A cross-sectional study on the association of serum uric acid levels with depressive and anxiety symptoms in people with epilepsy.

BACKGROUND: High serum uric acid (SUA) levels may provide protection against depression and anxiety through its defensive role in oxidative damage. The aim of this study was to test the hypothesis of the independent associations of lower SUA levels with depressive and anxiety symptoms among patients with epilepsy (PWE). METHODS: A cross-sectional study was performed among 320 PWE aged ≥18 years old in Northeast China. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 scale (GAD-7; Chinese version) were used as screening tools for depressive and anxiety symptoms for PWE. Serum uric acid levels were measured. The associations of SUA levels with depressive and anxiety symptoms were assessed by using binary logistic regression models, with adjustment for the related risk factors (P< 0.05). RESULTS: Lower SUA tertiles were significantly associated with higher C-NDDI-E and GAD-7 scores compared with the higher two tertiles (p=0.001, and p= 0.002). Patients with depressive symptoms exhibited significantly lower SUA levels compared to those without depressive symptoms (p< 0.001). SUA levels of patients with anxiety symptoms were significantly lower than those of patients without anxiety symptoms (p< 0.001). The first and second SUA tertiles were associated with depressive symptoms, with the third tertile group as the reference group, after adjusting for confounders (first tertile: OR = 4.694, 95% CI = 1.643~ 13.413, P = 0.004; second tertile: OR = 3.440, 95% CI = 1.278~9.256, P = 0.014). However, The first and second SUA tertiles were not associated with the risk of anxiety symptoms compared with the third tertile in the adjusted logistic regression model (First tertile: OR = 1.556, 95% CI = 0.699~3.464, P = 0.279; second tertile: OR = 1.265, 95% CI = 0.607~2.635, P = 0.530). CONCLUSION: We found that lower SUA levels were independently associated with depressive symptoms but not with anxiety symptoms among PWE. Further well-designed prospective cohort studies are required to determine the causality of the associations and to further clarify the mechanisms of SUA in depressive symptoms.

Efficacy of Phenobarbital and Prognosis Predictors in Women With Epilepsy From Rural Northeast China: A 10-Year Follow-Up Study.

OBJECTIVE: To investigate the efficacy of phenobarbital (PB), factors associated with it, reasons for early treatment termination, and mortality rates in adult women living in rural Northeast China. METHODS: A prospective study was conducted in seven counties of Jilin Province from 2010 to 2020. Adult women diagnosed with convulsive epilepsy were recruited into the study and baseline demographics recorded upon enrollment. Seizure frequency, prescribed drug dose, and adverse reactions were monitored monthly by door-to-door survey or telephone interview. RESULTS: A total of 1,333 women were included in the study. During the follow-up period, 169 participants (12.7%) were lost to follow-up, and 100 of them (7.5%) died. The percentage of seizure-free participants was 45.3% in the first year, 74.6% in the third year, and 96.6% in the 10th year. A higher baseline seizure frequency (OR = 1.005, 95% CI: 1.002-1.009), more frequent loss-of-consciousness seizures (OR = 1.620, 95% CI: 1.318-1.990), a higher daily dose of PB in the first year (OR = 1.018, 95% CI: 1.014-1.022), a younger age at onset (OR = 0.990, 95% CI: 0.982-0.998), and more severe drowsiness (OR = 1.727, 95% CI: 1.374-2.173) were associated with an increased risk of seizures in the first year, and the higher baseline seizure frequency was still associated with the occurrence of seizures in the third (OR = 1.007, 95% CI: 1.004-1.010) and fifth year (OR = 1.005, 95% CI: 1.002-1.008). Age at enrollment (HR = 0.983, 95% CI: 0.971-0.994) was the only factor that correlated with withdrawal from the study and with the death of the participant during the follow up period, but the correlation in each case was in opposite directions. SIGNIFICANCE: PB has high effectiveness, retention rate, mild side effects, and tolerability when used as a treatment for epilepsy in women from rural areas. Baseline seizure frequency is an important predictor of prognosis regardless of treatment duration. PB is still a valuable tool for the management of epilepsy in adult women from poverty-stricken areas.

Elevated Blood S100B Levels in Patients With Migraine: A Systematic Review and Meta-Analysis.

Background: In recent years, a growing number of researches indicate that S100B may act in migraine, but the relationship between S100B and migraine remains controversial. Therefore, the current study aimed to perform a meta-analysis to quantitatively summarize S100B levels in migraine patients. Methods: We used Stata 12.0 software to summarize eligible studies from PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases. We applied standardized mean differences (SMDs) with 95% confidence intervals (95%CIs) to appraise the association between S100B and migraine. Results: The combined results of nine case-control studies indicated that compared with healthy controls, overall migraine patients had significantly increased S100B levels in peripheral blood (SMD = 0.688, 95%CI: 0.341-1.036, P < 0.001). The S100B levels in migraineurs during ictal periods (SMD =1.123, 95%CI: 0.409-1.836, P = 0.002) and interictal periods (SMD = 0.487, 95%CI: 0313-0.661, P < 0.001), aura (SMD = 0.999, 95%CI: 0.598-1.400, P < 0.001) and without aura (SMD = 0.534, 95%CI: 0.286-0.783, P < 0.001) were significantly higher than those in the controls. The subgroup analyses by age, country, migraine assessment, and assay method of S100B also illustrated a statistically obvious association between S100B levels and migraine, indicating that age may be the most important source of heterogeneity. Sensitivity analysis showed that no individual study has a significant influence on the overall association between S100B and migraine. Conclusion: This meta-analysis demonstrates that the level of S100B in peripheral blood of patients with migraine was significantly increased. Migraine may be associated with pathological reactions involving S100B, which is instrumental for the clinical diagnosis of migraine and therapy that considers S100B as a potential target.

