Epilepsy, comorbid conditions in Canadian children: Analysis of cross-sectional data from cycle 3 of the national longitudinal study of children and youth

Purpose: The purpose of this study was to analyze national survey data to provide estimates of prevalence of epilepsy and associated developmental disabilities and comorbid conditions. Methods: We analyzed data from Cycle 3 of Canada\u27s National Longitudinal Survey of Children and Youth. The NLSCY captured, socio-demographic information, as well as age, sex, education, ethnicity, household income, chronic health related conditions from birth to 15 years old. The main survey question intended to identify epilepsy , cerebral palsy , intellectual disability , learning disability , and emotional and nervous difficulties in the population of children surveyed. Prevalence was based on the national cross-sectional sample and used 1000 bootstrap weights to account for survey design factors. Results: Cycle 3 of the NLSCY had the largest number of patients with diagnosed epilepsy. Prevalence figures (n/1000) for epilepsy and cerebral palsy (EPI-CP), epilepsy and intellectual disability (EPI-ID), epilepsy and learning disability (EPI-LD), and epilepsy and emotional nervous difficulties (EPI-EMO- NERV) were 1.1, 1.17, 2.58 and 1.34 respectively. Amongst children with epilepsy, 43.17% reported the presence of one or more of the above comorbid conditions. Conclusion: These results provide an initial prevalence estimate of comorbid conditions with epilepsy in Canadian children. In a high proportion of children with epilepsy, the PMK had reported at least one comorbid disorder. These findings carry implications for health care utilization and long-term outcomes. We discuss methodological aspects related to the ascertainment of epilepsy in both surveys, and to the validity and implications of our findings

Epilepsy, comorbid conditions in Canadian children: Analysis of cross-sectional data from cycle 3 of the national longitudinal study of children and youth

Purpose: The purpose of this study was to analyze national survey data to provide estimates of prevalence of epilepsy and associated developmental disabilities and comorbid conditions. Methods: We analyzed data from Cycle 3 of Canada\u27s National Longitudinal Survey of Children and Youth. The NLSCY captured, socio-demographic information, as well as age, sex, education, ethnicity, household income, chronic health related conditions from birth to 15 years old. The main survey question intended to identify epilepsy , cerebral palsy , intellectual disability , learning disability , and emotional and nervous difficulties in the population of children surveyed. Prevalence was based on the national cross-sectional sample and used 1000 bootstrap weights to account for survey design factors. Results: Cycle 3 of the NLSCY had the largest number of patients with diagnosed epilepsy. Prevalence figures (n/1000) for epilepsy and cerebral palsy (EPI-CP), epilepsy and intellectual disability (EPI-ID), epilepsy and learning disability (EPI-LD), and epilepsy and emotional nervous difficulties (EPI-EMO- NERV) were 1.1, 1.17, 2.58 and 1.34 respectively. Amongst children with epilepsy, 43.17% reported the presence of one or more of the above comorbid conditions. Conclusion: These results provide an initial prevalence estimate of comorbid conditions with epilepsy in Canadian children. In a high proportion of children with epilepsy, the PMK had reported at least one comorbid disorder. These findings carry implications for health care utilization and long-term outcomes. We discuss methodological aspects related to the ascertainment of epilepsy in both surveys, and to the validity and implications of our findings

Inteligencia artificial en la evaluación y manejo de pacientes con epilepsia.

