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1.
No Shinkei Geka ; 51(1): 137-144, 2023 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-36682759

RESUMO

Neuromodulation therapy for epilepsy is the third treatment option after medical treatment with antiepileptic drugs and surgical treatment, such as epileptic focal resection. In addition to vagus nerve stimulation(VNS), deep brain stimulation(DBS)and responsive neurostimulation(RNS)have been approved in several countries. These therapies consist of an implantable device and stimulating electrodes. These therapies have great potential to reduce seizure frequency and severity, improve patients' quality of life, and maintain therapeutic efficacy. When VNS was first introduced, electrical stimulation was set at regular intervals. However, current devices have introduced closed-loop therapy, in which stimulation is performed by detecting seizures. Multi-mode stimulation settings have also been introduced in VNS to adjust patient's seizure characteristics based on the time of the day when seizures are most likely to occur. This review describes the third therapeutic approach for the treatment of epilepsy based on recent research reports.


Assuntos
Estimulação Encefálica Profunda , Epilepsia , Estimulação do Nervo Vago , Humanos , Qualidade de Vida , Epilepsia/terapia , Convulsões , Estimulação Elétrica , Resultado do Tratamento
2.
No Shinkei Geka ; 51(1): 156-165, 2023 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-36682761

RESUMO

Apart from epilepsy specialists, neurosurgeons should also play an important role for epilepsy treatment in the Japanese healthcare structure. This review focuses on lifestyle guidance and counselling methods for general neurosurgeons to reduce risks of seizures in epilepsy patients, and to maximize patient independence. Reduction of seizure precipitants such as sleep deprivation, emotional stress, fatigue, and alcohol is key to epilepsy practice with appropriate anti-seizure medication. The modular service package epilepsy(MOSES)program may prove useful for patients by increasing awareness of their own seizure precipitants and empower them to manage their individual risks. This article also addresses the topics of practical guidance for counselling in(1)school life;(2)sports and physical activities;(3)pregnancy; and(4)eating habits. Multidimensional collaborations should be recommended to reduce the burden of hectic neurosurgeons.


Assuntos
Epilepsia , Estresse Psicológico , Humanos , Epilepsia/terapia , Estilo de Vida , Aconselhamento , Privação do Sono
3.
BMJ Open ; 13(1): e066872, 2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36720580

RESUMO

OBJECTIVES: Epilepsy treatment decision making is complex and understanding what informs caregiver decision making about treatment for childhood epilepsy is crucial to better support caregivers and their children. We synthesised evidence on caregivers' perspectives and experiences of treatments for childhood epilepsy. DESIGN: Systematic review of qualitative studies using a best-fit framework and Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. DATA SOURCES: Searched Embase, PubMed, CINAHL, PsycINFO, SocINDEX and Web of Science from 1 January 1999 to 19 August 2021. ELIGIBILITY CRITERIA: We included qualitative studies examining caregiver's perspectives on antiseizure medication, diet or surgical treatments for childhood epilepsy. We excluded studies not reported in English. DATA EXTRACTION AND SYNTHESIS: We extracted qualitative evidence into 1 of 14 domains defined by the Theoretical Domains Framework (TDF). One reviewer extracted study data and methodological characteristics, and two reviewers extracted qualitative findings. The team verified all extractions. We identified themes within TDF domains and synthesised summary statements of these themes. We assessed our confidence in our summary statements using GRADE-CERQual. RESULTS: We identified five studies (in six reports) of good methodological quality focused on parent perceptions of neurosurgery; we found limited indirect evidence on parents' perceptions of medications or diet. We identified themes within 6 of the 14 TDF domains relevant to treatment decisions: knowledge, emotion; social/professional role and identity; social influence; beliefs about consequences; and environmental context and resources. CONCLUSIONS: Parents of children with epilepsy navigate a complex process to decide whether to have their child undergo surgery. Educational resources, peer support and patient navigators may help support parents through this process. More qualitative studies are needed on non-surgical treatments for epilepsy and among caregivers from different cultural and socioeconomic backgrounds to fully understand the diversity of perspectives that informs treatment decision making.


