valid tools in clinical essays in order to achieve a more accurate assessment of the subjective adverse effects rate and disease severity when using AEDs.PurposeThe aim of this study was to correlate the severity of adverse effects of AEDs, with the presence of anxiety and depression in patients with epilepsy.MethodsThe Spanish version of the Liverpool Adverse Events Profile (LAEP) and the Hospital Anxiety and Depression Scale (HADS) were applied on 130 consecutive outpatients with epilepsy from the epilepsy clinic at the Mexico's National Institute of Neurology and Neurosurgery. A correlation analysis was carried out to determine if the presence of depression and anxiety was related to the adverse effects of AEDs. The relation between LAEP scores with other epidemiological variables was also assessed.ResultsOur study found a positive correlation between the LAEP and the HADS scores (p = <0.01).The most common adverse effects were drowsiness (81.5% [n = 106]), difficulty in concentrating (76% [n = 99]), and nervousness and/or agitation (75% [n = 97]). Female gender, a history of febrile seizures, persistent seizures and polytherapy were associated with a higher toxicity on LAEP. In our study, age at epilepsy onset, duration of epilepsy, type of epilepsy and patients’ age were not related to higher LAEP scores.ConclusionAdverse effects to AEDs can be related with the presence of psychiatric disorders such as anxiety and depression in patients with epilepsy.     

Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study

ObjectiveThe objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy.MethodsThe Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews.ResultsPsychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12 months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12 months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10; for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78).ConclusionsPsychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.     

Self-esteem in adolescents with epilepsy: Psychosocial and seizure-related correlates

PurposeThis study evaluated self-esteem in adolescents with epilepsy and its association with psychosocial and disease-related variables.MethodsThis was a cross-sectional study with patients enrolled between January and June 2010. Culture-Free Self-Esteem Inventory for Children (CFSEI-2) was administered to 140 children with epilepsy and 50 children with asthma, aged 10–18 years attending mainstream schools.ResultsAdolescents with epilepsy had a significantly lower overall self-esteem score when compared with those with asthma, 17 ± 5.21 versus 19.4 ± 3.83, respectively (P = 0.005). Thirty-one (22.1%) children with epilepsy compared with 4 (8.3%) with asthma had overall self-esteem score below the cutoff (P = 0.034). There was a significant correlation between overall self-esteem score and duration of epilepsy, Hospital Anxiety and Depression Scale (HADS) anxiety score, HADS depression score, and Strengths and Weaknesses of ADHD symptoms and Normal-Behaviors (SWAN) rating combined score. The impact of various correlates on individual domains was not identical. Independent factors associated with low overall self-esteem were HADS depression score (OR: 1.62; 95% CI: 1.2, 2.2; P = 0.002), duration of epilepsy (OR: 1.4; 95% CI: 1.04, 1.88; P = 0.024), and father employment status economically inactive (OR: 11.9; 95% CI: 1.07, 125; P = 0.044). Seizure-free ≥ 12 months was a favorable factor that was less likely to be associated with low self-esteem (OR: 0.14; 95% CI: 0.02, 0.81; P = 0.028).ConclusionSelf-esteem was compromised in adolescents with epilepsy. A significant correlation between self-esteem and psychological comorbidities was demonstrated. Enhancing social support and education programs may improve the self-esteem and, ultimately, the lives of adolescents living with epilepsy.     

Test-retest reliability of the N2 event-related potential in school-aged children with autism spectrum disorder (ASD)

ObjectiveThe N2 ERP component is used as a biomeasure of executive function in children with autism spectrum disorder (ASD). The aim of the current study was to evaluate the test-retest reliability of N2 amplitude in this population.MethodsERPs were recorded from 7 to 11-year-old children with ASD during Flanker (n = 21) and Go/Nogo tasks (n = 14) administered at two time points separated by approximately three months. Reliability of the N2 component was examined using intraclass correlation coefficients (ICCs).ResultsReliability for mean N2 amplitude obtained during the Flanker task was moderate (congruent: ICC = 0.542, 95% CI [0.173, 0.782]; incongruent: ICC = 0.629, 95% CI [0.276, 0.831]). Similarly, reliability for the Go/Nogo task ranged from moderate to good (‘go’: ICC = 0.817, 95% CI [0.535, 0.937]; ‘nogo’: ICC = 0.578, 95% CI [0.075, 0.843]).ConclusionsThese findings support the use of N2 amplitude as a biomeasure of executive function in school-aged children with ASD.SignificanceThis research addresses a critical gap in clinical neurophysiology, as an understanding of the stability and reliability of the N2 component is needed in order to differentiate variance explained by repeated measurement versus targeted treatments and interventions.     

