| 1. |
- Bjellvi, Johan, et al.
(författare)
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Risk factors for status epilepticus after brain disorders in adults: A multi-cohort national register study
- 2024
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Ingår i: EPILEPSY & BEHAVIOR. - 1525-5050 .- 1525-5069. ; 156
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: We aimed to describe risks of status epilepticus (SE) after different brain disorders in adults using population-wide register data. Our hypothesis was that SE would be more common in disorders with widespread pathology and that the risk would increase with disorder severity. Methods: We analyzed five large datasets created from the Swedish National Patient Register, the Cause of Death Register, and national quality registers with adults in Sweden with brain infections, dementia, multiple sclerosis (MS), stroke, and traumatic brain injury (TBI). Risk factors were assessed using Cox regression. Results: In adults with TBI, stroke, dementia, MS, or brain infections, the incidence rate of SE was highest in survivors of brain infections (64/100,000 person years) and stroke (64/100,000), followed by TBI (37/100,000), dementia (36/100,000), and MS (26/100,000). SE was considerably more common in patients with epilepsy after their brain disorder. Across all datasets severe disorder increased SE-risk. Herpes simplex encephalitis (HR 5.5 95 % CI: 2.6 -12), progressive MS (HR 2.3, 95 % CI: 1.1 -4.7), structural TBI (2.0, 95 % CI: 1.6 -2.6), and intracerebral hemorrhage (HR 1.5, 95 % CI: 1.2 -2.0) were the subtypes of brain disorders with the highest relative risk of SE. Having another CNS disorder increased SE-risk in TBI (HR 2.9, 95 % CI: 2.3 -3.7), brain infections (HR 2.8, 95 % CI: 1.7 -4.5), and dementia (HR 2.5, 95 % CI: 1.5 -4.2). Conclusion: SE-risk increases with disorder severity and number of CNS comorbidities. These findings can guide treatment strategy by allowing identification of high-risk patients. Pathophysiological studies are needed to better understand remote symptomatic SE.
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| 2. |
- Anckarsäter, Henrik, 1966, et al.
(författare)
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Persistent regional frontotemporal hypoactivity in violent offenders at follow-up.
- 2007
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Ingår i: Psychiatry research. - : Elsevier BV. - 0165-1781 .- 0925-4927 .- 1872-7123. ; 156:1, s. 87-90
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Tidskriftsartikel (refereegranskat)abstract
- Since cross-sectional brain-imaging studies demonstrating frontotemporal cerebral hypoactivity in violent offenders have generally been carried out around the time of trial and sentencing, the findings might be influenced by the stressful situation of the subjects. It seems that no group of offenders with this finding has yet been followed longitudinally. We have re-examined nine offenders convicted of lethal or near-lethal violence in whom single photon emission tomography (SPECT) previously had demonstrated frontotemporal hypoperfusion. The mean interval between the initial and the follow-up examination was 4 years. The initially observed hypoactivity was found to have remained virtually unchanged at follow-up: no mean change in the group exceeded 5% in 12 assessed regions of interest. Although preliminary due to the small sample size, this study suggests that frontotemporal brain hypoactivity is a trait rather than a state in perpetrators of severe violent crimes.
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| 3. |
- Bjellvi, Johan, et al.
(författare)
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Classification of complications of epilepsy surgery and invasive diagnostic procedures: A proposed protocol and feasibility study
- 2021
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Ingår i: Epilepsia. - : Wiley. - 0013-9580 .- 1528-1167. ; 62:11, s. 2685-2696
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Tidskriftsartikel (refereegranskat)abstract
- Objective In epilepsy surgery, which aims to treat seizures and thereby to improve the lives of persons with drug-resistant epilepsy, the chances of attaining seizure relief must be carefully weighed against the risks of complications and expected adverse events. The interpretation of data regarding complications of epilepsy surgery and invasive diagnostic procedures is hampered by a lack of uniform definitions and method of data collection. Methods Based on a review of previous definitions and classifications of complications, we developed a proposal for a new classification. This proposal was then subject to revisions after expert opinion within E-pilepsy, an EU-funded European pilot network of reference centers in refractory epilepsy and epilepsy surgery, later incorporated into the ERN (European Reference Network) EpiCARE. This version was discussed with recognized experts, and a final protocol was agreed to after further revision. The final protocol was evaluated in practical use over 1 year in three of the participating centers. One hundred seventy-four consecutive procedures were included with 35 reported complications. Results This report presents a multidimensional classification of complications in epilepsy surgery and invasive diagnostic procedures, where complications are characterized in terms of their immediate effects, resulting permanent symptoms, and consequences on activities of daily living. Significance We propose that the protocol will be helpful in the work to promote safety in epilepsy surgery and for future studies designed to identify risk factors for complications. Further work is needed to address the reporting of outcomes as regards neuropsychological function, activities of daily living, and quality of life.