Assuntos
Emoções , Epilepsia , Criança , Humanos , Epilepsia/terapia , Conhecimento , Pais , Tomada de Decisões
4.
BMC Oral Health ; 23(1): 51, 2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36717821

RESUMO

BACKGROUND: Epilepsy is a chronic neurological disease that could indirectly affect oral health, and it is necessary for dentists to be familiar with the specific needs of patients with epilepsy. Therefore, aim of the present study was to assess the factors associated with the level of knowledge about management of epileptic patients in Peruvian dental students. METHODS: This analytical, observational, cross-sectional and prospective study assessed 312 dental students from a Peruvian university during February to April 2022. A validated questionnaire of 20 closed multiple-choice questions was used to measure the level of knowledge about dental management in epileptic patients. A logit model was used to assess the influence of variables: gender, age, year of study, marital status, place of origin and area of residence, with the level of knowledge in dental students considering a significance level of p < 0.05. RESULTS: Of the total, 28.8%, 36.2% and 34.9% had a poor, fair and good level of knowledge, respectively, about the dental treatment of epileptic patients. On the other hand, it was observed that being a woman (OR = 0.44, CI 0.26-0.75) and being a third year student (OR = 0.39, CI 0.21-0.74) and fourth year student (OR = 0.43, CI 0.23-0.89) constituted a protective factor against poor knowledge about the dental management of epileptic patients, while being from the capital city constituted a risk factor. Finally, age, marital status and the students' area of residence were not considered influential factors (p > 0.05). CONCLUSION: Most of the students showed a poor and fair level of knowledge about the dental management of epileptic patients, with gender, academic year and place of origin being influential factors. It is advisable that authorities and teachers in the dental profession organize recurrent training programs on the care of patients with chronic diseases requiring special attention, since knowing general concepts, pharmacological management and dental care of epileptic patients will allow future dentists to develop competencies to improve and implement good quality care protocols for this group of patients.


Assuntos
Epilepsia , Estudantes de Odontologia , Feminino , Humanos , Estudos Transversais , Epilepsia/terapia , Peru , Estudos Prospectivos , Fatores Sociodemográficos , Inquéritos e Questionários , Conhecimentos, Atitudes e Prática em Saúde
5.
Rev. flum. odontol ; 1(60): 15-22, jan.-abr. 2023.
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1411181

RESUMO

A epilepsia configura-se como sendo uma patologia crónica oriunda de manifestação elétrica cerebral de caráter anormal, que ocasiona repercussões neurológicas. O tratamento da epilepsia emprega a administração medicamentosa e também pode utilizar o recurso da dieta cetogénica. Sabe-se que o recurso da utilização da dieta cetogênica para enfrentamento da epilepsia promove repercussões a nível da saúde bucal dos enfermos em tratamento. O objetivo deste artigo foi evidenciar como o emprego da dieta cetogênica na terapia utilizada para enfrentamento da epilepsia pode influenciar na saúde bucal dos indivíduos em tratamento. O tratamento medicamentoso da epilepsia emprega anticonvulsivantes e muitas vezes requer o uso de mais de um medicamento para tratamento, o que pode acarretar efeitos adversos a nível sistêmico e oral. Merecem atenção e cuidados odontológicos comumente o tratamento com fármacos por intermédio da administração da fenitoína, geralmente utilizada para tratamento da epilepsia, que pode trazer repercussões odontológicas e alterações periodontais, como a hiperplasia gengival. O conhecimento e a conscientização por parte dos cirurgiões dentistas acerca dos cuidados odontológicos que devem ser adotados para esses pacientes especiais portadores de epilepsia são de suma importância para realização de uma abordagem odontológica. Concluiu-se que as repercussões bucais oriundas da epilepsia devem ser identificadas e tratadas imediatamente, ao passo que o cirurgião dentista contata os pacientes enfermos, uma vez que caso contrário pode-se conviver com agravantes e piora no quadro odontológico apresentado, portanto deve-se primar por impedir a evolução desfavorável do estado de saúde bucal dos pacientes.


