Classification of Epilepsy

Epilepsija je jedna od najčešćih neuroloških bolesti, odnosno moždani poremećaj karakteriziran trajnom predispozicijom za nastanak epileptičnih napadaja te s neurobiološkim, kognitivnim, psihološkim i socijalnim posljedicama tog stanja. Posljednjih godina prati se znatno širenje našeg razumijevanja etiologije i patofiziologije ove bolesti, zahvaljujući napretku ponajprije neuroslikovnih dijagnostičkih metoda i molekularno-genskog testiranja. Određivanje kliničke semiologije epileptičnih napadaja te klasifikacije epilepsije, odnosno epileptičnog sindroma, vrlo je važno pri postavljanju ispravne dijagnoze te odabiru prikladnoga terapijskog algoritma. U klasifikaciji epileptičnih napadaja donedavno se upotrebljavala pojednostavnjena verzija klasifikacije Međunarodne lige protiv epilepsije (engl. International League Against Epilepsy – ILAE) iz 1981. i 1989. godine, koja znači klasifikaciju elektrokliničkih značajka. Godine 2010. ILAE predlaže reviziju klasifikacije u skladu s novim shvaćanjem epilepsije kao poremećaja mozgovne mreže uz prijedlog promjene terminologije, slijedom koje je 2017. godine objavljena nova operativna (praktična) klasifikacija epileptičnih napadaja. Potonja klasifikacija ne donosi fundamentalne promjene, ali dopušta veću fleksibilnost i transparentnost u imenovanju tipova epileptičnih napadaja. U ovom se radu, kao nastavak na novu terminologiju i podjelu epilepsije prema preporukama ILAE-a, predlaže terminologija klasifikacije epilepsije na hrvatskom jeziku.Epilepsy is one of the most common neurological diseases, i.e. a brain disorder characterized by a permanent predisposition to generate epileptic seizures, leading to neurobiological, cognitive, psychological, and social consequences of that condition. In recent years we have seen a considerable expansion of our understanding of etiology and patophysiology of this disease, primarily as a result of the improvement of diagnostic neuroimaging methods and molecular genetic tests. When making an accurate diagnosis and choosing an adequate treatment algorithm, determination of clinical semiology of epileptic seizures and classification of epilepsy or epileptic syndrome are essential. Until recently, epileptic seizures had been classified according to the simplified version representing a classification of electro-clinical features that was made by ILAE (International League Against Epilepsy) in 1981 and 1989. In 2010, ILAE proposed that the classification be revised in accordance with the new concept of understanding epilepsy as a brain network disorder, as well as that the terminology be changed. Consequently, a new operational (practical) classification of epileptic seizures was presented in 2017. The latter classification does not indicate any fundamental changes, but allows greater flexibility and transparency in the designation of types of epileptic seizures. In view of the new terminology and classification of epilepsy according to the ILAE guidelines, this paper proposes the Croatian terminology of the classification of epilepsy

