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1.
Eur J Med Res ; 28(1): 49, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36707895

RESUMO

BACKGROUND: Headache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs). METHODS: In this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected. RESULTS: Of 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028). CONCLUSION: MIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.


Assuntos
Epilepsia , Transtornos de Enxaqueca , Humanos , Adulto , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Cefaleia/epidemiologia , Cefaleia/complicações , Cefaleia/diagnóstico , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Comorbidade
2.
Neurosciences (Riyadh) ; 28(1): 19-26, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36617446

RESUMO

OBJECTIVES: To measure the burden of insomnia and daytime sleepiness (DTS) and their effects on sleep quality, and the risk factors of poor quality of sleep. METHODS: We conducted a cross-sectional study of 218 epilepsy patients. We administered well-validated and previously translated questionnaires to assess sleep quality, insomnia, and DTS using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale, respectively. RESULTS: Approximately 75% of participants reported poor sleep quality. Moreover, 42.2% did not have insomnia, while 37.6%, 17.9%, and 2.3% had subthreshold insomnia and clinical insomnia of moderate and severe severity, respectively. Roughly 64.2% of participants had normal sleep, 17.8% had an average amount of DTS, and 16.9% and 0.9% may and should seek medical attention, respectively. Compared to normal sleepers, patients with clinical insomnia were 5.45 times likely to experience poor sleep quality, whereas patients with an average amount of DTS and who were recommended to seek medical attention were 6.84 and 44.15 times likely to experience poor sleep quality, respectively. Patients who had seizures every month were 2.51 times likely to experience poor quality sleep, compared to patients who had seizures annually. CONCLUSION: We found a higher prevalence of poor quality of sleep, insomnia, and excessive DTS in our sample of Saudi epilepsy patients.


Assuntos
Distúrbios do Sono por Sonolência Excessiva , Epilepsia , Distúrbios do Início e da Manutenção do Sono , Humanos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Qualidade do Sono , Arábia Saudita/epidemiologia , Estudos Transversais , Epilepsia/complicações , Epilepsia/epidemiologia , Sono , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Convulsões , Inquéritos e Questionários
3.
Health Qual Life Outcomes ; 21(1): 5, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670421

RESUMO

BACKGROUND: Comorbid mental health conditions are common in people with epilepsy and have a significant negative impact on important epilepsy outcomes, although the evidence is mostly from high-income countries. This systematic review aimed to synthesise evidence on the association between comorbid mental health conditions and quality of life and functioning among people with epilepsy living in low- and middle income countries (LMICs). METHODS: We searched PubMed, EMBASE, CINAHL, Global Index medicus (GID) and PsycINFO databases from their dates of inception to January 2022. Only quantiative observational studies were included. Meta-analysis was conducted for studies that reported the same kind of quality of life and functioning outcome. Cohen's d was calculated from the mean difference in quality-of-life score between people with epilepsy who did and did not have a comorbid depression or anxiety condition. The protocol was registered with PROSPERO: CRD42020161487. RESULTS: The search strategy identified a total of 2,101 articles, from which 33 full text articles were included. Depression was the most common comorbid mental health condition (33 studies), followed by anxiety (16 studies). Meta-analysis was conducted on 19 studies reporting quality of life measured with the same instrument. A large standardized mean effect size (ES) in quality of life score was found (pooled ES = -1.16, 95% confidence interval (CI) - 1.70, - 0.63) between those participants with comorbid depression compared to non-depressed participants. There was significant heterogeneity between studies (I2 = 97.6%, p < 0.001). The median ES (IQR) was - 1.20 (- 1.40, (- 0.64)). An intermediate standard effect size for anxiety on quality of life was also observed (pooled ES = -0.64, 95% CI - 1.14, - 0.13). There was only one study reporting on functioning in relation to comorbid mental health conditions. CONCLUSION: Comorbid depression in people with epilepsy in LMICs is associated with poor quality of life although this evidence is based on highly heterogeneous studies. These findings support calls to integrate mental health care into services for people with epilepsy in LMICs. Future studies should use prospective designs in which the change in quality of life in relation to mental health or public health interventions across time can be measured.