Epilepsy is a chronic pathology arising from an abnormal electrical brain manifestation, which causes neurological repercussions. The treatment of epilepsy employs drug administration and can also use the ketogenic diet. It is known that the use of the ketogenic diet to cope with epilepsy promotes repercussions in terms of the oral health of patients undergoing treatment. The objective of this article was to show how the use of the ketogenic diet in the therapy used to cope with epilepsy can influence the oral health of individuals undergoing treatment. Drug treatment of epilepsy uses anticonvulsants and often requires the use of more than one drug for treatment, which can lead to adverse systemic and oral effects. Treatment with drugs through the administration of phenytoin, generally used for the treatment of epilepsy, which can bring dental repercussions and periodontal changes, such as gingival hyperplasia, deserves attention and dental care. Knowledge and awareness on the part of dental surgeons about the dental care that should be adopted for these special patients with epilepsy are of paramount importance for carrying out a dental approach. It was concluded that the oral repercussions arising from epilepsy should be identified and treated immediately, while the dental surgeon contacts sick patients, since otherwise one can live with aggravating factors and worsening of the dental condition presented, therefore, one should excel in preventing the unfavorable evolution of the patients' oral health status.


Assuntos
Saúde Bucal , Odontologia , Epilepsia/terapia , Dieta Cetogênica
6.
Epilepsy Res ; 189: 107068, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36549242

RESUMO

Collaboration is essential to the conduct of basic, applied and clinical research and its translation into the technologies and treatments urgently needed to improve the lives of people living with brain diseases and the health professionals who care for them. EPICLUSTER was formed in 2019 by the European Brain Research Area (EBRA) to support the coordination of epilepsy research in Europe. A key objective was to provide a platform to discuss shared research priorities by bringing together scientists and clinicians with multiple stakeholders including patient organisations and industry and the networks and infrastructures that provide healthcare and support research. Additional objectives were to facilitate access and sharing of data and biosamples, working together to ensure epilepsy is a priority for research funding, and embedding a culture of public and patient involvement (PPI) among epilepsy researchers. In this meeting report, we summarise the shared research priorities discussed by the leadership of EPICLUSTER at the recent final meeting. We also briefly review the discussion on patient and industry priorities, guidance on starting PPI for epilepsy researchers, and the sustainability of funding and infrastructures needed to ensure a comprehensive stakeholder-embedded community for epilepsy research.


Assuntos
Encefalopatias , Epilepsia , Médicos , Humanos , Epilepsia/terapia , Europa (Continente) , Encéfalo
7.
Lancet Neurol ; 22(1): 15-17, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36517157
8.
Int J Neural Syst ; 33(2): 2350008, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36495050

RESUMO

To enable an accurate recognition of neuronal excitability in an epileptic brain for modeling or localization of epileptic zone, here the brain response to single-pulse electrical stimulation (SPES) has been decomposed into its constituent components using adaptive singular spectrum analysis (SSA). Given the response at neuronal level, these components are expected to be the inhibitory and excitatory components. The prime objective is to thoroughly investigate the nature of delayed responses (elicited between 100[Formula: see text]ms-1 s after SPES) for localization of the epileptic zone. SSA is a powerful subspace signal analysis method for separation of single channel signals into their constituent uncorrelated components. The consistency in the results for both early and delayed brain responses verifies the usability of the approach.


Assuntos
Eletroencefalografia , Epilepsia , Humanos , Eletroencefalografia/métodos , Epilepsia/terapia , Encéfalo , Mapeamento Encefálico/métodos , Estimulação Elétrica/métodos
9.
Epilepsy Behav ; 138: 109001, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36495799

