Blood and cerebrospinal fluid immune cell profiles in patients with temporal lobe epilepsy of different etiologies

Abstract

Inflammation plays a role in the pathogenesis of immune‐mediated epilepsy, but also in epilepsy of other etiology such as hippocampal sclerosis. This study aimed to characterize immune cell signatures in the peripheral blood (PB) and cerebrospinal fluid (CSF) in temporal lobe epilepsy (TLE) of different etiologies. We retrospectively evaluated CSF routine parameters and immune cell profiles using flow cytometry in a cohort of 51 patients and 45 age‐matched controls with functional disorders. Groups were comprised of patients with nonlesional TLE ...

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Continuous EEG findings in patients with COVID‐19 infection admitted to a New York academic hospital system

Abstract

Objective

There is evidence for central nervous system complications of coronavirus disease 2019 (COVID‐19) infection, including encephalopathy. Encephalopathy caused by or arising from seizures, especially nonconvulsive seizures (NCS), often requires electroencephalography (EEG) monitoring for diagnosis. The prevalence of seizures and other EEG abnormalities among COVID‐19‐infected patients is unknown.

Methods

Medical records and EEG studies of patients hospitalized with confirmed COVID‐19 infections over a 2‐month period at a single US academic health system (four hospitals) were reviewed to describe the distribution of EEG findings ...

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Diagnostic algorithm for children presenting with epilepsia partialis continua

Abstract

Objective

To characterize a cohort of children with epilepsia partialis continua (EPC) and develop a diagnostic algorithm incorporating key differential diagnoses.

Methods

Children presenting with EPC to a tertiary pediatric neurology center between 2002 and 2019 were characterized.

Results

Fifty‐four children fulfilled EPC criteria. Median age at onset was 7 years (range 0.6‐15), with median follow‐up of 4.3 years (range 0.2‐16). The diagnosis was Rasmussen encephalitis (RE) in 30 of 54 (56%), a mitochondrial disorder in 12 of 54 (22.2%), and magnetic resonance imaging (MRI) lesion‐positive focal ...

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Algorithms in clinical epilepsy practice: Can they really help us predict epilepsy outcomes?

Abstract

Significant technological advances have improved our ability to localize epilepsy and investigate the electrophysiology in patients undergoing preparation for epilepsy surgery. Conversely, our process of decision‐making and outcome prediction has remained essentially restricted to subjective clinical judgment. This may have hindered our ability to improve outcomes. In this review, we highlight the cognitive biases that interfere with medical decision‐making and present data on the use of algorithms and statistical models in general health care, before pivoting to discuss applications in ...

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Convulsive seizures and some behavioral comorbidities are uncoupled in the Scn1aA1783V Dravet syndrome mouse model

Abstract

Objective

Dravet syndrome (Dravet) is a severe childhood epileptic encephalopathy. The disease begins with a febrile stage, characterized by febrile seizures with otherwise normal development. Progression to the worsening stage features recurrent intractable seizures and the presentation of additional nonepileptic comorbidities, including global developmental delay, hyperactivity, and motor deficits. Later in life, at the stabilization stage, seizure burden decreases, whereas Dravet‐associated comorbidities persist. To date, it remains debated whether the nonepileptic comorbidities result from severe epilepsy or represent an independent phenotypic ...

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Biomarkers of seizure response to vagus nerve stimulation: A scoping review

Abstract

Although vagus nerve stimulation (VNS) is a common procedure, seizure outcomes are heterogeneous, with few available means to preoperatively identify the ideal surgical candidate. Here, we perform a scoping review of the literature to identify biomarkers of VNS response in patients with drug‐resistant epilepsy. Several databases (Ovid MEDLINE, Ovid Embase, BIOSIS Previews, and Web of Science) were searched for all relevant articles that reported at least one biomarker of VNS response following implantation for intractable epilepsy. Patient demographics, seizure data, ...

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Trends in lobectomy/amygdalohippocampectomy over time and the impact of hospital surgical volume on hospitalization outcomes: A population‐based study

Abstract

Objective

Despite national guidelines supporting surgical referral in drug‐resistant epilepsy, it is hypothesized that surgery is underutilized. We investigated the volumes of lobectomy/amygdalohippocampectomy surgeries over time and examined differences in outcomes between (1) high‐volume (HV), middle‐volume (MV), and low‐volume (LV) hospitals and (2) Level 4 Centers versus non–Level 4 Centers.

Methods

The 2003‐2014 National Inpatient Sample (the largest all‐payer hospitalization database, representative of the US population) was utilized. Epilepsy was identified using a previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ...

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Blood biomarkers predictive of epilepsy after an acute stroke event

Abstract

Objective

Blood biomarkers have not been widely investigated in poststroke epilepsy. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and analyze their association with the development of epilepsy at long term.

Methods

A panel of 14 blood biomarkers was evaluated in patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z‐scores. Stroke and epilepsy‐related variables were also assessed: stroke severity, determined by National Institutes of Health Stroke Scale (NIHSS) score, stroke type and ...

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Integrating quality improvement into the ECHO model to improve care for children and youth with epilepsy

Abstract

Objective

Project ECHO (Extension for Community Healthcare Outcomes), a telementoring program, utilizes lectures, case‐based learning, and an “all teach–all learn” approach to increase primary care provider (PCP) knowledge/confidence in managing chronic health conditions. The American Academy of Pediatrics (AAP) Epilepsy and Comorbidities ECHO incorporated quality improvement (QI) methodology to create meaningful practice change, while increasing PCP knowledge/self‐efficacy in epilepsy management using the ECHO model.

Methods

Monthly ECHO sessions (May 2018 to December 2018) included lectures, case presentations/discussion, and QI review. Pediatric practices were ...

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A new era in electroencephalographic monitoring? Subscalp devices for ultra–long‐term recordings

Abstract

Inaccurate subjective seizure counting poses treatment and diagnostic challenges and thus suboptimal quality in epilepsy management. The limitations of existing hospital‐ and home‐based monitoring solutions are motivating the development of minimally invasive, subscalp, implantable electroencephalography (EEG) systems with accompanying cloud‐based software. This new generation of ultra–long‐term brain monitoring systems is setting expectations for a sea change in the field of clinical epilepsy. From definitive diagnoses and reliable seizure logs to treatment optimization and presurgical seizure foci localization, the clinical need ...

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