Assuntos
Epilepsia , Saúde Mental , Humanos , Países em Desenvolvimento , Qualidade de Vida , Ansiedade/epidemiologia , Epilepsia/complicações , Epilepsia/epidemiologia
4.
PLoS One ; 18(1): e0281040, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36706124

RESUMO

This study sought to identify differences in cannabis use and perceptions about cannabis in mitigating seizure-related symptoms in patients with epilepsy, and to evaluate differences in these patterns between drug-resistant versus pharmacoresponsive epilepsy. A collection of self-report surveys completed by patients with epilepsy (n = 76) were used to retrospectively compare differences in those with drug-resistant versus pharmacoresponsive epilepsy regarding 1) proportion who used cannabis, 2) frequency of use, 3) method of use, and 4) reason for use. A Cochran-Armitage test for trend indicated that of patients who used cannabis, a higher proportion of patients in the drug-resistant group used more frequently than in the pharmacoresponsive group. Almost half (48%) of those in the drug-resistant group reported daily use compared to approximately a third (36%) of those in the pharmacoresponsive group. Additionally, no patient in either group reported that cannabis was harmful in relation to seizure-related symptoms. Results from this study highlight the need for epilepsy providers to formally assess patients' perceptions and use of non-prescribed cannabis to inform clinical care decisions, particularly in the drug-resistant epilepsy population.


Assuntos
Cannabis , Epilepsia Resistente a Medicamentos , Epilepsia , Alucinógenos , Humanos , Anticonvulsivantes/uso terapêutico , Estudos Retrospectivos , Centros de Atenção Terciária , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Convulsões/tratamento farmacológico , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Epilepsia Resistente a Medicamentos/epidemiologia , Alucinógenos/uso terapêutico , Agonistas de Receptores de Canabinoides/uso terapêutico
5.
Brain Behav ; 13(1): e2852, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36542525

RESUMO

Approximately 80% of patients with epilepsy reside in poor resource settings. Despite the continued advancements and development of new treatment approaches, epilepsy remains a major health problem in developing countries. Consistent findings of epidemiologic studies reflect that both prevalence and treatment gap are higher in the developing world. The objective of this short review was to evaluate current treatment options and low-intensity, pulsed-focused ultrasound (FUS) as a potential new treatment option for epilepsy. Although some of the patients could be candidates for surgery, many factors, including poor health-care infrastructure, socioeconomic status, risks and complications associated with the surgery, and patients' preferences and attitudes toward the surgical procedure, limit the adherence to get surgical therapies. Low-intensity FUS, a novel and noninvasive therapeutic approach, has the potential to be approved by regulatory bodies and added to the list of standard treatment options for epilepsy. Improved understanding of epilepsy's prevalence and incidence in developing worlds, identification of potential new therapeutic options, and their evaluation through continuous studies and clinical trials are needed to reduce the burden of epilepsy and the treatment gap.


Assuntos
Países em Desenvolvimento , Epilepsia , Humanos , Epilepsia/epidemiologia
6.
Epilepsy Res ; 189: 107066, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36571905

RESUMO

OBJECTIVE: The present study aimed to explore the mechanisms underlying the comorbidity of epilepsy and migraine, identify potential common targets for drug intervention, and provide insight into new avenues for disease prevention and treatment using an integrated bioinformatic and network pharmacology approach. METHODS: Disease targets in epilepsy and migraine were screened using the DisGeNET database to identify intersecting gene targets. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEEG) enrichment analyses were then performed using the WebGestalt database. Furthermore, the STRING database was used to construct a protein-protein interaction (PPI) network, and Cytoscape software was used to analyze the protein molecular signals at the intersection of epilepsy and migraine. The Drugbank database was used to identify common targets for antiepileptic drugs in epilepsy and migraine to further analyze the disease-gene-target-drug interaction network. Finally, molecular docking simulations were performed to verify the hypothesis that migraine and epilepsy share common diseases and drug targets. RESULTS: A total of 178 common targets for epilepsy and migraine were identified using the DisGeNET database, and the 24 genes most related to the diseases were screened using the Score_gda gene scoring system. GO enrichment analysis indicated that common targets were mainly enriched in biological processes and molecular functions, including membrane potential regulation, inorganic ion transmembrane transport, axonal signaling, and ion channel activity. KEGG pathway enrichment analysis indicated that the mechanism of action might be related to neuroactive ligand receptors, AGE-RAGE, cAMP, and VEGF signaling pathways. The PPI network construction and analysis results showed that the PPI grid had 23 central nodes and 24 connected edges, with an average node degree of 2.09 and an average clustering coefficient of 0.384. The 10 genes with potentially important roles in epilepsy and migraine were CACNA1A, KCNQ2, KCNA1, SCN1A, PRRT2, SCN8A, KCNQ3, SCN2A, GRIN2A, and GABRG2. Drugbank database results indicated that antiepileptic drugs, including lamotrigine, topiramate, valproic acid, carbamazepine, gabapentin, and perampanel, also had common targets with migraine. The three most important targets exhibited strong binding affinity with drugs in the molecular docking simulations. CONCLUSION: Our systematic and comprehensive analyses of disease-gene-target-drug interaction networks identified several biological processes and molecular functions common to migraine and epilepsy, most of which were related to neuroactive ligand-receptor interactions. These data provide a new theoretical basis and reference for the clinical treatment of comorbid epilepsy and migraine and may aid in the development of novel pharmacological strategies.