Classification of Epilepsy

Epilepsija je jedna od najčešćih neuroloških bolesti, odnosno moždani poremećaj karakteriziran trajnom predispozicijom za nastanak epileptičnih napadaja te s neurobiološkim, kognitivnim, psihološkim i socijalnim posljedicama tog stanja. Posljednjih godina prati se znatno širenje našeg razumijevanja etiologije i patofiziologije ove bolesti, zahvaljujući napretku ponajprije neuroslikovnih dijagnostičkih metoda i molekularno-genskog testiranja. Određivanje kliničke semiologije epileptičnih napadaja te klasifikacije epilepsije, odnosno epileptičnog sindroma, vrlo je važno pri postavljanju ispravne dijagnoze te odabiru prikladnoga terapijskog algoritma. U klasifikaciji epileptičnih napadaja donedavno se upotrebljavala pojednostavnjena verzija klasifikacije Međunarodne lige protiv epilepsije (engl. International League Against Epilepsy – ILAE) iz 1981. i 1989. godine, koja znači klasifikaciju elektrokliničkih značajka. Godine 2010. ILAE predlaže reviziju klasifikacije u skladu s novim shvaćanjem epilepsije kao poremećaja mozgovne mreže uz prijedlog promjene terminologije, slijedom koje je 2017. godine objavljena nova operativna (praktična) klasifikacija epileptičnih napadaja. Potonja klasifikacija ne donosi fundamentalne promjene, ali dopušta veću fleksibilnost i transparentnost u imenovanju tipova epileptičnih napadaja. U ovom se radu, kao nastavak na novu terminologiju i podjelu epilepsije prema preporukama ILAE-a, predlaže terminologija klasifikacije epilepsije na hrvatskom jeziku.Epilepsy is one of the most common neurological diseases, i.e. a brain disorder characterized by a permanent predisposition to generate epileptic seizures, leading to neurobiological, cognitive, psychological, and social consequences of that condition. In recent years we have seen a considerable expansion of our understanding of etiology and patophysiology of this disease, primarily as a result of the improvement of diagnostic neuroimaging methods and molecular genetic tests. When making an accurate diagnosis and choosing an adequate treatment algorithm, determination of clinical semiology of epileptic seizures and classification of epilepsy or epileptic syndrome are essential. Until recently, epileptic seizures had been classified according to the simplified version representing a classification of electro-clinical features that was made by ILAE (International League Against Epilepsy) in 1981 and 1989. In 2010, ILAE proposed that the classification be revised in accordance with the new concept of understanding epilepsy as a brain network disorder, as well as that the terminology be changed. Consequently, a new operational (practical) classification of epileptic seizures was presented in 2017. The latter classification does not indicate any fundamental changes, but allows greater flexibility and transparency in the designation of types of epileptic seizures. In view of the new terminology and classification of epilepsy according to the ILAE guidelines, this paper proposes the Croatian terminology of the classification of epilepsy

Clinical and neurophysiological changes in patients with pineal region expansions [Kliničke i neurofiziološke značajke u bolesnika s ekspanzivnim tvorbama pinealne regije]

In the last 20 years neurological and neurosurgical follow up of our patients with pineal region expansions (118 patients) pointed to certain clinical and neurophysiological regularities. We performed retrospective study which included 84 patients with pineal region expansions in the period from 1992 to 2009. The study included 55 women and 29 men, mean age 30.08 +/- 13.93 years, with positive brain magnetic resonance imaging (MRI)--70 patients (83.4%) had simple pineal gland cysts, and 14 patients (16.67%) had expansive process in pineal region with compressive effect. All patients had headache, while 32 patients (38%) had epileptic phenomena--primary generalized seizures. Patients had common electroencephalography (EEG) pattern with paroxysmal discharges of 3Hz (or more than 3 Hz) spike-and-wave complexes. Operation with supracerebellar infratentorial approach was performed in 70 patients. In most of our patients indication for the operation was established based on the size of the cyst (15 mm or more), with the signs of compression on the quadrigeminal plate and compression of the surrounding veins, which could result in seizures and EEG changes verified in our group of patients. Pathohistological analysis revealed pineocytomas in 11 cases (15.71%), pinealoblastomas in 2 cases (2.86%), one case of teratoma (1.43%), while 56 patients had pineal gland cysts (80%). Following surgery clinical condition improved in all patients--patients became seizure-free and headaches significantly decreased. Other symptoms including diplopiae, nausea, vomiting, vertigo as well as blurred vision also disappeared. There were no complications after surgical procedures. This study points to often appearance of seizures that clinically and neurophysiologically present as primary generalized epilepsy in patients with pineal region expansions. Our hypotheses are that mass effect on the surrounding veins that affects normal perfusion, compressive effect on the quadrigeminal plate and the aqueduct of the midbrain, hemosiderin deposists, as well as secretion disturbances of anticonvulsive agent melatonin can be involved in the pathogenesis of seizures. We suggest to perform high resolution brain MRI with special demonstration of pineal region in all young patients that have seizures and specific EEG changes