A Survey of Hesitancy and Response to the COVID-19 Vaccine Among Patients With Epilepsy in Northeast China.

Objective: This study was conducted to investigate the hesitancy and response of people with epilepsy (PWE) to the coronavirus disease 2019 (COVID-19) vaccine. Methods: We conducted an online survey among PWE in northeast China about hesitancy and response to the COVID-19 vaccine. Their demographic background and symptomatic data about epilepsy were also recorded, and we analyzed the epilepsy-related risk factors in delaying the vaccine. Results: In total, 357 patients with confirmed epilepsy were included in the survey, and only 38 (11%) patients received the COVID-19 vaccine. Fear of aggravating epilepsy (58%, n = 185), discouragement from health workers for epilepsy (22%, n = 70), and fear of patients of other unknown serious side effects (13%, n = 42) were the main reasons for delaying vaccination. A higher seizure frequency was the only epilepsy-related risk factor in delaying the vaccine (OR = 1.104, 95% CI: 0.988-1.233). None of the vaccinated patients reported that the vaccine aggravated their epilepsy. Significance: Understanding concerns about the COVID-19 vaccine among PWE could help to improve health education and promote the establishment of an immune barrier.

Treatment Outcome and Risk Factors of Adult Newly Diagnosed Epilepsy: A Prospective Hospital-Based Study in Northeast China.

Objective: The study was conducted to summarize the treatment outcomes of newly diagnosed epilepsy (NDE) and analyse the risk factors for refractory epilepsy (RE) in Northeast China. Methods: A total of 466 adult patients with NDE were consecutively enrolled in this programme. Clinical data were collected at baseline and each follow-up. Several scales concerning recognition and mood were also completed at the first visit. Results: Seizure-free status was achieved by 52% (n = 244) of the patients; however, 15% (n = 68) manifested RE. A total of 286 (61%) patients continued with the first ASM as monotherapy, among which 186 (40%) patients became seizure-free. Fifteen (22%) patients with RE became seizure-free following ASM adjustment and 34 patients (14%) had breakthrough seizures after being classified as seizure-free. One patient developed RE after attaining seizure-free status. Breakthrough seizures during the first expected interictal interval [Odds ratio (OR) = 5.81, 95% CI: 2.70-12.50], high seizure frequency at baseline (OR = 1.24, 95% CI: 1.04-1.49), younger age of onset (OR = 1.42, 95% CI: 1.12-1.79), and male sex (OR = 2.64, 95% CI: 1.26-5.53) were risk factors for RE. Significance: Treatment outcomes of the majority of NDE cases are good. New risk factors could help physicians more promptly and accurately identify patients who are likely to develop RE. Seizure-free state is not long enough to commence the withdrawal of ASMs. RE is not permanent and seizure-free may be achieved subsequently by appropriate drug adjustment.

Non-Convulsive Status Epileptics Presenting with Periodic Lateralized Epileptiform Discharges and Coma after Cerebral Hemorrhage: A Case Report.

BACKGROUND: Non-convulsive status epileptics (NCSE) is a common neurological emergency necessitating rapid assessment and management, but is often underdiagnosed as it lacks specific electroencephalographic features. The diagnostic value of periodic lateralized epileptiform discharges (PLEDs) in NCSE is still unclear. Herein, we reported a case with NCSE manifesting as PLEDs and coma. CASE REPORT: A 62-year-old man presented with epileptic seizures. Based on clinical and radiological profiles, he was diagnosed with frontal hemorrhage, coma, and NCSE. An electroencephalogram (EEG) revealed PLEDs. A combined antiepileptic regimen was initiated and, over a follow-up period of 2 months, a favorable outcome was achieved. CONCLUSION: EEG may help identify potential NCSE in comatose patients, and PLEDs can be an atypical manifestation of NCSE, which can be effectively treated with antiepileptic drugs. The emphasis in NCSE is on early identification and individualized therapeutic regimens.

One-Year Analysis of Risk Factors Associated With Cognitive Impairment in Newly Diagnosed Epilepsy in Adults.