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| 4. |
- Bjellvi, Johan, et al.
(författare)
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Complications of epilepsy surgery in Sweden 1996-2010 : a prospective, population-based study
- 2015
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Ingår i: Journal of Neurosurgery. - 0022-3085 .- 1933-0693. ; 122:3, s. 519-525
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Tidskriftsartikel (refereegranskat)abstract
- OBJECT Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. METHODS The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life. and lasting longer than 3 months) or minor (resolving within 3 months). RESULTS A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% Cl 1.09-1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. CONCLUSIONS This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.
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| 5. |
- Bjellvi, Johan, et al.
(författare)
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Complications of epilepsy surgery in Sweden 1996-2010: a prospective, population-based study
- 2015
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Ingår i: J Neurosurg. - : Journal of Neurosurgery Publishing Group (JNSPG). - 0022-3085 .- 1933-0693. ; 122:3, s. 519-25
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Tidskriftsartikel (refereegranskat)abstract
- OBJECT: Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. METHODS: The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months). RESULTS: A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09-1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. CONCLUSIONS: This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.
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| 6. |
- Bjellvi, Johan, et al.
(författare)
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Epilepsy duration and seizure outcome in epilepsy surgery: A systematic review and meta-analysis
- 2019
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Ingår i: Neurology. - 1526-632X. ; 93:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To conduct a systematic review and meta-analysis on the effect of earlier or later resective epilepsy surgery on seizure outcome. METHODS: We searched the electronic databases PubMed, EMBASE, and Cochrane Library for studies investigating the association of epilepsy duration and seizure freedom after resective surgery. Two reviewers independently screened citations for eligibility and assessed relevant studies for risk of bias. We combined data in meta-analyses using a random effects model. We assessed the certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Twenty-five studies were included, 12 of which had data suitable for meta-analyses. Comparing seizure outcome if epilepsy surgery was performed before vs after 2, 5, 10, and 20 years of epilepsy duration, and comparing epilepsy duration <5 years to >10 years, we found significant effects favoring shorter duration with risk differences ranging from 0.15 to 0.21 and risk ratios ranging from 1.20 to 1.33 (p < 0.01 for all comparisons). According to GRADE, we found low certainty of evidence favoring shorter epilepsy duration before surgery. CONCLUSION: People with shorter epilepsy duration are more likely to be seizure-free at follow-up. Furthermore, there is a positive association between shorter duration and seizure freedom also for very long epilepsy durations. Patients who might benefit from epilepsy surgery should therefore be referred for presurgical assessments without further delay, regardless of epilepsy duration. The low certainty of evidence acknowledges concerns regarding study heterogeneity and possible residual confounding. Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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| 7. |
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| 8. |
- Bjellvi, Johan, et al.
(författare)
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Risk Factors for Seizure Worsening After Epilepsy Surgery in Children and Adults: A Population-Based Register Study.