PREDICTORS OF QUALITY OF LIFE IN PATIENTS WITH DRUG RESISTANT EPILEPSY AFTER NEUROSURGICAL TREATMENT: ONE-YEAR FOLLOW-UP

Background: Invasive neurosurgical treatment or minimally invasive neurosurgical treatment are methods of choice for the treatment of patients with drug resistant epilepsy. The aim of this study was to evaluate the impact of neurosurgical treatment and the quality of life of patients with drug resistant epilepsy and to determine what are the potential predictors of quality of life of patients with drug resistant epilepsy one year after neurosurgical treatment. Subjects and methods: The research was performed at the Referral Centre for Epilepsy, Department of Neurology, University Hospital Centre Zagreb from February 2015 to February 2020 with Ethics commitee approval. The study included 96 patients with drug resistant epilepsy who were examined for the quality of life before and one year after neurosurgical treatment using the form questionnaire "Quality of life in epilepsy" (QOILE-31) validated Croatian 1.0 version and the questionnaire to assess the degree of depression "Beck Depression Inventory I" (BDI-I) validated Croatian version. Results: Of 96 patients with drug resistant epilepsy one year after neurosurgical treatment 46 (47.9%) patients remained completely free from epileptis seizures. Wilcoxon equivalent pair test showed that the number of epileptic seizures one year after neurosurgical treatment was significantly lower (median before neurosurgical treatment is 10; and after neurosurgical treatment is 1, p<0.001). The most informative potential statistically significant predictor variables of quality of life based on the criterion variables QOLIE-31 and BDI-I are: total disease duration in years (p=0.034), patient age (p=0.042), number of antiepileptics one year after neurosurgical treatment (p=0.001), the number of epileptic seizures per month (p=0,016), and social welfare rights (p=0.045). Conclusion: Neurosurgical treatment of patients with drug resistant epilepsy significantly reduces the number of epileptic seizures which significantly improves their overall quality of life one year after neurosurgical treatment

Effect of antiepileptic drug comedication on lamotrigine concentrations

Aim To estimate the effect size of concomitant antiepileptic therapy on the concentrations of lamotrigine, a drug often prescribed in combination with other antiepileptic drugs (AED), which can act as enzyme inducers or inhibitors. Methods A total of 304 patients with epilepsy, aged 18- 70 years, were divided into a lamotrigine monotherapy group and groups receiving lamotrigine with AEDs that act as enzyme inducers, enzyme inhibitors, or both. We compared lamotrigine monotherapy serum concentrations with those where lamotrigine was administered with a metabolic inhibitor valproate, metabolic inducers carbamazepine, oxcarbazepine, phenobarbital, phenytoin, or topiramate, and both an inducer and an inhibitor. Results Comparison of trough lamotrigine monotherapy concentrations and lamotrigine polytherapy concentrations showed an almost similar median concentration in case of drug-inducers, and higher lamotrigine concentration in case of comedication with valproate as an inhibitor. A significant difference was confirmed after dose correction (P < 0.001). Significant positive correlations of lamotrigine trough serum concentrations with valproate were observed before and after the dose correction (r = 0.480, P < 0.001 and r = 0.561, P < 0.001, respectively). Positive correlations between the dose-corrected lamotrigine trough concentration and carbamazepine (r = 0.439; P < 0.001) or monohydroxy metabolite of oxcarbazepine (MHD) (r = 0.675; P < 0.001) were also significant. Conclusion Higher valproate levels resulted in higher inhibition potency and higher lamotrigine levels. Increased dose-corrected concentrations of inducers carbamazepine and MHD, after the process of induction was finished, did not lower lamotrigine concentrations. These findings can be of clinical significance for optimal AED dosing