RESUMO

RATIONALE: Project UPLIFT is an evidence-based epilepsy self-management program shown to prevent and treat depression through an 8-session, group telehealth intervention. Since 2012, the program has been disseminated by training community-based providers to deliver UPLIFT to people with epilepsy (PWE). Limited research has described the adoption, implementation, and practice-based maintenance of self-management programs like UPLIFT. We sought to gain a better understanding of this process from trained program adopters. METHODS: A cross-sectional evaluation of adoption and implementation experiences was conducted. An online survey with closed- and open-ended questions was distributed to 120 UPLIFT program adopters to collect information about reasons for being trained and experiences implementing the program. Survey items were developed based on the RE-AIM model to assess program reach, effectiveness, adoption, implementation, and maintenance. For closed-ended responses, frequencies and cross-tabs were calculated. Open-ended responses were reviewed and grouped by theme. RESULTS: 41 respondents completed the survey (34% response rate). Respondents were from a variety of organizations including clinical (39%, n = 16), educational/research (17%, n = 7), and Epilepsy Foundation affiliates/chapters (12%, n = 5), among others. The most frequently endorsed reason for training in UPLIFT was an interest in supporting PWE (73%, n = 30). Most respondents rated delivering UPLIFT as very important (49%, n = 20) or important (32%, n = 13) to the organization. Sixty-one percent (n = 25) of respondents reported implementing (implementors) UPLIFT. Of those who had not yet implemented UPLIFT, 50% (n = 8) planned on implementing it at some point. Among program implementors, the most frequently reported implementation facilitators included participant interest (68%, n = 17), training (68%, n = 17), and organizational support (64%, n = 16). Program implementors indicated having program champions (80%, n = 20). The most frequently reported implementation challenge reported was recruitment (72%, n = 18). In open-ended responses, funding was a key theme that would facilitate continued implementation, but 48% (n = 12) responded that did not have access to resources and/or funding to help continue offering UPLIFT. Developing partnerships was recommended to improve the reach and maintenance of the program. Despite challenges, implementors agreed (44%, n = 11) or strongly agreed (36%, n = 9) that UPLIFT was effective in addressing mental health problems among program participants, and 76% (n = 19) plan on continuing to offer UPLIFT. CONCLUSION: Implementation surveys increase understanding of program adoption and impact for dissemination trainees. Implementation benefits from program champions, strong partnerships, and sustained funding. Continued refinement of implementation support, such as developing a sustained referral system, maintaining relationships with trainees, supporting evaluation activities, and exploring opportunities for program updates to further enhance adoption, implementation, and maintenance.


Assuntos
Epilepsia , Autogestão , Telemedicina , Humanos , Estudos Transversais , Epilepsia/terapia , Inquéritos e Questionários , Avaliação de Programas e Projetos de Saúde
10.
Epilepsy Behav ; 138: 109056, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36571868

RESUMO

BACKGROUND: Cognitive behavioral therapy (CBT) is the recommended treatment for depression in patients with epilepsy (PWE). However, there are no studies that calculate the effect size of CBT on depression and quality of life (QoL) in PWE. METHODS: We searched seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, Ovid Medline, and PsycINFO). We included 13 studies examining CBT for depression in PWE and calculated its effect size. RESULTS: A total of 13 studies met the criteria. After treatment, CBT improves depression in PWE (g = 0.36, 95%CI: 0.18 to 0.54, I2 = 50%), and the efficacy maintains during follow-up (g = 0.47, 95%CI: 0.04 to 0.89, I2 = 80%). Subgroup analysis has shown that individual CBT (g = 0.47, 95%CI: 0.20 to 0.73, I2 = 0%) had a greater effect size than group CBT (g = 0.30, 95%CI: 0.07 to 0.53, I2 = 62%) in the treatment of depression. Likewise, CBT has a positive effect on the QoL improvement of PWE (g = 0.34, 95%CI: 0.11 to 0.57, I2 = 64%). In controlling seizures, CBT did not differ from the control group (g = -0.06, 95%CI: -0.32 to 0.19, I2 = 0%). CONCLUSIONS: Cognitive behavioral therapy interventions were effective in improving depression and QoL in PWE, but not effective in controlling seizures. The efficacy of CBT interventions targeting seizure control seems to be uncertain.


Assuntos
Terapia Cognitivo-Comportamental , Epilepsia , Humanos , Depressão/etiologia , Depressão/terapia , Qualidade de Vida , Epilepsia/complicações , Epilepsia/terapia , Convulsões
11.
J Pediatr Adolesc Gynecol ; 35(1): 39-47.e1, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34547472

