Surgical Outcome of Temporal Plus Epilepsy is Improved by Multilobar Resection

Abstract found in PubMed and originally published in Epilepsia

Objective: Temporal plus epilepsy (TPE) represents a rare type of epilepsy characterized by a complex epileptogenic zone including the temporal lobe and the close neighboring structures. We investigated whether the complete resection of temporal plus epileptogenic zone as defined through stereoelectroencephalography (SEEG) might improve seizure outcome in 38 patients with TPE.

Methods: Inclusion criteria were as follows: epilepsy surgery performed between January 1990 and December 2001, SEEG defining a temporal plus epileptogenic zone, unilobar temporal operations (“temporal lobe epilepsy [TLE] surgery”) or multilobar interventions including the temporal lobe (“TPE surgery”), magnetic resonance imaging either normal or showing signs of hippocampal sclerosis, and postoperative follow-up of at least 12 months. For each assessment of postoperative seizure outcome, at 1, 2, 5, and 10 years, we carried out descriptive analysis and classical tests of hypothesis, namely, Pearson ?2 test or Fisher exact test of independence on tables of frequency for each categorical variable of interest and Student t-test for each continuous variable of interest, when appropriate.

Results: Twenty-one patients underwent TPE surgery and 17 underwent TLE surgery with a follow-up of 12.4 ± 8.16 years. In the multivariate models, there was a significant effect of the time from surgery on Engel Class IA versus IB-IV outcome, with a steadily worsening trend from 5-year follow-up onward. TPE surgery was associated with better results than TLE surgery.

Significance: This study suggests that surgical outcome in patients with temporal plus epilepsy can be improved by a tailored, multilobar resection and confirms that SEEG is mandatory when a temporal plus epilepsy is suspected.

Epilepsy Awareness Among School-Aged Students in Poland

Abstract found in DocWire News and originally published in Epilepsy & Behavior

OBJECTIVE: Epilepsy can be a well-controlled condition with only a slight impact on patients’ life. Lack of knowledge within society contributes to children with epilepsy experiencing discrimination and hostility. The aim of this study was to evaluate the awareness of epilepsy and general views on people struggling with this disease among school-aged children.

METHODS: The study was conducted on a random sample of Polish school students, in total 472 participants. Participants’ knowledge was assessed by a self-completed survey.

RESULTS: Students are unaware of the wide range of symptoms occurring during seizures. More than half claimed that people experiencing epilepsy should not perform sports activities. Alarmingly, 30% of participants believe that those patients should not leave the house and they should be excluded from many jobs. Almost all participants would help a person experiencing seizures and remember proper head protection; shockingly, 20% of children would try to put something in the person’s mouth. Older students seem to be better educated on epilepsy, but the percentage of incorrect personal beliefs and myths is similar for each age group.

SIGNIFICANCE: School-aged students have insufficient knowledge of epilepsy. More emphasis should be put on first aid during seizures and on the spectrum of epilepsy symptoms. Educating society is important for life quality of people experiencing epilepsy.

Incidence and Prevalence of Major Epilepsy-Associated Brain Lesions

Abstract found in ScienceDirect and originally published in Epilepsy & Behavior

Epilepsy surgery is an effective treatment option for drug-resistant focal epilepsy patients with associated structural brain lesions. However, little epidemiological data are available regarding the number of patients with these lesions. We reviewed data regarding (1) the prevalence and incidence of epilepsy; (2) the proportion of epilepsy patients with focal epilepsy, drug-resistant epilepsy, and drug-resistant focal epilepsies; and (3) the number of epilepsy presurgical evaluations and surgical resections. We also assessed the relative proportion of brain lesions using post-surgical histopathological findings from 541 surgical patients from the Cleveland Clinic and 9,523 patients from a European multi-center cohort. Data were combined to generate surgical candidate incidence and prevalence estimates and the first lesion-specific estimates for hippocampal sclerosis (HS), low-grade epilepsy-associated brain tumors (LEAT), malformations of cortical development (MCD), glial scars, vascular malformations, and encephalitis. The most frequently diagnosed brain lesions were HS (incidence = 2.32 ± 0.26 in 100,000, prevalence = 19.40 ± 2.16 in 100,000) for adults and MCD (incidence = 1.15 ± 0.34 in 100,000, prevalence = 6.52 ± 1.89 in 100,000) for children. Our estimates can guide patient advocacy groups, clinicians, researchers, policymakers in education, development of health care strategy, resource allocation, and reimbursement schedules.