PREDICTORS OF QUALITY OF LIFE IN PATIENTS WITH DRUG RESISTANT EPILEPSY AFTER NEUROSURGICAL TREATMENT: ONE-YEAR FOLLOW-UP

Background: Invasive neurosurgical treatment or minimally invasive neurosurgical treatment are methods of choice for the treatment of patients with drug resistant epilepsy. The aim of this study was to evaluate the impact of neurosurgical treatment and the quality of life of patients with drug resistant epilepsy and to determine what are the potential predictors of quality of life of patients with drug resistant epilepsy one year after neurosurgical treatment. Subjects and methods: The research was performed at the Referral Centre for Epilepsy, Department of Neurology, University Hospital Centre Zagreb from February 2015 to February 2020 with Ethics commitee approval. The study included 96 patients with drug resistant epilepsy who were examined for the quality of life before and one year after neurosurgical treatment using the form questionnaire "Quality of life in epilepsy" (QOILE-31) validated Croatian 1.0 version and the questionnaire to assess the degree of depression "Beck Depression Inventory I" (BDI-I) validated Croatian version. Results: Of 96 patients with drug resistant epilepsy one year after neurosurgical treatment 46 (47.9%) patients remained completely free from epileptis seizures. Wilcoxon equivalent pair test showed that the number of epileptic seizures one year after neurosurgical treatment was significantly lower (median before neurosurgical treatment is 10; and after neurosurgical treatment is 1, p<0.001). The most informative potential statistically significant predictor variables of quality of life based on the criterion variables QOLIE-31 and BDI-I are: total disease duration in years (p=0.034), patient age (p=0.042), number of antiepileptics one year after neurosurgical treatment (p=0.001), the number of epileptic seizures per month (p=0,016), and social welfare rights (p=0.045). Conclusion: Neurosurgical treatment of patients with drug resistant epilepsy significantly reduces the number of epileptic seizures which significantly improves their overall quality of life one year after neurosurgical treatment

IMPACT OF INVASIVE EEG MONITORING AND RESECTIVE NEUROSURGICAL TREATMENT ON THE QUALITY OF LIFE IN PATIENTS WITH DRUG RESISTANT EPILEPSY - PRELIMINARY RESULTS

Background: Neurosurgical treatment is one of important way to cure drug resistant epilepsy. After invasive EEG monitoring and the invasive neurosurgical treatment (resective surgery) there are possible complications (intracranial haemorrhage, cortic al lesions and infections), however there are possible neuropsyhologic outcomes such as memory outcomes, language outcomes and psychiatric outcomes. The quality of life in epilepsy (QOLIE-31) scale is a self-completed questionnaire which contains seven subscales which address the following aspects: emotional well-being, social functioning, energy/fatigue, cognitive functioning, seizure worry, medication effects and overall quality of life. Our study aimed to examine the quality of life in patients with drug resistant epilepsy who had undergone invasive EEG monitoring and resective neurosurgical treatment through the application of t he QOLIE-31 scale. Subjects and methods: The study included 9 patients with drug resistant epilepsy who had undergone invasive EEG monitoring followed by resective neurosurgical treatment in the period from 2010 to 2016, and the control group of 15 patients with drug resistant epilepsy who had not undergone neurosurgical procedures. Clinical variables of interest for this study were obtained through phone contact, and the QOLIE-31 scale was applied. Results: In the domaine of seizure worry, patients in the examined group were more concerned about the seizures (54.7) compared to the examined group (80), as well as in the overal quality of life (examined group 57.5; control group 77.5). Patien ts in the control group complained more in the domain of antiepileptic therapy (score 70.7) than patients in the examined group (scor e 100). In the other domains: emotional well-being, energy/fatigue, cognitive functioning, and social functioning there were mino r deviations between the examined and control groups. Conclusion: There was no statistically significant difference between individual QOLIE-31 questionnaires, as well as between the two groups of respondents