Assuntos
Epilepsia , Transtornos de Enxaqueca , Humanos , Anticonvulsivantes/uso terapêutico , Ligantes , Simulação de Acoplamento Molecular , Farmacologia em Rede , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Epilepsia/genética , Comorbidade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/genética
7.
Epilepsy Behav ; 138: 109024, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36495798

RESUMO

Although vaccines are generally safe in persons with epilepsy (PWE), seizures can be associated with vaccination, including COVID-19. This study assessed the occurrence of COVID-19 vaccination-related seizure exacerbations in PWE. Adult PWE who had received a COVID-19 vaccine were consecutively recruited at a tertiary epilepsy clinic between June 2021 and April 2022. Patient demographics, including epilepsy history, vaccination details, and reported adverse effects were recorded. Seizure exacerbation, defined as occurring within one week of vaccination, was assessed. Five hundred and thirty PWE received the COVID-19 vaccine. 75 % received the Comirnaty (Pfizer) vaccine as their initial dose. Most patients (72 %) were taking ≥ 2 antiseizure medications (ASM) and had focal epilepsy (73 %). One-third were 12 months seizure free at their first vaccination. 13 patients (2.5 %) reported a seizure exacerbation following their first vaccination, three of whom required admission. None were seizure-free at baseline. Six of these patients (46 %) had a further exacerbation of seizures with their second vaccine. An additional four patients reported increased seizures only with the second vaccine dose. Seizure exacerbations are infrequently associated with COVID-19 vaccination, mainly in patients with ongoing seizures. The likelihood of COVID-19 infection complications in PWE outweighs the risk of vaccination-related seizure exacerbations.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Epilepsia , Adulto , Humanos , COVID-19/complicações , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Epilepsia/epidemiologia , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Vacinação/efeitos adversos
8.
Hum Genomics ; 16(1): 71, 2022 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-36539902

RESUMO

BACKGROUND: Epilepsy, a serious chronic neurological condition effecting up to 100 million people globally, has clear genetic underpinnings including common and rare variants. In Saudi Arabia, the prevalence of epilepsy is high and caused mainly by perinatal and genetic factors. No whole-exome sequencing (WES) studies have been performed to date in Saudi Arabian epilepsy cohorts. This offers a unique opportunity for the discovery of rare genetic variants impacting this disease as there is a high rate of consanguinity among large tribal pedigrees. RESULTS: We performed WES on 144 individuals diagnosed with epilepsy, to interrogate known epilepsy-related genes for known and functional novel variants. We also used an American College of Medical Genetics (ACMG) guideline-based variant prioritization approach in an attempt to discover putative causative variants. We identified 32 potentially causative pathogenic variants across 30 different genes in 44/144 (30%) of these Saudi epilepsy individuals. We also identified 232 variants of unknown significance (VUS) across 101 different genes in 133/144 (92%) subjects. Strong enrichment of variants of likely pathogenicity was observed in previously described epilepsy-associated loci, and a number of putative pathogenic variants in novel loci are also observed. CONCLUSION: Several putative pathogenic variants in known epilepsy-related loci were identified for the first time in our population, in addition to several potential new loci which may be prioritized for further investigation.


