Abstract found on PubMed

The association between attention deficit hyperactivity disorder (ADHD) and tuberous sclerosis complex (TSC) is widely reported, with support for the role of epilepsy, yet the mechanisms underlying the association across development are unclear. The Tuberous Sclerosis 2000 Study is a prospective longitudinal study of TSC. In Phase 1 of the study, baseline measures of epilepsy, cortical tuber load and mutation were obtained with 125 children aged 0 – 16 years. In Phase 2, at an average of 8 years later, ADHD symptoms were measured for 81 of the participants. Structural equation modelling revealed an indirect pathway from genetic mutation, to cortical tuber load, to epileptic spasm severity in infancy, to ADHD symptoms in middle childhood and adolescence, in addition to a pathway linking current seizure severity to ADHD symptoms. Findings were retained when IQ was entered as a correlated factor. The findings support a cascading developmental pathway to ADHD symptoms mediated by early-onset and severe epilepsy in the first two years of life. This warrants detailed investigation of seizure characteristics and cognitive and behavioural sequelae associated with ADHD from early in life, to further understanding of the association between ADHD and early-onset epilepsy across syndromic and non-syndromic populations.

Abstract found on PubMed

In an aging world, it is important to know the burden of epilepsy affecting populations of older persons. We performed a selective review of epidemiological studies that we considered to be most informative, trying to include data from all parts of the world. We emphasized primary reports rather than review articles. We reviewed studies reporting the incidence and prevalence of epilepsy that focused on an older population as well as studies that included a wider age range if older persons were tabulated as a subgroup. There is strong evidence that persons older than approximately 60 years incur an increasing risk of both acute symptomatic seizures and epilepsy. In wealthier countries, the incidence of epilepsy increases sharply after age 60 or 65 years. This phenomenon was not always observed among reports from populations with lower socioeconomic status. This discrepancy may reflect differences in etiologies, methods of ascertainment, or distribution of ages; this is an area for more research. We identified other areas for which there are inadequate data. Incidence data are scarcer than prevalence data and are missing for large areas of the world. Prevalence is lower than would be expected from cumulative incidence, possibly because of remissions, excess mortality, or misdiagnosis of acute symptomatic seizures as epilepsy. Segmentation by age, frailty, and comorbidities is desirable, because “epilepsy in the elderly” is otherwise too broad a concept. Data are needed on rates of status epilepticus and drug-resistant epilepsy using the newer definitions. Many more data are needed from low-income populations and from developing countries. Greater awareness of the high rates of seizures among older adults should lead to more focused diagnostic efforts for individuals. Accurate data on epilepsy among older adults should drive proper allocation of treatments for individuals and resources for societies.

Abstract found on DovePress 

Background and Study Aims: Antiepileptic drugs are the first choice of treatment for patients with epilepsy. However, the withdrawal of antiepileptic drugs after seizure-free remains a significant focus for the majority of patients with epilepsy and their families. In this study, we evaluated the risk factors associated with relapse after drug withdrawal in patients with seizure free for 2 years. We aimed to guide patients in seizure-free to assess the risk of drug withdrawal.

Patients and Methods: Through screening, 452 patients with epilepsy were included in the study. Patients were followed up for at least 2 years or more. Analyzed their clinical data by applying the ? 2-test, Kaplan-Meier survival analysis and multivariate Cox regression analysis.

Results: 423 patients completed follow-up, of which 304 cases recurred (71.9%). Related recurrence factors include age of onset, type of seizure, number of AEDs, seizure-free time before withdrawal, and electroencephalogram (EEG) results before drug withdrawal (P< 0.05). The results of correlation analysis showed that age of onset, seizure frequency, seizure type, number of AEDs, the period from AEDs treatment to a seizure-free status, EEG results before drug withdrawal, and pre-medication course, were all significantly related to the recurrence of seizures after drug reduction and withdrawal (P< 0.05). We identified a range of independent risk factors, including onset age, seizure frequency, Multiple AEDs and the period from AEDs treatment to a seizure-free status.

Conclusion: The overall recurrence rate of epilepsy in our patient cohort was high, and the peak recurrence period was within one year of drug withdrawal. Patients with partial seizures, a short seizure-free time before withdrawal, severe EEG abnormalities before drug reduction, and a long course of the disease, are prone to relapse. Patients with an older age at onset and a high frequency of attack, those taking multi-drug combination therapy, and those that take a long time to gain control, should be managed carefully to AEDs withdrawal.