Standardization of Seizure Response Times and Data Collection in an Epilepsy Monitoring Unit

Abstract found in PubMed

Objective: We sought to improve seizure response times in the epilepsy monitoring unit (EMU), improve the accuracy and reliability of seizure response time data collection, and develop a standardized and automated approach for seizure response data collection in the EMU.

Methods: We used Quality Improvement (QI) methodology to understand the EMU workflow involved in responding to seizures (a process map); to create a theory of change that stated the desired aim, potential drivers/barriers and interventions (i.e., key driver diagram) and perform iterative interventions to address some of the drivers plan-do-study-act (PDSA) cycles. We performed three PDSA cycles with a focus on improving the seizure alert system in our EMU. Adjustments were made to the methodology as it became clear that this was a systems issue, and our project would need to focus on improving the system rather than iteratively improving a functioning (stable) system.

Results: Over a 6-month period, 252 seizure response times were recorded and analyzed. We performed 3 interventions. The first was initiating twice monthly meetings with nursing and EEG techs to discuss the project and provide feedback on response times. The second was the implementation of a new Hill-Rom seizure alert system to reduce alert times and automate data tracking. The third was implementing a new alert deactivation system to reduce variability in the data. Following these 3 interventions, variation, and data collection methods were improved while also maintaining improvements in seizure response times.

Significance: We identified and implemented an alert system in our epilepsy monitoring unit which led to more efficient and accurate data collection while maintaining improved response times that resulted from the first intervention. This lays the groundwork for future quality improvement initiatives and has created a framework for standardizing seizure response time recording and data collection that can be replicated at other centers with similar infrastructure, personnel and workflows.

Impact of the COVID-19 Pandemic on Persons with Epilepsy in Uganda: A Descriptive Cross-Sectional Study

Abstract found in PubMed and originally published in Epilepsy & Behavior

Objective: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the disease course, lives, and psychosocial wellbeing of persons with epilepsy (PWE) in Uganda.

Methods: From April 2021 till May 2021, we carried out a descriptive cross-sectional study at four hospitals located in four regions of Uganda. PWE presenting at the study sites were offered a structured questionnaire in the local language. We used the PHQ-9 questionnaire to screen for depression and the GAD-7 to screen for anxiety. Univariate and multivariable logistic regression was used to investigate factors associated with anxiety and depression.

Results: A total of 370 responses were collected. The median age of the respondents was 20.5 years (IQR 15-29), and 51.9% were males. During the lockdown period, the seizure frequency increased in 87 (23.5%) PWE. Various forms of physical and psychological violence were inflicted upon 106 (28.6%) PWE. Fifty-eight (15.7%) screened positive for anxiety and 65 (17.6%) positive for depression. Both increased seizure frequency and experienced violence were associated with experiencing depression and anxiety.

Conclusion: The COVID-19 pandemic and lockdown impacted seizure frequency and the psychosocial wellbeing of people with epilepsy in Uganda. Increased seizure frequency was associated with higher rates of anxiety and depression. This underlines the importance of continued follow-up of PWE and a low threshold to screen for depression, anxiety, and domestic violence.