Assuntos
Epilepsia , Exoma , Humanos , Arábia Saudita/epidemiologia , Exoma/genética , Epilepsia/epidemiologia , Epilepsia/genética , Epilepsia/diagnóstico , Linhagem , Predisposição Genética para Doença
9.
PLoS One ; 17(12): e0278908, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36490273

RESUMO

BACKGROUND: Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients. OBJECTIVE: This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021. METHODS: A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05. RESULTS: Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment. CONCLUSIONS: Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.


Assuntos
Traumatismos Craniocerebrais , Epilepsia , Humanos , Estudos Transversais , Etiópia/epidemiologia , Hospitais , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Cognição
10.
PLoS One ; 17(12): e0278907, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36520790

RESUMO

OBJECTIVE: This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa. METHODS: The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates. RESULTS: After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23-31) and 34% in clinical settings (95% CI, 30-39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression. CONCLUSION: Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.


Assuntos
Epilepsias Parciais , Epilepsia , Humanos , Feminino , Masculino , Depressão/complicações , Depressão/epidemiologia , Qualidade de Vida , Epilepsia/complicações , Epilepsia/epidemiologia , Convulsões/complicações
11.
J Stroke Cerebrovasc Dis ; 31(12): 106858, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36343476

RESUMO

OBJECTIVES: Ischemic stroke is one of the most common causes of epilepsy in adults. The incidence of post-stroke epilepsy (PSE) is approximately 7%. Risk factors are higher stroke severity, cortical localization, higher National Institute of Health Stroke Scale (NIHSS) upon admission and acute symptomatic seizures. We analyzed the predictive factors of PSE development in our population. MATERIALS AND METHODS: Retrospective observational cohort of adult patients (age ≥ 18 years) with ischemic stroke assessed between January 2012 and June 2020. Patients with personal history of epilepsy and potentially epileptogenic structural injury other than acute or chronic stroke were excluded. Demographic, clinical and imaging variables were evaluated in a multivariate analysis for independent risk factors associated with PSE. RESULTS: Medical records of 1586 stroke patients were reviewed, 691 met the inclusion criteria and had at least one year of follow-up. Of them, 428 (61.9%) were males. During follow-up, 6.2% had diagnosis of PSE (42/691) with a higher frequency of: previous ischemic stroke, higher NIHSS upon admission, treatment with rt-PA, higher Fazekas scale grade, cortical involvement, hemorrhagic transformation, acute symptomatic seizures, longer hospitalization and higher modified Rankin Scale (mRS) at discharge compared to the group without PSE. In a multivariate analysis, acute symptomatic seizures (OR=3.22, p: 0.033), cortical involvement (OR=0.274, p < 0.05), Fazekas scale score (OR=0.519, p < 0.05) and mRS at discharge (OR=1.33, p: 0.043) were independent risk factors. CONCLUSIONS: The variables related to higher risk of PSE were similar to those reported in the literature, highlighting the importance of neuroimaging findings, acute symptomatic seizures during hospitalization and neurological deficit at discharge. The data obtained will serve as the basis for construction of predictive models, allowing to individualize PSE probability in our population.


Assuntos
Epilepsia , AVC Isquêmico , Acidente Vascular Cerebral , Masculino , Humanos , Adolescente , Feminino , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/etiologia , Convulsões/diagnóstico , Convulsões/epidemiologia , Convulsões/etiologia , Fatores de Risco
12.
Epilepsy Behav ; 137(Pt A): 108965, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36343531