Abstract found on PubMed 

Objective: Identifying factors associated with surgical decision making is important to understand reasons for underutilization of epilepsy surgery. Neurologists’ recommendations for surgery and patients’ acceptance of these recommendations depend on clinical epilepsy variables, e.g., lateralization and localization of seizure onset zones. Moreover, previous research shows associations with demographic factors, e.g., age and sex. Here, we investigate the relevance of patients’ psycho-social profile for surgical decision making.

Methods: We prospectively studied 296 patients from two large German epilepsy-centers. Multiple logistic regression analyses were used to investigate variables linked to neurologists’ recommendations for and patients’ acceptance of surgery or intracranial video-EEG monitoring. Patients’ psycho-social profiles were assessed via self-reports and controlled for various clinical-demographic variables. Model selection was performed using the Akaike Information Criterion.

Results: As expected, models for neurologists’ surgery recommendations primarily revealed clinical factors such as lateralization and localization of the seizure onset zone, load with antiseizure medication (ASM) and site of the epilepsy-center. For this outcome, employment was the only relevant psycho-social aspect (OR = 0.38; 95%-CI = [0.13; 1.11]). In contrast, three of the five relevant predictors for patients’ acceptance were psycho-social: Higher odds were found for those with more subjective ASM adverse events (OR = 1.04; 95%-CI = [0.99;1.00]), more subjective seizure severity (OR = 1.12; 95%-CI= [1.01;1.24]), and lower subjective cognitive impairment (OR = 0.98; 95%-CI = [0.96;1,00]).

Significance: We demonstrated the relevance of patients’ psycho-social profile for decision making in epilepsy surgery – particularly for the patients’ decisions. Thus, in excess to clinical-demographic variables, patients’ individual psycho-social characteristics add to the understanding of surgical decision making. From a clinical perspective, this calls for individually tailored counseling to assist patients in finding the optimal treatment option.

Abstract found in PubMed

Epilepsy is a chronic neurological disorder that presents as recurrent, unprovoked seizures. Pharmacotherapy is the main treatment for epilepsy, but at least 30% of patients with epilepsy have pharmacoresistant epilepsy. Therefore, non-pharmacological treatments are still required. In addition to electrophysiological aberrations contributing to epileptogenesis and pathophysiology in epilepsy, neuroinflammation, oxidative stress, and metabolic derangement have been investigated as drug targets in the treatment of epilepsy. Vitamins have antioxidant, anti-inflammatory, and immunomodulatory effects, which can be beneficial for the treatment of epilepsy. Herein, we comprehensively review the role of vitamins in epilepsy. Certain epilepsies are vitamin-dependent or vitamin-responsive. Most studies on vitamins in epilepsy are of low evidence level or limited to animal studies. Nevertheless, vitamin supplementation should be considered in epilepsy therapy. Additionally, certain anti-seizure medications may alter the serum levels of certain vitamins. Monitoring the serum levels of vitamins and supplementing vitamins when needed are suggested during the follow-up of patients with epilepsy.

Abstract found on PubMed

Background: Cognitive behavioral therapy (CBT) is the recommended treatment for depression in patients with epilepsy (PWE). However, there are no studies that calculate the effect size of CBT on depression and quality of life (QoL) in PWE.

Methods: We searched seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, Ovid Medline, and PsycINFO). We included 13 studies examining CBT for depression in PWE and calculated its effect size.

Results: A total of 13 studies met the criteria. After treatment, CBT improves depression in PWE (g = 0.36, 95%CI: 0.18 to 0.54, I² = 50%), and the efficacy maintains during follow-up (g = 0.47, 95%CI: 0.04 to 0.89, I² = 80%). Subgroup analysis has shown that individual CBT (g = 0.47, 95%CI: 0.20 to 0.73, I² = 0%) had a greater effect size than group CBT (g = 0.30, 95%CI: 0.07 to 0.53, I² = 62%) in the treatment of depression. Likewise, CBT has a positive effect on the QoL improvement of PWE (g = 0.34, 95%CI: 0.11 to 0.57, I² = 64%). In controlling seizures, CBT did not differ from the control group (g = -0.06, 95%CI: -0.32 to 0.19, I² = 0%).

Conclusions: Cognitive behavioral therapy interventions were effective in improving depression and quality of life in patients with epilepsy, but not effective in controlling seizures. The efficacy of cognitive behavioral therapy interventions targeting seizure control seems to be uncertain.