RESUMO

STUDY OBJECTIVE: To evaluate knowledge, attitudes, and practices about sexual and reproductive health (SRH) for adolescent and young adult (AYA) women with epilepsy among general pediatricians, adolescent medicine specialists, and pediatric gynecologists. DESIGN: Survey comprising previously validated and novel items that underwent content validity testing and was distributed through specialty listservs. Categorical variables analyzed with χ2 or Fisher exact tests, and continuous variables with Kruskal-Wallis tests. SETTING: Online. PARTICIPANTS: Physicians and Advanced practice providers. INTERVENTIONS: Online survey. MAIN OUTCOME MEASURE(S): Questions testing SRH knowledge, assessing confidence in SRH counseling practices and frequency of intended SRH counseling, and identifying barriers and facilitators to SRH provision for AYA women with epilepsy. RESULTS: Of 329 participants, 57% were general pediatricians, 27% were adolescent medicine specialists, and 16% were pediatric gynecologists. On 15 items assessing knowledge, general pediatricians scored significantly lower than respondents in the other specialties (P < .01). Among 11 items about confidence in SRH skills, general pediatricians were significantly less confident than respondents in the other specialties (P < .01). General pediatricians reported that they would perform annual counseling less often on 7 SRH counseling topics compared with respondents in the other specialties (P < .01). In all, 54% of the respondents reported that barriers to SRH provision include limited time during visits and lack of epilepsy knowledge. Respondents identified facilitators including guidelines/algorithms for managing SRH (83%), provider education (61%), and electronic health record alerts (60%). CONCLUSION: Responses suggest suboptimal knowledge, confidence, and care provision regarding SRH for AYA women with epilepsy, particularly among general pediatricians. Identified barriers and facilitators may serve as targets for interventions to improve SRH provision.


Assuntos
Epilepsia , Pessoal de Saúde , Adolescente , Criança , Atenção à Saúde , Epilepsia/terapia , Feminino , Humanos , Saúde Reprodutiva , Inquéritos e Questionários , Adulto Jovem
12.
Sci Adv ; 8(48): eadd2577, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36459557

RESUMO

Hyperphosphorylated microtubule-associated protein tau has been implicated in dementia, epilepsy, and other neurological disorders. In contrast, site-specific phosphorylation of tau at threonine 205 (T205) by the kinase p38γ was shown to disengage tau from toxic pathways, serving a neuroprotective function in Alzheimer's disease. Using a viral-mediated gene delivery approach in different mouse models of epilepsy, we show that p38γ activity-enhancing treatment reduces seizure susceptibility, restores neuronal firing patterns, reduces behavioral deficits, and ameliorates epilepsy-induced deaths. Furthermore, we show that p38γ-mediated phosphorylation of tau at T205 is essential for this protection in epilepsy, as a lack of this critical interaction reinstates pathological features and accelerates epilepsy in vivo. Hence, our work provides a scope to harness p38γ as a future therapy applicable to acute neurological conditions.


Assuntos
Doença de Alzheimer , Epilepsia , Animais , Camundongos , Epilepsia/genética , Epilepsia/terapia , Convulsões/genética , Convulsões/terapia , Fosforilação , Doença de Alzheimer/genética , Doença de Alzheimer/terapia , Modelos Animais de Doenças
13.
FP Essent ; 523: 15-19, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36459664

RESUMO

Epilepsy is the most common neurologic condition in children and is characterized by recurrent unprovoked seizures. Epilepsy can be diagnosed after a first unprovoked seizure if characteristic clinical and electroencephalographic features suggest a high risk of future seizures. Epilepsy is classified based on seizure type, underlying causes, and potential electroclinical syndromes. This classification guides management and predicts its effectiveness. Some epilepsy syndromes resolve spontaneously (ie, are self-limited) or improve with management (ie, are pharmacoresponsive). Syndromes that contribute to intellectual disability, referred to as developmental and epileptic encephalopathies, are not self-limited, are unlikely to improve with management (ie, are pharmacoresistant), and are associated with poor long-term outcomes. Antiseizure drugs are the mainstay of epilepsy management. Some broad-spectrum drugs are used to manage multiple seizure types, and others have indications for specific seizure types or epilepsy syndromes. Dietary therapy, surgical resection, and neuromodulation may be options if drugs do not control seizures. Neurodevelopmental and mental conditions are common in children with epilepsy. These include intellectual disability, learning disabilities, autism spectrum disorder, attention-deficit/hyperactivity disorder, depression, and anxiety. Patients with epilepsy should undergo screening for these associated conditions as part of routine care. Physicians should instruct caregivers and family members on how to manage seizures, including use of rescue drugs.