Epilepsy is a condition that frequently coexists with significant morbi-mortality levels, seriously affects the quality of life and, in up to one third of patients, is refractory to a variety of treatment approaches. Artificial intelligence (AI) has largely benefitted the study, treatment, and prognosis of patients with epilepsy through the course of recent years. These achievements applied the fields of diagnosis, automated seizure prediction, advanced seizure monitoring and electroencephalogram, use of genetics in diagnosis and management, imaging algorithms in the treatment, neuromodulation, and robotic surgery. This review conveys the actual and future directions of AI. a branch of science that has shown promising results in the treatment and diagnosis of patients with epilepsy.La epilepsia es una enfermedad que frecuentemente conlleva significativos niveles de morbi-mortalidad, afecta seriamente la calidad de vida y, en cerca de un tercio de los pacientes, es refractaria a diversos tratamientos. La inteligencia artificial (IA) ha beneficiado el estudio, tratamiento y pronóstico de los pacientes con epilepsia a través de los años. Estos logros abarcan diagnóstico, predicción de crisis automatizada, monitoreo avanzado de crisis epilépticas y electroencefalograma, uso de recursos genéticos en manejo y diagnóstico, algoritmos en imagen y tratamiento, neuromodulación y cirugía robótica. La presente revisión explica de forma práctica los avances actuales y futuros de la inteligencia artificial, rama de la ciencia que ha mostrado resultados prometedores en el diagnóstico y tratamiento de pacientes con epilepsia

Epilepsia mioclónica juvenil

La epilepsia mioclónica juvenil (EMJ) es un trastorno generalizado que se inicia usualmente en la pubertad o adolescencia y se caracteriza por la presencia de mioclonías y, con menor frecuencia, crisis tónico-clónica generalizadas y ausencias. A nivel internacional, se estima que anualmente tiene lugar un nuevo caso de EMJ por cada 1000-2000 personas. El diagnóstico es fundamentalmente de naturaleza clínica, corroborado por información electroencefalográfica. El fármaco de primera elección para el tratamiento de la EMJ sigue siendo el ácido valpróico; sin embargo, se han reportado resultados eficaces con lamotrigina y levetiracetam para el control de EMJ en monoterapia o politerapia, con topiramato como terapia coadyuvante para el control de las crisis tónico-clónicas generalizadas

Síndrome de Lennox Gastaut. Aproximación diagnóstica y avances terapéuticos: Fármacos antiepilépticos, Canabidiol y otras alternativas.

El Síndrome de Lennox Gastaut es una encefalopatía epiléptica catastrófica de inicio en la infancia con características electro-clínicas definidas de la siguiente manera: 1) presencia de múltiples tipos de crisis epilépticas especialmente tónicas; 2) deterioro cognitivo asociado a cambios conductuales; 3) presencia de complejos punta-onda lenta generalizados en el electroencefalograma (EEG) y paroxismos generalizados de actividad rítmica rápida durante el sueño. Su etiología puede ser estructural o genética (antes denominadas sintomáticas y criptogénicas, respectivamente). El diagnóstico inicial puede ser difícil ya que con frecuencia no se identifican todos los criterios al comienzo del cuadro y el diferencial considera otros síndromes epilépticos de inicio en la infancia, tales como las epilepsias mioclónicas. El tratamiento es muy complejo, se carece de guías definidas de práctica clínica, por lo cual la experiencia de expertos es relevante. Se sugiere inicio de medicación con valproato. Lamotrigina, felbamato, topiramato, rufinamida y clobazam son los fármacos de elección de segunda línea aprobados por la Administración Federal de Alimentos y Drogas de los Estados Unidos. (FDA). El manejo quirúrgico incluye cirugía resectiva y callosotomía total o parcial. Otras alternativas son estimulación del Nervio Vago, dieta cetogénica, estimulación cerebral profunda y el uso médico de cannabis