Satisfaction and Effectiveness of Tele-Medicine in Follow-Up of People with Epilepsy in a Resource-Poor Setting During COVID-19

Abstract found in PubMed and originally published in Epilepsy & Behavior

Background: Effectiveness of different tele-medicine strategies varies in different medical conditions. Use of basic tele-medicine strategy like mobile health (m-health) can be an effective option in different medical conditions in a resource-poor setting.

Aims: To study effectiveness and satisfaction of tele-medicine among persons with epilepsy (PWE) in a developing nation during COVID-19 pandemic.

Methods: Persons with epilepsy aged 18 years or more who have attended epilepsy clinic at least once physically and were asked for regular follow-up were included. A cross-sectional telephonic survey was conducted to assess effectiveness of tele-medicine over past 1 year. Satisfaction was assessed by tele-medicine satisfaction questionnaire.

Result: 31.9% of PWE have used tele-medicine facility in last 1 year and 58.2% were unaware of the availability of such a facility. Among those who utilized tele-medicine, 95.3% were able to explain their concerns satisfactorily during tele-consultation and change in prescription was done in 42.8%. None experienced any new adverse event. Overall, more than 95% were satisfied with tele-consultation and more than 80% wanted to use it again.

Conclusion: Even basic tele-medicine strategies can be a very effective and satisfactory mode of follow-up for people with epilepsy in resource-poor settings. Steps should be undertaken to make people aware of the availability of such a facility.

Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A Study from Pakistan

Abstract found in PubMed and originally published in Epilepsy & Behavior

Background: Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE).

Methods: A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31).

Results: The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ? 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL.

Conclusion: The findings suggest high prevalence of excessive daytime sleepiness and poor sleep quality in people with epilepsy in Pakistan. A significant negative association exists between sleep complaints and health-related quality of life (HRQoL). During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.

Short-Term Effectiveness of a Condensed Series of Standard EEG Lectures for Adult Neurology Residents

Abstract found in PubMed and originally published in Epilepsy Disord

To investigate (i) the short-term effectiveness of a series of traditional didactic EEG lectures for an adult neurology resident cohort and (ii) whether the educational benefit of such lectures correlates with residents’ prior formal EEG exposure. We evaluated the short-term effectiveness of traditional lectures by testing residents’ EEG knowledge before and after a series of four EEG lectures given by epilepsy attending physicians. The EEG test consisted of both normal (27) and abnormal (10) EEG questions. Only residents who performed the test before (pre-test) and after (post-test) and attended at least two lectures were included. Residents were divided based on whether they had at least one EEG rotation during or prior to the study (Group A) or not (Group B). Twelve residents met the inclusion criteria: two PGY1 (postgraduate year 1), four PGY2, one PGY3, and five PGY4 residents. One of these residents did not complete the abnormal EEG section of the tests. The time interval between both tests ranged from 40 to 75 days. The overall score (mean±SEM) for the normal (n=12) EEG section was 47±6.1% (pre-test) and 58±5.5% (post-test) (p=0.0168). The overall score for the abnormal (n=11) EEG section was 48±7.2% (pre-test) and 62±8.6% (post-test) (p=0.0396). Group A (n=6) pre- and post-test scores were 53±6.7% and 72±4.6%, respectively (p=0.0008). Group B (n=5) pre- and post-test scores were 42±11.4% and 48±11.7%, respectively (p=0.3777). A condensed series of four EEG lectures given by epilepsy attending physicians generated a statistically significant increase in EEG knowledge among adult neurology residents who already had some degree of formal in-residency EEG exposure. Standard EEG lectures may be an invaluable tool in resident EEG education. It would be advisable to ensure that residents undergo hands-on EEG exposure through formal rotations either prior to or during standard lectures in order to generate maximal educational benefits via this teaching avenue.

Sleep Disorders and ADHD Symptoms in Children and Adolescents with Typical Absence Seizures: An Observational Study

Abstract found in PubMed and originally published in Epilepsy & Behavior

Objective: To assess the occurrence of sleep disorders (SD) and attention deficit hyperactivity disorder (ADHD) symptoms in children with typical absence seizures (TAS) compared to control children and to evaluate the impact of epilepsy-related factors on sleep and attention in children with TAS.