Assuntos
Transtorno do Espectro Autista , Epilepsia , Síndromes Epilépticas , Deficiência Intelectual , Criança , Humanos , Epilepsia/diagnóstico , Epilepsia/terapia , Convulsões
15.
Rev Neurol ; 75(12): 369-376, 2022 12 16.
Artigo em Espanhol | MEDLINE | ID: mdl-36514203

RESUMO

INTRODUCTION: Using microelectrodes for recording purposes in deep brain stimulation (DBS) has proven to be very useful. Their efficiency can be improved by characterising the properties of extracellular action potentials (EAPs). PATIENTS AND METHODS: We analysed the records of nine patients who underwent surgery for epilepsy or aggressiveness under general anaesthesia. The properties of the EAPs of the centromedian, ventral intermediate, ventrocaudal and posteromedial hypothalamic nuclei of the thalamus have been determined. RESULTS: We have analysed 706 thalamic and 142 hypothalamic cells. The proportion of cell types was found to be specific to each cell nucleus. The most frequent cell type was P1P2N1 (59.5%), followed by N1P1N2 (23.1%). The first phase of the EAP is highly variable. The properties of the EAP phases of the same morphology differ greatly from one nucleus to another. CONCLUSIONS: We have shown that several deep brain nuclei have properties that are specific to the morphology of the EAPs. This will allow for improved localisation of these nuclei during DBS.


TITLE: Hacia una definición fisiológica positiva de los núcleos cerebrales profundos en humanos.Introducción. El registro con microelectrodos en la estimulación cerebral profunda (ECP) ha demostrado una gran utilidad. Es posible mejorar su eficiencia caracterizando las propiedades de los potenciales de acción extracelulares (PAE). Pacientes y métodos. Hemos analizado registros de nueve pacientes operados por epilepsia o agresividad bajo anestesia general. Se han determinado las propiedades de los PAE de los núcleos talámicos centromediano, ventral intermedio, ventrocaudal e hipotalámico posteromedial. Resultados. Hemos analizado 706 células talámicas y 142 hipotalámicas. La proporción de tipos celulares resultó específica de cada núcleo celular. El tipo celular más frecuente fue P1P2N1 (59,5%), seguido por N1P1N2 (23,1%). La primera fase del PAE es altamente variable. Las propiedades de las fases del PAE de la misma morfología difieren altamente entre núcleos. Conclusiones. Hemos demostrado que diversos núcleos cerebrales profundos tienen propiedades específicas de la morfología de los PAE. Esto permitirá una mejora en la localización de estos núcleos durante la ECP.


Assuntos
Estimulação Encefálica Profunda , Epilepsia , Humanos , Tálamo , Microeletrodos , Epilepsia/terapia , Potenciais de Ação
16.
Cells ; 11(24)2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36552892

RESUMO

Epilepsy is a life-threatening neurological disease that affects approximately 70 million people worldwide. Although the vast majority of patients may be successfully managed with currently used antiseizure medication (ASM), the search for alternative therapies is still necessary due to pharmacoresistance in about 30% of patients with epilepsy. Here, we review the effects of ASMs on stem cell treatment when they could be, as expected, co-administered. Indeed, it has been reported that ASMs produce significant effects on the differentiation and determination of stem cell fate. In addition, we discuss more recent findings on mesenchymal stem cells (MSCs) in pre-clinical and clinical investigations. In this regard, their ability to differentiate into various cell types, reach damaged tissues and produce and release biologically active molecules with immunomodulatory/anti-inflammatory and regenerative properties make them a high-potential therapeutic tool to address neuroinflammation in different neurological disorders, including epilepsy. Overall, the characteristics of MSCs to be genetically engineered, in order to replace dysfunctional elements with the aim of restoring normal tissue functioning, suggested that these cells could be good candidates for the treatment of epilepsy refractory to ASMs. Further research is required to understand the potential of stem cell treatment in epileptic patients and its interaction with ASMs.