Epilepsias mioclónicas progresivas

Progressive myoclonus epilepsies (PME) are infrequent neurodegenerative disorders clinically and genetically heterogeneous cause, characterized by action myoclonus, seizures and progressive neurologic disability. They mainly affect children and teenagers. Its early clinical features make the differential diagnosis difficult with other, more frequent neurogenetic diseases such as juvenile myoclonic epilepsy. The majority of genetic mutations that lead to these diseases are known to be autosomal-recessive inheritance, with autosomal-dominant or mitochondrial inheritance being of exceptional frequency. The diagnosis is made when the mutations are identified in a patient with characteristic clinical features (like in the Univerritch-Lundborg disease or North Sea PME). On the other hand, in some cases pathological (vgr., for Lafora body disease or for Myoclonic epilepsy with ragged-red fibers) or specific laboratory test (such as sialic acid in urine for Sialidosis), are more useful. It is important to make as specific a diagnosis as possible because there are some genetically defined therapies for some of these diseases. The management of the seizures in these diseases includes the use of valproic acid as a first-line drug treatment, and other drugs like zonisamide and levetiracetam as second-line. However, the lack of response to antiepileptic drugs is not uncommon. Although the prognosis varies within diseases, it is generally unfavorable and may lead to disability or early death.Las epilepsias mioclónicas progresivas (EMP) son enfermedades neurodegenerativas infrecuentes, clínica y genéticamente heterogéneas, caracterizadas por presentar mioclonías de acción, crisis epilépticas y deterioro neurológico progresivo. Afectan principalmente a niños y adolescentes. Su cuadro clínico inicial dificulta un adecuado diagnóstico diferencial con otras enfermedades neurológicas genéticas más frecuentes como la epilepsia mioclónica juvenil. Se sabe que la mayoría de mutaciones genéticas que causan estas enfermedades reflejan una herencia autosómica recesiva, con variantes dominante o mitocondrial de excepcional frecuencia. El diagnóstico tiene lugar cuando se identifican las mutaciones en un paciente con un cuadro clínico característico (como es el caso de la enfermedad de Unverritch-Lundborg o la EMP del Mar del Norte). Por otro lado, en algunos casos son más útiles la anatomía patológica (para la enfermedad de cuerpos de Lafora o la epilepsia mioclónica con fibras rojas rasgadas) o exámenes auxiliares específicos (vgr., ácido siálico en orina para Sialidosis). Es importante hacer el diagnóstico específico ya que ello permite un tratamiento genético definido para algunas de estas enfermedades. El manejo de las crisis epilépticas incluye el uso de valproato como fármaco de primera línea, en tanto que otros como zonisamida y levetiracetam constituyen una segunda línea; sin embargo, la falta de respuesta al tratamiento médico antiepiléptico es relativamente común. El pronóstico puede variar entre una enfermedad y otra, pero, por lo general, suele ser desfavorable conduciendo a discapacidad severa o muerte temprana

Epilepsy Risk Following Bariatric Surgery for Weight Loss

Background and objectives: A previous study reported finding that epilepsy risk is elevated following bariatric surgery for weight loss; however, this association has not been adequately explored. Our objectives were to (1) estimate the risk of epilepsy following bariatric surgery for weight loss relative to a non-surgical cohort of patients with an obesity diagnosis, and (2) identify epilepsy risk factors among bariatric surgery recipients. Methods: We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants were accrued between July 1, 2010, and December 31, 2016, and followed until December 31, 2019. All Ontario residents 18 years of age and older who had bariatric surgery during the accrual period were eligible for inclusion in our exposed cohort. Patients hospitalized with a diagnosis of obesity and who did not have bariatric surgery during the accrual period were eligible for inclusion in our unexposed cohort. We excluded patients with a history of seizures, epilepsy, various seizure or epilepsy risk factors, psychiatric disorders, or drug or alcohol abuse/dependence. In our primary analysis, we used inverse probability of treatment weighting to control for confounding. A marginal Cox proportional hazards model was then used to estimate the risk of epilepsy associated with bariatric surgery. A Cox model was also used to identify epilepsy risk factors among exposed participants. Results: The final sample included 16,958 exposed participants and 622,514 unexposed participants. Following inverse probability of treatment weighting, the estimated rates of epilepsy were 50.1 and 34.1 per 100,000 person-years among those who did and did not have bariatric surgery, respectively. The hazard ratio for developing epilepsy after bariatric surgery was 1.45 (95% CI=1.35, 1.56). Among participants who received bariatric surgery, stroke during follow-up increased epilepsy risk (HR=14.03, 95% CI=4.26, 46.25). Discussion: In this study, we found that patients with a history of bariatric surgery were at increased risk of developing epilepsy. These findings suggest that epilepsy is a long-term risk associated with bariatric surgery for weight loss