Methods: The Sleep Disturbance Scale for Children (SDSC) and the ADHD rating scale were filled in by parents of a cohort composed by 82 children aged from 5 to 15.6 years, 49% of boys (41 with TAS with a syndromic diagnosis of childhood absence epilepsy and 41 controls). For children with TAS, the Pediatric Epilepsy Side Effects Questionnaire was completed. Statistical analyses were conducted in order to compare sleep and attention scores between groups. In children with TAS, a correlation was computed between these scores. Logistics regression models were conducted to identify predictors of excessive diurnal sleepiness and inattention in children with TAS.

Results: Compared to controls, children with TAS had higher total scores for subjective sleep (mean 42.9 vs 38.3, p = 0.05) and attention disorders (mean 16.8 vs 11.6, p = 0.01), especially for excessive diurnal sleepiness (mean 3.9 vs 3.2, p = 0.02) and inattention (mean 9.3 vs 5.6, p = 0.003) components. In children with TAS, sleep problems were significantly under-reported by parents. Sleep disorders symptoms as breathing-related sleep disturbance, excessive diurnal sleepiness or naps at or after 7 years of age were reported. Subjective sleep and attention disorders were significantly correlated (r = 0.43, p = 0.01). Subjective excessive diurnal sleepiness may be the result of a polytherapy (p = 0.05) or a side effect of anti-seizure medication (ASM) (p = 0.03) but children without medication side effects also reported subjective SD. In children with TAS, the risk of inattention symptoms was increased in boys (p = 0.02), with a high BMI (p = 0.05), or with ASM side effects (p = 0.03).

Conclusions: This study demonstrates that children with typical absence seizures (TAS) are at risk of sleep and attention disorder symptoms. If attention disorders in a context of epilepsy are now widely assessed and identified, sleep disorders are still under-estimated. An accurate identification and management of sleep disorders could improve academic performances, quality of life, and seizure management in children with TAS.

Characterizing the Driving Dilemma Among Patients with Psychogenic Nonepileptic Seizures: A Single-Center Prospective Cohort Study

Abstract appeared in PubMed and was originally published in Epilepsy & Behavior

Objective: Driving is a critical topic to counsel among patients with epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES), with significant legal and public health implications. This prospective cohort study examined the frequency of ES and PNES in a single institution’s Epilepsy Monitoring Unit (EMU) and assessed driving-related issues between each group.

Methods: Adult patients from the Mayo Clinic Arizona Epilepsy Monitoring Unit (EMU) were given comprehensive surveys addressing driving history. Descriptive analysis and statistics were used to summarize differences between patients with ES and PNES. Differences between patients with epilepsy and PNES were determined by Pearson chi-square.

Results: Nearly half (n = 75/163) of all patients admitted to the EMU were diagnosed with PNES. Although the PNES group had a statistically significant higher frequency of events (p = 0.01), 87.7% of these patients reported compliance with the driving law recommendations, suggesting a trend that patients who have been counseled regarding fitness-to-drive are likely to follow the recommendation. One-third of patients with PNES reported an event while operating a motor vehicle and 8% (n = 2/25) resulted in a motor vehicle collision severe enough to require hospitalization. In contrast to those with ES, 25% of patients reported a typical event while driving and 25% (n = 2/8) of those resulted in a collision requiring hospitalization. The incidence of habitual events while driving is higher in the population with PNES (n = 25) when compared to those with ES (n = 8); however, it appears that patients with PNES were less likely to become involved in an accident resulting in seriously bodily injury than in ES.

Conclusions: Compared to patients with PNES, patients with epileptic seizures have less frequent events but more severe collisions. This study reinforces the need for diligent driving counseling to help prevent driving-related injuries in patients with PNES and epileptic seizures.