Applicability of the International League Against Epilepsy (ILAE) 2022 diagnostic criteria for epilepsy syndromes in children: A retrospective review of 1550 children with epilepsy.

OBJECTIVE: Recently, the ILAE Nosology and Definitions Task Force defined diagnostic criteria for epilepsy syndromes. There is paucity of data on the use of these new diagnostic criteria in children with epilepsy, and how these criteria may lead to changes from previous practice. METHODS: This was a retrospective chart review of data of children attending the epilepsy clinic in a tertiary care children's hospital from January 2011 to January 2023. The clinical details such as age at onset, types of seizures, co-morbidities, and results of EEG, MRI and genetic testing were reviewed. Epilepsy syndrome diagnosis was made as per the ILAE 2022 criteria, and compared with the previous syndrome diagnosis as per records. RESULTS: Data from 1550 children (63 % boys) with epilepsy were analysed, and 55.4 % children were classified to have epilepsy syndromes as per the new ILAE 2022 diagnostic criteria. Application of the new 2022 ILAE diagnostic criteria was associated with a change in name alone in 676 (77.8 %) children. Hundred (11.5 %) children were newly classified under an epilepsy syndrome who had previously remained unclassified. Eleven (1.3 %) children who were previously classified into an epilepsy syndrome could not be classified using the new diagnostic criteria. Eight (0.9 %) were shifted to a new syndromic category. Overall, change in diagnosis occurred in 13.7 (11.5 + 1.3 + 0.9)%. No change in epilepsy syndrome classification/nomenclature occurred in 74 (8.5 %) children. SIGNIFICANCE: The new diagnostic criteria led to an overall change in diagnosis in 13.7 % of children with epilepsy. These criteria will hopefully lead to uniformity in diagnosis of epilepsy syndromes across diverse settings.

Outcomes and Factors Affecting Transcranial Direct Current Stimulation in Alzheimer's Disease Patients: A Systematic Review.

INTRODUCTION: Alzheimer's disease (AD) is the most common form of dementia. There have been various proposed pharmacologic and non-pharmacologic treatments proposed for preventing cognitive decline in AD patients. Transcranial Direct Current Stimulation (tDCS) is a neuromodulation technique used to enhance cognitive functions and motor skills of the brain. Our study aimed to assess the effects of tDCS in AD patients, including effects on general cognitive status, memory, attention, executive functions, language, IQ, and neuropsychological effects, along with the factors influencing the outcomes. METHODS: Systematic searches were conducted for relevant evidence using PubMed, ScienceDirect, and Cochrane Library databases for (Transcranial Direct Current Stimulation) and (Alzheimer's). Duplicates were removed, and the remaining articles were screened for double-blind, placebo-controlled, randomized clinical trials (Phase III), case studies, and case series on patients diagnosed with AD using tDCS. The articles were assessed for full text, and studies were selected and analyzed to include in the review. RESULTS: Overall, 20 studies were reviewed. Cognitive status, executive function and working memory, recognition memory, and language function may improve following AtDCS depending on the stimulation polarity and area stimulated. No significant effects of tDCS were seen on attention, associative memory, recall memory, visuospatial ability, and neuropsychiatric symptoms. DISCUSSION: Therapy outcomes and the factors that could affect them were analyzed, which included the number of sessions taken, current density, stimulation polarity (cathodal/anodal/dual), area stimulated, training(s) given, and study timeline. CONCLUSION: tDCS is a well-tolerated therapy that can be used for improving several cognitive domains in patients having Alzheimer's disease. Its treatment outcomes are affected by polarity (cathodal/ anodal), site of stimulation, number of sessions taken, and any training(s) given during the study.