What are the predictors of major depression in adult patients with epilepsy?

Epilepsy is not only a chronic neurological disorder but also a condition associated with other comorbidities. The purpose of this study was to determine the prevalence of major depression in a cohort of adult patients with epilepsy (PWEs) living in north China, and investigate the predictors of major depression in PWEs. A total of 215 consecutive cases were enrolled and divided into two groups: PWEs with major depression and PWEs without major depression. Patients were assessed for demographic characteristics, epilepsy details, and social status. A total of 65 of 215 (30.23%) PWEs exhibited comorbid major depression. A binary logistic regression model revealed the strong predictor variables of major depression to be drug responsiveness (odds ratio [OR]=0.23; p=0<0.01; 95% CI [0.13–0.39]), presence of chronic medical illnesses (OR=0.19; p=0.015<0.05; 95% CI [0.05–0.72]), and employment status (OR=0.42; p=0.015<0.05; 95% CI [0.21–0.84]).     

Next generation sequencing in children with unexplained epilepsy: A retrospective cohort study

ObjectiveTo evaluate the clinical utility of next-generation sequencing (NGS) in unexplained pediatric epilepsy, and to identify the potential predictors associated with Mendelian genetic causes.MethodsTwo hundred and ten children with unexplained epilepsy, who underwent NGS test were included. We analyzed the demographic, clinical and genetic characteristics, and executed a Logistic regression analysis for identifying predictors for Mendelian genetic causes. Patients were classified as either with isolated epilepsy or syndromic epilepsy with concurrent neurodevelopmental phenotypes.ResultsThe overall diagnostic yield was 29.0% (61/210). A total of 68 variants spanning 39 genes were identified in 58 patients (27.6%, 58/210) from exome sequencing based testing. Of the 68 variants, 33 were novel ones. Besides, STAR and CNTN2 were identified to be a candidate gene for epilepsy. Patients with syndromic epilepsy had a much higher diagnostic yield than that of isolated epilepsy (53/135, 39.3% vs. 8/75, 10.7%, p = 0.000). The odds ratio of detecting genetic cause was 3.939 (95% CI 1.369–11.332) for syndromic epilepsy without epileptic encephalopathy (EE), 5.814 (95% CI 2.208–15.306) for EE, 2.958 (95% CI 1.093–8.000) for patients with seizure onset <12 months, and 2.932 (95%CI 1.414–6.080) for female. Of the 210 patients, 78.4% of patients (145/185) had at least a 50% reduction in seizure frequency and 58.9% (109/185) reached seizure freedom. There was no difference between seizure prognosis and diagnostic outcomes.SignificanceNGS is effective for Mendelian genetic etiological diagnosis for unexplained pediatric epilepsy. Female patients with syndromic epilepsy with onset within the first year of life are most likely to yield a positive test result.     

Efficacy and safety of melatonin for sleep onset insomnia in children and adolescents: a meta-analysis of randomized controlled trials

ObjectiveTo evaluate the efficacy and safety of melatonin in the treatment of sleep onset insomnia in children and adolescents.MethodsElectronic databases and bibliographies of relevant reports were searched for randomized, placebo-controlled, clinical trials that used melatonin in children and adolescents with sleep onset insomnia. The quality of the included studies was assessed by the Cochrane Collaboration's risk-of-bias method. The mean differences (MD) and the odds ratios (OR) with 95% confidence interval (CI) were estimated by a random-effects model. Primary outcomes were sleep onset time (SOT), drop-out for all causes and drop-out for adverse events. Secondary outcomes included dim light melatonin onset (DLMO), sleep onset latency (SOL), total sleep time (TST), light-off time, and wake-up time.ResultsSeven trials with 387 participants were finally included after a systematic search. The overall quality of the included studies was low to moderate. SOT in patients receiving melatonin advanced more than patients receiving placebo (MD = −0.62 h, 95% CI −0.80, −0.45), as well as DLMO (MD = −0.82 h, 95% CI −1.23, −0.41). No differences were found in the outcome of drop-out for all causes (OR = 1.51, 95% CI 0.57, 4.05) or drop-out for adverse events (OR = 3.35, 95% CI 0.13, 86.03). Severe adverse events, migraine, and mild generalized epilepsy were reported in two cases. SOL decreased and TST increased, MD = −0.36 h (95% CI −0.49, −0.24) and MD = 0.38 h (95% CI 0.09, 0.66), respectively. Light-off time and wake-up time did not differ significantly.ConclusionsMelatonin was an effective and tolerable drug in the short-term treatment of sleep onset insomnia in children and adolescents. More studies, especially in adolescents, are needed to investigate the efficacy and safety of melatonin.     