RESUMO

Psychiatric disorders are frequent among people with epilepsy but often under-recognized. The diagnosis and treatment of these disorders in low- and low-middle-income countries (LMICs) are challenging. METHODS: This cross-sectional survey included people recruited during a community epilepsy screening program involving 59,509 individuals from poor communities in Ludhiana in Northwest India. Adults (age ≥18 years) with confirmed epilepsy on antiseizure medications were screened for depression and anxiety using the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) twice over two years of follow-up. They were later interviewed for symptoms using the Brief Psychiatric Rating Scale, which was then confirmed by assessments by an experienced psychiatrist. RESULTS: Of the 240 people with confirmed epilepsy, 167 (70%) were adults, of whom, 116 (70%) eventually participated in the study. The NDDI-E with a cut-off of 15 identified depression in 14 (12%) of 116 people after one year of follow-up and 17 (15%) at two years. The GAD-7 using a cut-off of 6 identified 22 (19%) at one year and 32 (28%) with anxiety at two years. The area under the curves for NDDI-E was estimated as 0.62 (95%CI, 0.51-0.73; SE: 0.06; p = 0.04) and for GAD-7 as 0.62 (95%CI, 0.46-0.78; SE: 0.08; p = 0.12). Brief Psychiatric Rating Scale identified 63 (54%) people with psychiatric symptoms, for whom, a psychiatric diagnosis was confirmed in 60 (52%). A psychiatric diagnosis was associated with education below high school [Odds Ratio (OR): 2.59, 95%CI, 1.12-5.1; p = 0.03], later age of seizure onset (OR, 1.05, 95%CI: 1.0-1.10; p = 0.04), seizure frequency of at least one/year at enrolment (OR, 2.36, 95%CI: 1.0-5.58; p = 0.05) and the use of clobazam (OR, 5.09, 95%CI, 1.40-18.42; p = 0.01). CONCLUSION: Depression and anxiety are common in people with epilepsy. Our findings underscore the low yields of screening instruments, NDDI-E and GAD-7, and comparatively better professionally-administered diagnostic assessments in resource-limited settings in LMICs. Moreover, previously established cut-offs do not apply to the community studied.


Assuntos
Epilepsia , Adulto , Humanos , Adolescente , Escalas de Graduação Psiquiátrica , Estudos Transversais , Epilepsia/complicações , Epilepsia/epidemiologia , Epilepsia/tratamento farmacológico , Transtornos de Ansiedade/diagnóstico , Convulsões/complicações , Depressão/epidemiologia , Depressão/diagnóstico , Reprodutibilidade dos Testes
13.
Epilepsy Res ; 188: 107038, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332544

RESUMO

Epilepsy is a disease where disparities and inequities in risk and outcomes are complex and multifactorial. While most epilepsy research to date has identified several key areas of disparities, we set out to provide a multilevel life course model of epilepsy development, diagnosis, treatment, and outcomes to highlight how these disparities represent true inequities. Our piece also presents three hypothetical cases that highlight how the solutions to address inequities may vary across the lifespan. We then identify four key domains (structural, socio-cultural, health care, and physiological) that contribute to the persistence of inequities in epilepsy risk and outcomes in the United States. Each of these domains, and their core components in the context of epilepsy, are reviewed and discussed. Further, we highlight the connection between domains and key areas of intervention to strive towards health equity. The goal of this work is to highlight these domains while also providing epilepsy researchers and clinicians with broader context of how their work fits into health equity.


Assuntos
Epilepsia , Equidade em Saúde , Humanos , Estados Unidos , Epilepsia/epidemiologia , Epilepsia/terapia , Disparidades em Assistência à Saúde
14.
Iran J Med Sci ; 47(6): 588-593, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36380979

RESUMO

Background: Previous studies have shown that patients with epilepsy (PWE) perceived significant disruption in the quality and provision of care due to the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to investigate the effect of this pandemic on seizure control status and changes in seizure frequency in PWE. Methods: A consecutive sample of adult PWE registered in the database of Shiraz Epilepsy Center (Shiraz, Iran) was included in the study. In July 2021, phone interviews were conducted with all selected patients. Information such as age, sex, last seizure, seizure type, and frequency during the 12 months before the study, and history of COVID-19 contraction was extracted. The seizure control status of the patients in 2019 (pre-pandemic) was compared with that during the COVID-19 pandemic. Data were analyzed using SPSS software with the Fisher's exact test and Pearson's Chi squared test. P<0.05 was considered statistically significant. Results: A total of 158 patients were included in the study, out of which 62 (39.2%) patients had a stable seizure control status, 47 (29.7%) had fewer seizures, and 50 (31.6%) had more seizures. Breakthrough seizures were reported by 32 (34.4%) patients. Seizure frequency increased in 18 (27.7%) and decreased in 46 (70.7%) patients. Conclusion: Overall, the COVID-19 pandemic has not been a major precipitating factor nor has it affected the seizure control status of PWE. In treated epilepsy, a fluctuating course with periods of seizure freedom followed by relapses is part of its natural history.