Long Term outcomes after NORSE: Treatment with Vagus Nerve Stimulation

New-onset refractory status epilepticus (NORSE) is associated with high mortality, therapy resistant epilepsy (TRE) and poor cognitive and functional outcomes. Some patients develop multifocal TRE, for whom surgery with a curative intention, is not an option. In these patients, Vagus Nerve Stimulation (VNS) is performed as a palliative treatment. We report the long-term outcomes regarding seizure frequency, functional and cognitive outcome, and effectiveness of VNS in two patients with TRE as a consequence of NORSE. In the first patient with cryptogenic NORSE, VNS implantation occurred during the acute stage, probably contributing to the cessation of her status epilepticus. However, in the long-term follow-up, the patient persisted with daily multifocal seizures. In the second patient, VNS implantation was delayed to manage his epilepsy when the NORSE, ultimately due to autoimmune encephalitis, had resolved. During long-term follow-up, no reduction in seizure frequency was achieved. The current evidence supporting the use of VNS in patients with TRE after NORSE warrants further investigation

Eventos no epilépticos psicógenos: El desafío constante de su diagnóstico y tratamiento.

Psychogenic Non-Epileptic Events (PNEE) are paroxysmal episodes described as behavioral changes, sensory- sensitive disturbances, or motor manifestations that resemble epileptic seizures without showing underlying epileptiform activity, are not deliberately produced by the individual, and respond to multifactorial biopsychosocial mechanisms. Epidemiological information is limited due to the heterogeneous nature of the affected population, and to the limited accessibility to the video electroencephalogram (vEEG) necessary for its diagnosis. In such context, the convergence of two important elements is necessary: a detailed clinical history (clinical characteristics suggestive of PNEE, and identification of the associated factors), and the absence of electroencephalographic “ictal” changes in the vEEG. A psychological evaluation provides additional information, relevant for the diagnostic corroboration and management. The diagnosis must be made in a timely manner, to avoid complications in its evolution and treatment. A positive and encouraging attitude to the patient is vital when informing him/her of the diagnosis, as it also is the coordination between the treating neurologist and mental health professionals involved in the management and monitoring of the case. Cognitive behavioral psychotherapy, associated with psychopharmacotherapy -when needed-- constitute the most effective treatment approach for these patients. There are limited studies on the current epidemiological and clinical evolution of patients with PNEE in Latin America, and additional research regarding this problem is much needed, given its impact on the quality of life of the patients and on the cost of its management in the health care systems.Los eventos no epilépticos psicógenos (ENEP) son episodios paroxísticos descritos como cambios conductuales, alteraciones sensorio-sensitivas, o manifestaciones motoras que se asemejan a las crisis epilépticas pero sin mostrar actividad epileptiforme subyacente, no son producidos deliberadamente por el individuo, y responden a mecanismos multifactoriales de índole biopsicosocial. La información epidemiológica es limitada debido a la naturaleza heterogénea de la población afectada, así como a la escasa accesibilidad al videoelectroencefalograma (vEEG) necesario para su diagnóstico. En este contexto, es necesaria la convergencia de dos elementos importantes: historia clínica detallada (características clínicas sugerentes de ENEP e identificación de los factores asociados) y la ausencia de cambios electroencefalográficos en el vEEG durante el episodio. La evaluación psicológica provee información adicional relevante para la corroboración diagnóstica y para su manejo. El diagnóstico debe realizarse de manera oportuna, para evitar complicaciones en su evolución y tratamiento. Es vital una actitud positiva y alentadora hacia el/la paciente al momento de comunicarle su diagnóstico, así como la coordinación entre el neurólogo tratante y los profesionales de salud mental involucrados en el manejo y seguimiento del caso. La psicoterapia cognitiva conductual, asociada a psicofármacoterapia -cuando pertinente-, constituyen el tratamiento más eficaz de estos pacientes. Existen limitados estudios en Latinoamérica sobre aspectos epidemiológicos y clínico-evolutivos de pacientes con ENEP, por lo que más investigación y publicaciones respecto a esta problemática son indispensables dado su impacto sobre la calidad de vida de los pacientes y sobre el costo de su manejo en los sistemas de salud