Response to first drug trial predicts outcome in childhood temporal lobe epilepsy.

OBJECTIVE: To construct a clinical prediction model for the early identification of children destined to develop refractory temporal lobe epilepsy (TLE) 2 years after epilepsy onset. METHODS: Patients with TLE between 1 and 18 years old seen in the Division of Neurology at Children's Hospital of Philadelphia during 1999 were identified through billing records and chart review. Data were abstracted independently on 5 candidate predictor variables for refractory TLE and on seizure frequency outcome at 2 years after epilepsy onset. RESULTS: One hundred twenty patients met inclusion criteria and had at least 2 years of follow-up. Forty-five of 120 patients (37.5%) had refractory TLE at 2 years after onset, and 75 of 120 (62.5%) were seizure free. Three significant predictors of refractory TLE were found on bivariate analysis: an early risk factor for epilepsy (risk ratio = 3.5 [95% CI 2.2, 5.6]), temporal lobe abnormality on MRI scan (2.9 [95% CI 1.9, 4.6]), and failure of the first antiepileptic drug (AED) trial (16.5 [95% CI 6.3, 43.9]). Logistic regression indicated that the best model to predict refractory TLE contained only the variable "failure of first AED trial," with a positive predictive value of 0.89 (95% CI 0.76, 0.96) and negative predictive value of 0.95 (95% CI 0.87, 0.99) to predict "refractory TLE" at 2 years. CONCLUSIONS: Failure of first AED trial accurately predicts refractory TLE at 2 years after onset, based on retrospective cohort data in children. If verified prospectively and with longer follow-up, this finding should support earlier consideration of surgical options.     

Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan

BackgroundJapanese forensic mental health services for patients with psychiatric disorders under the Medical Treatment and Supervision Act was initiated in 2005; however, the prognosis of those patients is not well-known, particularly regarding mortality and suicide. This study aimed to evaluate the all-cause mortality and suicide rate in forensic psychiatric outpatients who had been discharged from forensic psychiatric wards in Japan.MethodsParticipants included 966 patients who had been discharged from forensic psychiatric wards. Data were collected from July 15, 2005 to July 15, 2018 at 29 of the 33 forensic psychiatric wards in Japan. Only the patients who provided written informed consent were included. We and collaborators at each forensic psychiatric ward identified demographic data of participants from the medical records for the inpatient treatment period. The reintegration coordinators, who belonged to the Ministry of Justice, investigated the prognosis of the participants during the outpatient treatment order period. We then connected demographic data and participants’ prognosis for analysis. The crude rates (CRs) and standardized mortality ratios (SMRs) were calculated to analyze all-cause mortality and suicide rates. Univariate analysis was performed to examine the factors associated with all-cause mortality and suicide rates using the Cox proportional hazards ratio model.ResultsThe participants included 3.3 times as many men (n = 739) compared to women (n = 227), and their combined mean age was 47.3 (SD = 12.9). The most common primary psychiatric diagnosis was psychotic disorders (81.3%). The mean follow-up period was 790.2 days (SD = 369.6). The total observation period was 2091.2 person-years. The CR for all-cause death was 812.9 per 100,000 person-years (95% CI [426.5, 1199.4]), while the SMR for all-cause death was 2.2 (95% CI [1.3, 3.5]). The CR for completed suicide was 478.2 per 100,000 person-years (95% CI [181.8, 774.6]). The suicide SMR was 17.9 (95% CI [8.6, 32.9]) overall, 7.7 (95% CI [2.5, 18.0]) for men, and 79.4 (95% CI [25.8, 185.2]) for women. Univariate analysis showed that women had higher completed suicide risk than men (hazard ratio = 3.599, 95% CI [1.041, 12.445]).ConclusionThe all-cause mortality and completed suicide rates were higher in participants than observed in the general population consistent with the results of previous international studies.     

