Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures

Objective: To evaluate prospectively the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including dedicated epilepsy protocol MRI.Methods and materials: We included all consecutive patients 60 years or older who participated in a prospective study on new onset epilepsy. The work-up included the acquisition of a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We evaluated the frequency and types of epileptogenic lesions in the whole cohort and stratified those variables by age, gender, types and number of seizures at presentation. We also correlated the EEG findings with the clinical characteristics and neuroimaging results.Results: Of the 101 patients enrolled in the study and who underwent an epilepsy protocol MRI, an epileptogenic lesion was identified in 67% of cases. The most common etiologies were vascular events, followed by tumoral causes and traumatic brain injuries. Epileptogenic lesions were more likely to be identified in patients who presented with only focal aware and impaired awareness seizures. In addition, patients with tumoral epilepsy were significantly more likely to only experience those seizure types compared to patients with other pathological substrates. Interictal/ictal discharges were detected in the EEG of 21% of patients. Epileptiform discharges were significantly more frequent in patients with an epileptogenic lesion on brain MRI, especially in those with a brain tumor.Conclusions: Our results stress the importance of obtaining a dedicated epilepsy protocol MRI in elderly patients with new onset seizures. An epileptogenic lesion will be identified in approximately two thirds of patients with important implications regarding initiation of treatment. In addition, the data underscore the value of distinguishing the types of seizures experienced at presentation as this will apprise the treating physician on the likelihood of identifying an epileptogenic lesion and on the probable etiologies

Prospective study of epilepsy with generalized tonic–clonic seizures alone: Clinical features, response to treatment, and likelihood of medication withdrawal

Abstract Objective This prospective study aimed to delineate the demographics, natural progression, and treatment response of patients newly diagnosed with epilepsy with generalized tonic–clonic seizures alone (EGTCA). Furthermore, our objective includes assessing the seizure recurrence rate post antiseizure medication (ASM) discontinuation within this cohort, alongside exploring predictive factors for seizure relapse. Methods The study cohort, derived from an ongoing, prospective, multicenter investigation on children and adults with new‐onset unprovoked seizures, included consecutive patients enrolled between March 2010 and March 2020, and meeting mandatory ILAE criteria for EGTCA diagnosis. Participants underwent a 3‐h sleep‐deprived video‐EEG recording along with an epilepsy protocol brain magnetic resonance imaging (MRI) with repeat EEG at each follow‐up. Cumulative time‐dependent probabilities of seizure recurrence were calculated using Kaplan–Meier survival analysis. Logistic regression identified variables associated with seizure recurrence following ASM taper. Results Eighty‐nine patients with a median age of 16 years were included, constituting 31% of those diagnosed with an idiopathic generalized epilepsy. Regarding the circadian distribution of seizures, 59.6% of patients exclusively experienced diurnal seizures, 12.4% exclusively nocturnal, and 28.1% experienced both diurnal and nocturnal seizures. Generalized spike–wave discharges (GSWD) were present in the initial EEG of 88% of patients. A GTC recurred in 14% of patients treated with ASM compared with 73% of untreated patients (p < 0.00001). ASM discontinuation was attempted in 50 patients after a median treatment duration of 3 years, with 44% experiencing a recurrence. Patient‐initiated taper and a mixed circadian seizure pattern independently predicted a higher likelihood of recurrence post‐ASM discontinuation. Significance Our findings underscore the importance of prompt treatment upon the diagnosis of EGTCA. Notably, lifelong treatment may not be imperative; patients seizure‐free for at least 2 years, with the absence of GSWD on EEG, often maintained seizure freedom after ASM withdrawal, especially with physician‐initiated tapering. Plain Language Summary Seizures in individuals diagnosed with “epilepsy with generalized tonic‐clonic seizures alone” (EGTCA) typically start during adolescence and often respond well to antiseizure medications. An electroencephalogram, which measure brain waves, will show abnormal discharges in most patients with EGTCA. Lifelong treatment with antiseizure medication is not necessary for everyone with EGTCA; approximately, 40% can successfully stop treatment without facing seizure recurrence. Patients who stop medication on their own have a higher risk of seizures returning compared with those who undergo cessation under a doctor's supervision

Early predictors of remission in children and adolescents with new-onset epilepsy: A prospective study