Assuntos
Epilepsia , Células-Tronco Mesenquimais , Humanos , Epilepsia/terapia , Células-Tronco , Diferenciação Celular , Engenharia Genética
17.
Arch Pediatr ; 29(5S): 5S14-5S19, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36585066

RESUMO

Tuberous sclerosis (TSC) epilepsy includes infantile spasms and focal seizures before the age of 2 years, whereas focal seizures are predominant over 2 years and generalized seizures may occasionally be part of Lennox-Gastaut syndrome. The better and earlier the seizure control, the better the child's subsequent cognitive and behavioral prognosis. As for epilepsy of other causes, therapeutic options depend on the type of seizure/epilepsy, age and drug resistance, but there are significant specificities for TSC. (1) As first-line treatment, vigabatrin is unanimously recommended for infantile spasms and focal seizures before 2 years and is also widely used for seizures over 2 years, as are levetiracetam and carbamazepine. (2) If seizures persist (about 40% of children and adolescents), cannabidiol and everolimus, an inhibitor of the mTOR pathway, have recently been approved as adjunctive therapy to the arsenal of antiseizure medications authorized for this age group and to the ketogenic diet. (3) Surgery is an essential treatment option in cases of drug resistance and should be discussed as soon as two treatments have failed. Presurgical investigations and operating techniques have recently progressed spectacularly, for example laser thermocoagulation with stereotactic location. A particularity of TSC is the possibility of sequential interventions on several epileptogenic tubers. (4) Finally, the innovative principle of initiating "pre-seizure" treatment with vigabatrin from the first months of life has just proven effective on the subsequent development of epilepsy in TSC. © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.


Assuntos
Epilepsia , Espasmos Infantis , Adolescente , Criança , Humanos , Pré-Escolar , Vigabatrina/uso terapêutico , Espasmos Infantis/tratamento farmacológico , Epilepsia/terapia , Epilepsia/tratamento farmacológico , Convulsões/etiologia , Prognóstico , Anticonvulsivantes/uso terapêutico
18.
Proc Natl Acad Sci U S A ; 119(46): e2206828119, 2022 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-36343238

RESUMO

Focused ultrasound (FUS) is a powerful tool for noninvasive modulation of deep brain activity with promising therapeutic potential for refractory epilepsy; however, tools for examining FUS effects on specific cell types within the deep brain do not yet exist. Consequently, how cell types within heterogeneous networks can be modulated and whether parameters can be identified to bias these networks in the context of complex behaviors remains unknown. To address this, we developed a fiber Photometry Coupled focused Ultrasound System (PhoCUS) for simultaneously monitoring FUS effects on neural activity of subcortical genetically targeted cell types in freely behaving animals. We identified a parameter set that selectively increases activity of parvalbumin interneurons while suppressing excitatory neurons in the hippocampus. A net inhibitory effect localized to the hippocampus was further confirmed through whole brain metabolic imaging. Finally, these inhibitory selective parameters achieved significant spike suppression in the kainate model of chronic temporal lobe epilepsy, opening the door for future noninvasive therapies.


Assuntos
Epilepsia do Lobo Temporal , Epilepsia , Animais , Epilepsia/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Ultrassonografia , Hipocampo/diagnóstico por imagem
19.
Epilepsy Res ; 188: 107035, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332540

RESUMO

INTRODUCTION: Researchers have called for innovative tailored interventions to address specific challenges to physical activity (PA) engagement for young people with epilepsy (YPE). Working with YPE and their parents, this study aimed to identify barriers and facilitators to adoption and maintenance of PA among YPE prior to and during the COVID-19 pandemic. METHODS: Ten YPE (all female) and their 13 caregivers, and five additional caregivers to males (N = 18; 72% mothers), completed virtual focus group sessions prior to and during the COVID-19 pandemic. Trained Child Life specialists asked questions about barriers and facilitators of PA engagement experienced by YWE, which included a specific focus on the impact of epilepsy. RESULTS: Thematic analysis of the data identified both epilepsy-specific and generic themes that impact PA participation among YPE. These included: (i) epilepsy experience/impact and accommodation; (ii) safety precautions; (iii) concern about seizures; (iv) social connections and acceptance; (v) parent and family support; (vi) intrapersonal self-regulation and motivation; (vii) health benefits; and (viii) key factors in common with all youth. CONCLUSION: This study provides valuable insight into diverse social-ecological health factors that impact PA participation among YPE from two key stakeholder perspectives (YPE and their caregivers). By understanding these lived experiences, providers can better tailor individual support for YPE and their families to foster and maintain a healthy active lifestyle.


Assuntos
COVID-19 , Epilepsia , Adolescente , Criança , Masculino , Humanos , Feminino , Pandemias , Pais , Epilepsia/terapia , Grupos Focais
20.
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
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