Social Anxiety and Empathy: A Systematic Review and Meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to clarify the association between social anxiety and affective (AE) and cognitive empathy (CE).Methods1442 studies from PsycINFO, Medline, and EMBASE (inception-January 2020) were systematically reviewed. Included studies (N = 48) either predicted variance in empathy using social anxiety scores or compared empathy scores between socially anxious individuals and a control group.ResultsSocial anxiety and AE were statistically significantly positively associated, k = 14, r = .103 (95%CI [.003, .203]), z = 2.03, p = .043. Sex (Q_M (2) = 18.79, p < .0001), and type of measures (Q_M (1 = 7.34, p = .007) moderated the association. Correlations were significant for male samples (r_male = .316, (95%CI [.200, .432])) and studies using self-report measures (r_self-report = .162 (95%CI [.070, .254])). Overall, social anxiety and CE were not significantly associated, k = 52, r =-.021 (95%CI [-.075, .034]), z= -0.74, p = .459. Sample type moderated the association (Q_M (1) = 5.03, p < .0001). For clinical samples the association was negative (r_clinical= -.112, (95%CI [-.201, -.017]).ConclusionThere was evidence for a positive association between social anxiety and AE, but future studies are needed to verify the moderating roles of sex and type of measure. Besides, low CE might only hold for patients with SAD.     

Patient emotions and perceptions of antiepileptic drug changes and titration during treatment for epilepsy

ObjectiveTo investigate the impact of antiepileptic drug (AED) change and dose titration on the emotional well-being of patients with epilepsy.MethodsMembers of an online epilepsy community were invited to voluntarily participate in an online survey. The cross-sectional anonymous survey consisted of 31 multiple choice questions balanced in terms of variety and positivity/negativity of emotions concerning participants' most recent AED change. To substantiate survey results, spontaneous comments from epilepsy-related online forums and social media websites that mentioned participants' experiences with AED medication changes (termed passive listening statements) were analyzed and categorized by theme.ResultsAll 345 survey participants (270 [78.3%] female; 172 [49.9%] were 26–45 years old) self-reported an epilepsy/seizure diagnosis and were currently taking seizure medication; 263 (76.2%) were taking ≥ 2 AEDs and 301 (87.2%) had ≥ 1 seizure in the previous 18 months. All participants reported a medication change within the previous 12 months (dose increased [153 participants (44.3%)], medication added [105 (30.4%)], dose decreased [49 (14.2%)], medication removed [38 (11.0%)]). Improving seizure control (247 [71.6%]) and adverse events (109 [31.6%]) were the most common reasons for medication change. Primary emotions most associated (≥ 10% of participants) with an AED regimen change were (before medication change; during/after medication change) hopefulness (50 [14.5%]; 43 [12.5%]), uncertainty (50 [14.5%]; 69 [20.0%]), and anxiety (35 [10.1%]; 45 [13.0%]), and were largely due to concerns whether the change would work (212/345 [61.4%]; 180/345 [52.2%]). In the text analysis segment aimed at validating the survey, 230 participants' passive listening statements about medication titration were analyzed; additional seizure activity during dose titration (93 [40.4%]), adverse events during titration (71 [30.9%]), higher medication dosages (33 [14.3%]), and drug costs (25 [10.9%]) were the most commonly noted concerns.ConclusionAlthough the emotional well-being of patients with epilepsy is complex, our study results suggest that participants report their emotional well-being as negatively affected by changes in AED regimen, with most patients reporting uncertainty regarding the outcome of such a change. Future research is warranted to explore approaches to alleviate patient concerns associated with AED medication changes.     

Association between short sleep duration and metabolic syndrome in Chinese children and adolescents