Cognitive impairment (CI) occurs in people with epilepsy, affecting their quality of life. This study aimed to identify factors associated with CI in adult patients with newly diagnosed epilepsy. Additionally, we sought to determine whether any particular cognitive function is impaired predominantly by anti-seizure medications or by other factors. We enrolled 229 patients with newly diagnosed epilepsy and 191 participants were followed up for 1 y. We used the Montreal Cognitive Assessment as a tool to quantify CI. The sub-item scores were also collected to assess whether any aspects of CI are predominantly affected by anti-seizure medication treatment. Subjective memory decline due to anti-seizure medications was also recorded. One-hundred-and-two participants (44.5%) had CI onset before anti-seizure medication treatment. Aging, low education level, stroke or brain surgery etiology, and anxious symptoms were identified as risk factors for CI before anti-seizure medications use. Brain surgery for the young, anxious status for the middle-aged, and depressive status for the elderly were risk factors for CI at different ages. The elderly PWE had worse memory than the others. PWE with TLE had worse cognition, especially in memory and naming. The overall impact of anti-seizure medications on cognition was mild. Refractory epilepsy was a predictor of cognitive decline. Subjective memory decline was predicted by high-risk treatment and by a finding of refractory epilepsy. Clarifying the risk factors for CI can help the physician to assess the probable risk of CI for each individual before the start of anti-seizure medication treatment, which may lead to better compliance.

Isoflurane-Induced Burst Suppression Is a Thalamus-Modulated, Focal-Onset Rhythm With Persistent Local Asynchrony and Variable Propagation Patterns in Rats.

Background: Inhalational anesthetic-induced burst suppression (BS) is classically considered a bilaterally synchronous rhythm. However, local asynchrony has been predicted in theoretical studies and reported in patients with pre-existing focal pathology. Method: We used high-speed widefield calcium imaging to study the spatiotemporal dynamics of isoflurane-induced BS in rats. Results: We found that isoflurane-induced BS is not a globally synchronous rhythm. In the neocortex, neural activity first emerged in a spatially shifting, variably localized focus. Subsequent propagation across the whole cortex was rapid, typically within <100 milliseconds, giving the superficial resemblance to global synchrony. Neural activity remained locally asynchronous during the bursts, forming complex recurrent propagating waves. Despite propagation variability, spatial sequences of burst propagation were largely preserved between the hemispheres, and neural activity was highly correlated between the homotopic areas. The critical role of the thalamus in cortical burst initiation was demonstrated by using unilateral thalamic tetrodotoxin injection. Conclusion: The classical impression that anesthetics-induced BS is a state of global brain synchrony is inaccurate. Bursts are a series of shifting local cortical events facilitated by thalamic projection that unfold as rapid, bilaterally asynchronous propagating waves.

Miller-Fisher syndrome complicated by Bickerstaff brainstem encephalitis: A case report.

RATIONALE: Bickerstaff brainstem encephalitis (BBE) and Miller-Fisher syndrome (MFS) might be a pedigree disease. Herein, we report a rare case that fits the diagnoses of both MFS and BBE. PATIENT CONCERNS: A 48-year-old woman was hospitalized due to blurred vision and unsteady gait lasting for 9 days, and numbness of the limbs lasting for 6 days. Physical examination showed restricted eye movement without nystagmus, bilateral flattening of forehead and nasolabial folds, and positive eyelash sign. Her tongue deviated to the left when protruded. She had negative tendon reflex, bilateral Babinski signs, hypalgesia, and numbness in all limbs. She had positive Romberg sign and failed the right heel-knee-tibia tests. Her brain diffusion-weighted magnetic resonance imaging (DWI) showed an abnormally high circular signal in the brainstem surrounding the fourth ventricle. She also had cerebral spinal fluid (CSF) albuminocytological dissociation and GQ1b-IgG antibodies in both CSF and serum. DIAGNOSES: The case fits the diagnoses of both MFS and BBE. INTERVENTIONS: The patient was treated with dexamethasone. OUTCOMES: The condition of the patient significantly improved after the administration of dexamethasone. Her symptoms had continued to improve by the 6-week and 2-month follow-ups. LESSONS: These results suggest that BBE and MFS might be a pedigree disease and timely hormone therapy is expected to improve patients'outcomes.

Reversible splenial lesion syndrome due to oxcarbazepine withdrawal: case report and literature review.

Background Reversible splenial lesion syndrome is a distinct entity radiologically characterized by a reversible lesion in the splenium of the corpus callosum. According to previous reports, this condition may be associated with antiepileptic drug use or withdrawal. We herein report a case of reversible splenial lesion syndrome associated with oxcarbazepine withdrawal. Case Report A 39-year-old man presented with an 8-year history of epileptic seizures. During the previous 3 years, he had taken oxcarbazepine irregularly. One week prior to admission, he withdrew the oxcarbazepine on his own, and the epilepsy became aggravated. Magnetic resonance imaging (MRI) revealed an isolated lesion in the splenium of the corpus callosum with slight hypointensity on T1-weighted imaging and slight hyperintensity on T2-weighted imaging. Regular oxcarbazepine was prescribed. Over a 5-month follow-up period, repeat MRI showed that the abnormal signals in the splenium of the corpus callosum had completely disappeared. Conclusion Reversible splenial lesion syndrome is a rare clinicoradiological disorder that can resolve spontaneously with a favorable outcome. Clinicians should be aware of this condition and that oxcarbazepine withdrawal is a possible etiological factor.