- 2020
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 1524-4040 .- 0148-396X. ; 87:4, s. 704-711
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Tidskriftsartikel (refereegranskat)abstract
- Increased seizure frequency and new-onset tonic-clonic seizures (TCS) have been reported after epilepsy surgery.To analyze potential risk factors for these outcomes in a large cohort.We studied prospectively collected data in the Swedish National Epilepsy Surgery Register on increased seizure frequency and new-onset TCS after epilepsy surgery 1990-2015.Two-year seizure outcome was available for 1407 procedures, and data on seizure types for 1372. Increased seizure frequency at follow-up compared to baseline occurred in 56 cases (4.0%) and new-onset TCS in 53 (3.9%; 6.6% of the patients without preoperative TCS). Increased frequency was more common in reoperations compared to first surgeries (7.9% vs 3.1%; P=.001) and so too for new-onset TCS (6.7% vs 3.2%; P=.017). For first surgeries, binary logistic regression was used to analyze predictors for each outcome. In univariable analysis, significant predictors for increased seizure frequency were lower age of onset, lower age at surgery, shorter epilepsy duration, preoperative neurological deficit, intellectual disability, high preoperative seizure frequency, and extratemporal procedures. For new-onset TCS, significant predictors were preoperative deficit, intellectual disability, and nonresective procedures. In multivariable analysis, independent predictors for increased seizure frequency were lower age at surgery (odds ratio (OR) 0.70 per increasing 10-yr interval, 95% CI 0.53-0.93), type of surgery (OR 0.42 for temporal lobe resections compared to other procedures, 95% CI 0.19-0.92), and for new-onset TCS preoperative neurological deficit (OR 2.57, 95% CI 1.32-5.01).Seizure worsening is rare but should be discussed when counseling patients. The identified risk factors may assist informed decision-making before surgery.
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| 9. |
- Bjellvi, Johan, et al.
(författare)
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[Status epilepticus in children and adults]. : Status epilepticus hos barn och vuxna - Orsaken är ofta akut sjukdom – utredning och behandling bör ske parallellt.
- 2018
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Ingår i: Lakartidningen. - 1652-7518. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- Status epilepticus, a condition with prolonged or repeated seizures, is a common neurological emergency with significant morbidity and mortality. This text outlines the treatment and initial work-up for convulsive and non-convulsive status epilepticus in adults and children. The most serious form is convulsive (tonic-clonic) status epilepticus, which requires rapid treatment and work-up. Bensodiazepines are the preferred initial treatment, while antiepileptic drugs and anesthetics are added if seizures continue. For other forms of status epilepticus, the treatment depends on the type of seizures and the patient's general condition. Etiological work-up is essential in any case of status epilepticus. Effective treatment and work-up in status epilepticus requires a defined treatment protocol and multidisciplinary cooperation.
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| 10. |
- Bjellvi, Johan
(författare)
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Surgical and neurological adverse effects of epilepsy surgery
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study surgical and neurological complications of preoperative invasive investigations and epilepsy surgery procedures (Papers I-II) and seizure worsening after epilepsy surgery (Paper III). A further aim was to improve reporting of adverse effects related to invasive investigations and epilepsy surgery by proposing and evaluating an evidence-based protocol for monitoring complications (Paper IV). Papers I-III were based on data from the prospective Swedish National Epilepsy Surgery Register. In Paper IV, a literature review of previous definitions and classifications of complications in epilepsy surgery was the starting point for a consensus-based proposal agreed within an international network of epilepsy surgery centers. The final protocol was clinically evaluated at three of the centers during a period of one year. Complications were seen in 4.8% of 271 invasive EEG procedures, none of which were major. Subdural grids had the highest risk. Complications related to invasive investigations increased the risk for complications related to subsequent epilepsy surgery (Paper I). After 865 epilepsy surgery procedures, major complications were seen in 3.0%, and minor complications in 7.5%. Higher age at surgery was a risk factor for complications (Paper II). After 1407 epilepsy surgery procedures, increased seizure frequency occurred in 4.0% cases, and new-onset tonic-clonic seizures in 3.9%. Both outcomes were more common in reoperations. Lower age at surgery and extratemporal procedures were independent risk factors for increased seizure frequency, and preoperative neurologic deficits for new-onset tonic-clonic seizures (Paper III). The agreed protocol for complications was used for 90 procedures with a total of 18 complications (not differentiated into major or minor). Areas for future improvements of the protocol were identified (Paper IV). Complications and seizure worsening are rare outcomes after epilepsy surgery. Robust data on negative outcomes are important in order for patients and parents to make informed decisions about epilepsy surgery. Prospective data collection with standardized protocols may improve reporting of adverse effects.
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