BackgroundThe relationship between short sleep duration and metabolic syndrome (MetS) in children and adolescents has been inconsistent. This study aimed to examine the association between short sleep duration and MetS in Chinese children and adolescents.MethodsData were from a cross-sectional survey conducted in Jinan, China between September 2013 and November 2014. A total of 1008 children and adolescents aged 6–17 years were included. Sleep duration was self-reported by participants and categorized as normal or short (<9 h in children aged 6–12 years or <8 h in adolescents aged 13–17 years) according to the recommendations of the American Academy of Sleep Medicine. MetS was defined based on the modified criteria of the National Cholesterol Education Program Adult Treatment Panel III.ResultsAfter adjusted for sex, age, parental education levels, and midpoint of sleep, compared with normal sleep duration, short sleep duration was associated with increased odds of MetS (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.09–2.95) and abdominal obesity (OR: 1.60, 95% CI: 1.14–2.25). In the subgroups stratified by age and sex, compared with normal sleep duration, short sleep duration was associated with increased odds of abdominal obesity (OR: 2.34, 95% CI: 1.07–5.13) in girls aged 6–12 years; short sleep duration was associated with increased odds of MetS (OR: 2.49, 95% CI: 1.06–5.84), abdominal obesity (OR: 2.30, 95% CI: 1.10–4.82), and high TG (OR: 2.63, 95% CI: 1.11–6.21) in boys aged 13–17 years.ConclusionsShort sleep duration associated with higher odds for MetS in Chinese children and adolescents. Interventions to improve sleep duration could help prevent and control MetS among children and adolescents.     

Prevalence and Predictors of Stroke in Patients with Crohn's Disease: A Nationwide Study

ObjectivesMounting evidence points to the microbiome as a susceptibility factor for neurological disorders. Patients with Crohn's disease (CD) are at higher ischemic stroke (IS) risk, but no large scale epidemiologic studies have identified risk factors for stroke in this population.Materials and MethodsWe analyzed the 2017 Nationwide Inpatient Sample (NIS) dataset to identify patients with a discharge diagnosis of Crohn's disease using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code K50.X. We identified patients with a primary/secondary discharge diagnosis of IS using ICD-10-CM code I63.X. We compared sociodemographic and clinical variables between stroke and non-stroke patients with CD. Logistic regression analysis was applied to identify factors associated with IS.ResultsOf 30,212 patients with CD, 369 (1.2 %) had a discharge diagnosis of IS. Older age (odds ratio [OR], 1.03 [95% CI, 1.02–1.04], top quartile income (OR, 1.58 [95% CI, 1.10–2.30]), and hospitalization in a South Atlantic (OR, 1.82 [95% CI, 1.11-3.14]), East South Central (OR, 2.30 [95% CI, 1.28-4.25]), or West South Central hospital (OR, 2.40 [95% CI, 1.39-4.28]) were independently associated with IS. Clinical variables independently associated with IS in patients with CD included: atrial fibrillation (OR, 1.66 [95% CI, 1.15-2.33]), atherosclerosis (OR, 2.41 [95% CI, 1.32-4.10]), hyperlipidemia (OR, 1.69 [95% CI, 1.33-2.15]), hypertension (OR, 1.53 [95% CI, 1.18-1.98]) and valvular disease (OR, 1.62 [95% CI, 1.01-2.48).ConclusionA subset of traditional stroke risk factors are associated with IS in patients with CD. CD patients with these conditions could be targeted for vascular risk reduction and surveillance.     

Association of elevated neutrophil-to-lymphocyte ratio with increased intracranial aneurysm stability scores and aneurysm growth

Background and purposeInflammation involves in the progression of intracranial aneurysms (IAs). However, whether the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker links to IAs stability is unidentified. This study was performed to assess the association of the NLR with IAs stability.MethodsWe retrospectively reviewed the medical records of patients diagnosed with unruptured IAs from January 2014 to June 2018. According to the quartiles of the NLR, patients with unruptured IAs were categorized into four groups. We evaluated the association between the NLR and IAs stability scores and IAs growth. Multiple logistic regression models were used in the analysis.ResultsA significant dose-response association was found between the NLR with IAs stability scores and IAs growth. After adjustment for potential confounders, an elevated NLR (fourth quartile) was associated with increased PHASES score (>5) (adjusted odds ratio [OR], 2.007; 95% confidence interval [CI], 1.361–2.960; p<0.001 [p for trend <0.001]), increased ELAPSS score (>15) (adjusted OR, 1.581; 95% CI, 1.074–2.328; p=0.020 [p for trend =0.001]), increased JAPAN 3-year rupture risk score (>5) (adjusted OR, 1.512; 95% CI, 1.033–2.215; p=0.034 [p for trend <0.001]), and IAs growth (adjusted OR, 16.759; 95% CI, 3.022–92.928; p=0.001 [p for trend <0.001]).ConclusionAn elevated NLR was associated with increased IAs stability scores and IAs growth. The association between NLR and IAs stability need further investigate.