International audiencePurpose: This study aims to identify predictive factors of a two-year remission (2YR) in a cohort of children and adolescents with new-onset seizures based on baseline clinical characteristics, initial EEG and brain MRI findings.Methods: A prospective cohort of 688 patients with new onset seizures, initiated on treatment with antiseizure medication was evaluated. 2YR was defined as achieving at least two years of seizure freedom during the follow-up period. Multivariable analysis was performed and recursive partition analysis was utilized to develop a decision tree.Results: The median age at seizure onset was 6.7 years, and the median follow-up was 7.4 years. 548 (79.7%) patients achieved a 2YR during the follow up period. Multivariable analysis found that presence and degree of intellectual and developmental delay (IDD), epileptogenic lesion on brain MRI and a higher number of pretreatment seizures were significantly associated with a lower probability of achieving a 2YR. Recursive partition analysis showed that the absence of IDD was the most important predictor of remission. An epileptogenic lesion was a significant predictor of non-remission only in patients without evidence of IDD, and a high number of pretreatment seizures was a predictive factor in children without IDD and in the absence of an epileptogenic lesion.Conclusion: Our results indicate that it is possible to identify patients at risk of not achieving a 2YR based on variables obtained at the initial evaluation. This could allow for a timely selection of patients who require close follow-up, consideration for neurosurgical intervention, or investigational treatments trials

Multi-organ damage induced by anabolic steroid supplements: a case report and literature review

Abstract Introduction The use of anabolic supplements and other related drugs for body building and to enhance athletic performance is nowadays widespread and acutely pervasive all around the world. This alarming increase in the use of anabolic and amino acid supplements has been linked to a diverse array of pathologies. As previously reported, the abuse of androgenic steroids is not without severe physiological, psychiatric and physical costs. The case we report here describes multi-organ damage resulting from the abuse and uncontrolled use of anabolic steroid supplements, mainly testosterone. Case presentation A 24-year-old white man presented with abdominal pain concomitant with nausea and vomiting. Laboratory analysis revealed hypercalcemia, elevated liver enzymes and high levels of amylase, lipase and creatine protein kinase. Conclusion Amino acid as well as anabolic supplements may lead to abnormal functioning of many organs, which could be fatal in some instances. This mandates worldwide and concerted efforts to educate the public, especially the youth, about the dangers of these increasingly abused drugs.</p

Predictors of drug‐resistant epilepsy in childhood epilepsy syndromes: A subgroup analysis from a prospective cohort study

International audienceObjective: Previous studies assessing factors associated with drug-resistant epilepsy (DRE) were constrained by their amalgamation of all epilepsy syndromes in their analyses and the absence of uniform criteria for defining DRE. Our objective was to identify predictors of DRE among the four primary childhood epilepsy syndrome groups within a cohort of children with new onset seizures, using the International League Against Epilepsy (ILAE) definition of DRE and the recent classification of epilepsies.Methods: This is a prospective study of 676 children with new onset seizures initiated on antiseizure medication. Patients were monitored for the occurrence of DRE according to the ILAE criteria and were categorized into one of four epilepsy groups: self-limited focal epilepsies (SeLFEs), genetic generalized epilepsies (GGEs), developmental epileptic encephalopathies (DEEs), and focal epilepsies.Cox regression analysis was performed to identify predictors of DRE within each epilepsy group.</div

Role of phosphogypsum and NPK amendments on the retention or leaching of metals in different soils

Column leaching tests were conducted to investigate the effects of soil physicochemical characteristics on metal mobility in the subsurface. The metals investigated originated from disposed industrial waste byproducts and from agrochemicals spread over the farmlands. Soil column tests can provide insights into leaching of metals to underlying water compartments. The findings of this study can be used for prevention strategies and for setting risk assessment approaches to land-use and management, and soil and water quality and sustainability. Soils collected from an industrial (IS) watershed and an agricultural (AQ) hydrographic basin were used in soil column leaching experiments. The soil samples were characterized for mineralogy, functional groups, grain size, surface charge, soil type, porosity, and cation exchange capacity (CEC) along with elemental composition. Varying concentrations of phosphogypsum industrial waste or agrochemical (NPK fertilizer) was then added to the surface of the packed columns (n ¼ 28). The columns were subjected to artificial rain over a period of 65 days. Leachates were collected and analyzed for dissolved Naþ, Kþ, and Cd2þ throughout the experimental period, whereas residual Cd content in the subsurface soil was measured at the end of the experiment. Physicochemical characterization indicated that the AQ soil has a higher potential for metal retention due to its fine clay texture, calcareous pH, high organic matter content and CEC. Metal release was more prominent in the IS soil indicating potential contamination of the surrounding soil and water compartments. The higher metal release is attributed to soil physicochemical characteristics. High calcium concentrations of phosphogypsum origin is expected to compete for adsorbed bivalent elements, such as Cd, resulting in their release. The physicochemical characteristics of the receiving media should be taken into consideration when planning land-use in order to achieve sustainable development. Soil physiochemical characteristics play a key role in determining the behavior and fate of elements upon application of amendments. Sandy soils should not be assigned to industrial zones or landfills due to their high permeability, unlike fine clay soils. Furthermore, application of fertilizers on sandy soils can threaten groundwater quality, whereas their extensive use on clayey soil can cause soil salinisatio