Assuntos
COVID-19 , Epilepsia , Adulto , Humanos , Lactente , Pandemias , COVID-19/epidemiologia , Convulsões/epidemiologia , Epilepsia/complicações , Epilepsia/epidemiologia , Recidiva
15.
J Neuroimmunol ; 373: 577999, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36395637

RESUMO

BACKGROUND: Anti-IgLON5 is a rare neurologic disease that can present with epileptic seizures. However, epileptic seizures have not been characterized and are underreported. We aimed to investigate the clinical characteristics and demographics of epileptic seizures in patients with anti-IgLON5 disease. METHODS: We reported a case of anti-IgLON5 disease presenting with epileptic seizures and presented a comprehensive literature review on epileptic seizures in patients with the anti-IgLON5 disease. We searched the Medline, Pubmed, and Web of Science databases using the following search algorithm: "IgLON5" or "anti-IgLON5" or "IgLON5 antibody" limited to publications in English. RESULTS: We identified 183 cases from 66 publications. In addition to our case, nine (4.9%) patients with anti-IgLON5 disease had reported epileptic seizures, either focal or generalized. Of those, epileptic seizures were one of the main reasons for neurology consultation in six (3.2%). Patients with epileptic seizures affected both sexes similarly and usually developed in middle age. In addition to epileptic seizures, a majority of patients had sleep disorders and cognitive impairment. The frequency of epileptic seizures was reduced with the treatment of immunotherapy and antiseizure medication. CONCLUSION: Anti-IgLON5 disease can present with epileptic seizures, and our study expands the clinical spectrum of the anti-IgLON5 disease.


Assuntos
Encefalite , Epilepsia , Doença de Hashimoto , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Convulsões , Moléculas de Adesão Celular Neuronais
16.
BMC Infect Dis ; 22(1): 851, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376817

RESUMO

BACKGROUND: Taenia solium cysticercosis is a zoonotic disease that is endemic in many low- and middle-income countries where risk factors for disease transmission are present. The economic impact of cysticercosis on public health and on the pig production sector is not well known in many of those countries, including Burundi. This study aimed at estimating the burden of T. solium cysticercosis in Burundi including data on humans and pigs. METHODS: Epidemiological and economic data were collected from literature up to July 30, 2021 and governmental and non-governmental agencies. Direct and indirect costs for neurocysticercosis (NCC)-associated epilepsy and losses due to porcine cysticercosis were estimated to assess the economic burden, while the health burden was estimated using zoonotic disability-adjusted life years (zDALYs). Different probability distributions (Uniform, Beta, Dirichlet and Gamma) were applied depending on the type of epidemiological parameter. Monte Carlo simulations and 100,000 iterations were used to calculate the 95% uncertainty interval (UI) for each parameter and perform sensitivity analyses. RESULTS: In Burundi, 4.26 million USD (95% UI, 1,858,308-8,190,951) were estimated as economic impact due to T. solium cysticercosis in humans and pigs, of which 40.2% (95% UI, 10.3-75.1) of the total costs were due to NCC-associated epilepsy and 59.8% (95% UI, 24.9-89.7) of the losses due to porcine cysticercosis. The cost per NCC-associated epilepsy case was 72 USD (95% UI, 25-168), representing 30.8% of the GDP per capita in 2020. The probable incident cases and deaths for NCC-associated epilepsy were 9065 (95% UI, 2370-16,716) and 61 (95% UI, 16-114), respectively. More than 2 zDALYs (95% UI, 1.1-3.4) per thousand person-years was estimated, of which an average of 1.3 DALYs [0;0] (95% UI, 0.3-2.6) was due to NCC- associated epilepsy and 0.8 animal loss equivalents (ALEs) (95% UI, 0.3-1.5) due to porcine cysticercosis. CONCLUSIONS: This study provides evidence of a significant burden of T. solium cysticercosis for Burundi's population. We urge policy makers to use these evidence-based results and put T. solium cysticercosis on the public health agenda of the country. This study recommends urgent action to find solutions for integrated control strategies for T. solium cysticercosis in Burundi.


Assuntos
Cisticercose , Epilepsia , Neurocisticercose , Doenças dos Suínos , Taenia solium , Humanos , Suínos , Animais , Burundi/epidemiologia , Doenças dos Suínos/epidemiologia , Prevalência , Cisticercose/epidemiologia , Cisticercose/veterinária , Neurocisticercose/epidemiologia , Epilepsia/epidemiologia
17.
PLoS Negl Trop Dis ; 16(11): e0010870, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36342903

RESUMO

BACKGROUND: Neurocysticercosis (NCC), a zoonotic disease caused by the pork tapeworm T. solium, represents one of the most common causes of secondary epilepsy but remains often undiagnosed due to lack of awareness and diagnostic facilities. METHODOLOGY: We pooled data from four cross-sectional studies on epilepsy and NCC in eastern Africa. Study sites were in Uganda, Malawi and in Tanzania (Dar es Salaam and Haydom). The study in Uganda and Malawi were community-based, the two studies in Tanzania were hospital-based. The same questionnaire was used for assessment of clinical characteristics of patients with epilepsy. Computed tomography (CT) scans and serological testing were performed in order to diagnose NCC. RESULTS: Overall, 1,179 people with epilepsy were included in our analysis. Of those, 941 PWE underwent CT scanning and were pooled for NCC analysis. Seventy patients were diagnosed with NCC, but NCC prevalence differed considerably between sites ranging from 2.0% (95%CI 0.4% to 3.6%) in Dar es Salaam to 17.5% (95%CI 12.4% to 22.6%) in Haydom. NCC prevalence did not show any association with sex but increased with age and was higher in rural than urban settings. In addition, being a farmer, non-Muslim, eating pork and living with pigs close by was associated with a higher NCC prevalence. PWE with NCC experienced their first epileptic seizure around 3 years later in life compared to PWE without NCC and their epileptic seizures seemed to be better controlled (p<0.001). There was no difference between focal onset seizures and focal signs on neurological examination in both groups (p = 0.49 and p = 0.92, respectively). The rT24H-EITB had a sensitivity for the detection of NCC of 70% (95% confidence interval [CI] 51 to 84%), the LLGP of 76% (95%CI 58 to 89%) and the antigen ELISA of 36% (95% CI 20 to 55%). CONCLUSIONS: NCC is prevalent among PWE in eastern Africa, although it may not be as common as previously stated. Demographic characteristics of PWE with NCC differed from those without NCC, but semiological characteristics and results on neurological examination did not differ compared to PWE without NCC. Interestingly, seizures seemed to be less frequent in PWE with NCC. Being aware of those differences and similarities may help triaging PWE for neuroimaging in order to establish a diagnosis of NCC.


Assuntos
Epilepsia , Neurocisticercose , Taenia solium , Animais , Suínos , Neurocisticercose/complicações , Neurocisticercose/diagnóstico , Neurocisticercose/epidemiologia , Estudos Transversais , Tanzânia/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Epilepsia/etiologia , Convulsões/epidemiologia
18.
Prim Health Care Res Dev ; 23: e70, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36367324

RESUMO

BACKGROUND: Epilepsy is a common neurological condition. It affects around 1% of the global population. This study aims to evaluate the knowledge and attitudes toward epilepsy. METHODS: This is a cross-sectional observational study. An online questionnaire was distributed to medical students in their clinical and preclinical years and interns at Riyadh's four public universities. Then a comparison was made to see whether attending more courses in medical school would influence the students' knowledge and attitudes. RESULTS: In the present study, 95% of medical students had heard about epilepsy or convulsive seizures (a significantly larger proportion of clinical students had heard about epilepsy than preclinical students (99.0% versus 92%, P-value = 0.000)). Furthermore, 34.0% believed that epilepsy could be treated. Moreover, 79.1% of those polled claimed that brain disease originated from epilepsy, followed by genetic factors (64.1%) and convulsions (92.3%) as the most common symptoms. CONCLUSION: Regarding medical students' awareness of epilepsy, it turns out that it is good and better than reported in other research, especially among clinical students rather than preclinical students, who have a negative attitude toward epileptic patients. Consequently, there is a need to further development of their knowledge throughout future campaigns and conferences, and curricula that should be tailored to help improve awareness and attitudes toward epilepsy.


Assuntos
Epilepsia , Estudantes de Medicina , Humanos , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Arábia Saudita/epidemiologia , Epilepsia/diagnóstico , Epilepsia/epidemiologia , Inquéritos e Questionários
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