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| 2. |
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| 3. |
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| 4. |
- Kennebäck, G, et al.
(author)
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Changes in arrhythmia profile and heart rate variability during abrupt withdrawal of antiepileptic drugs. Implications for sudden death.
- 1997
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In: Seizure. - 1059-1311 .- 1532-2688. ; 6:5, s. 369-75
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Journal article (peer-reviewed)abstract
- Sudden unexpected death (SUD) has been associated with low or undetectable concentrations of antiepileptic drugs in patients with epilepsy suggesting that a sudden fall in plasma levels of these drugs might be a critical factor for the occurrence of SUD. We studied the changes in arrhythmia profile and heart-rate variability, during abrupt withdrawal of carbamazepine and phenytoin treatment in 10 patients with side effects on these drugs. Continuous ECG recording and daily measurements of drug plasma concentrations were performed from the last day of steady-state treatment and the following 4 days. Three patients had a 10-fold increase in ventricular premature beats. In addition, there was a significant reduction in heart-rate variability, assessed over 24 hours, in both the time (SDNN index, P = 0.03) and frequency domains from days 1-5. In the frequency domain analysis there was a significant reduction in total power (P = 0.01), very-low-frequency power (P = 0.004) and in low-frequency (LF) power (P = 0.01). Similar reductions in heart-rate variability and increases in ventricular automaticity have been associated with increased mortality in other patient groups. Two factors that might contribute to the increased rate of SUD in patients with epilepsy have thus been identified.
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| 5. |
- Landtblom, Anne-Marie, 1953-
(author)
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Did St Birgitta suffer from epilepsy? A neuropathography
- 2004
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In: Seizure. - 1059-1311 .- 1532-2688. ; 13:3, s. 161-167
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Journal article (peer-reviewed)abstract
- Several famous religious personalities have been discussed as possibly having had epilepsy. Partial epileptic fits can be accompanied by religious experiences. The Swedish St Birgitta of Vadstena is focused on from this perspective as the exterior of the skull thought to belong to her has a prominent tuberculum with a corresponding interior indentation possibly indicating the previous existence of a meningioma, a well known cause of epilepsy. This article scrutinises arguments for and against the possibility of epileptic features in the revelations of the saint, as well as in her life story.
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| 6. |
- Räty, Lena, et al.
(author)
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Seizures and therapy in adolescents with uncomplicated epilepsy
- 2003
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In: Seizure. - 1059-1311 .- 1532-2688. ; 12:4, s. 229-236
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Journal article (peer-reviewed)abstract
- Purpose: This study aimed to describe seizures and their therapy among Swedish adolescents, aged 13–22, with active but uncomplicated epilepsy.Method: The adolescents answered questionnaires (158/193). Data were also obtained from medical records.Results: Epileptic seizure types could be specified in 92.1% of the cases. Predominant types were Primary Generalised Tonic–Clonic Seizures and Partial Complex Seizures with Secondary Generalisation. Clinical diagnoses by physicians were unspecified in 25.8%. Ninety percent were on antiepileptic drugs (AEDs), most commonly valproate and carbamazepine. New AEDs were used in 9.3% of the cases and polytherapy in 13.9%. More than 40% of the respondents had seizures despite AED treatment. Side effects of AEDs were experienced by 61%, most commonly tiredness, concentration difficulties and headache. Patients on polytherapy experienced significantly more side effects. The choice of a new AED over a traditional one was not related to seizure type or seizure control.Conclusions: Many adolescents had persistent seizures despite treatment at a specialist regional epilepsy centre. This, plus the high reported rate of side effects of AED treatment, suggests that treatment is not optimal for the group studied. As traditional AEDs strongly dominated treatment possibly newly marketed AEDs are underused in this group.
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| 7. |
- Almgren, Malin, et al.
(author)
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Population-based study of antiepileptic drug exposure in utero-Influence on head circumference in newborns
- 2009
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 18:10, s. 672-675
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Journal article (peer-reviewed)abstract
- Purpose: To study the effect of AED exposure on head circumference in the newborn. Methods: Data on all Swedish singletons births between 1995 and 2005, over 900,000 births, were obtained from the Swedish Medical Birth Registry. The effects of AEDs on birth-weight-adjusted mean head circumference (bw-adj-HC) were estimated by comparison with data from all births in an analysis which was adjusted for year of birth, maternal age, parity, maternal smoking, and maternal body mass index. Results: A significant reduction of mean bw-adj-HC was seen after both carbamazepine (CBZ) (standard deviation scores (SDS) = 0.15, p < 0.001) and valproic acid (VPA) (SDS = 0.10, p = 0.04) in monotherapy. No effect on mean bw-adj-HC was seen for phenytoin, clonazepam, lamotrigine and gabapentin. There was a significant increase in the occurrence of microcephaly (bw-adj-HC smaller than 2 SD below the mean) after any AED polytherapy (OR = 2.85, 95% CI: 1.74-4.78) but not after AED monotherapy or monotherapy with CBZ or VPA. CBZ OF VPA was taken by 71% of the pregnant mothers on AED, and the usage increased over time. Conclusions: CBZ and VPA in monotherapy during pregnancy reduce mean bw-adj-HC. AED polytherapy increases the rate of microcephaly but no significant effect is seen of AED monotherapy. The possible significance for the further development of the child is uncertain but should be explored. (C) 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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| 8. |
- Andersson, Klara, et al.
(author)
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Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.
- 2020
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 74, s. 71-76
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Journal article (peer-reviewed)abstract
- Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied.We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth.Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls.We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.
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| 9. |
- Axelson, Hans W., et al.
(author)
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Successful localization of the Broca area with short-train pulses instead of "Penfield" stimulation.
- 2009
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 18:5, s. 374-375
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Journal article (peer-reviewed)abstract
- Direct electrical stimulation of functional cortical areas is a standard procedure in epilepsy and glioma surgery. Many previous studies support that stimulation of the motor cortex with short-train pulses is a less epileptogenic alternative to the 50–60 Hz ‘Penfield’ technique. However, whether the short-train stimulation is useful also in mapping of speech areas is unclear. In this case report we present a patient with oligodendroglioma near the Broca area. Extraoperative electrical stimulation via a subdural grid electrode was primarily performed to locate the speech area. The cortex was stimulated with short-train pulses (5 pulses, 0.5 pulse duration and 3 ms interpulse interval) in addition to 1–3 s 50 Hz stimulation.The patient had speech arrest from both types of stimulation techniques during a naming task. It was however critical that the short (14.5 ms) train stimulation was synchronized with the presentation of the naming objects. If not, there was no speech arrest. Despite this possible pitfall, this case has encouraged us to further try short-train stimulation in attempts to reduce stimulus-triggered seizures during mapping of eloquent areas.
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| 10. |
- Beckung, Eva, 1950, et al.
(author)
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Motor and sensory dysfunctions in children with mental retardation and epilepsy.
- 1997
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In: Seizure : the journal of the British Epilepsy Association. - 1059-1311. ; 6:1, s. 43-50
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Journal article (peer-reviewed)abstract
- The aim of this study was to assess motor and sensory functions in a population-based series of 88 mentally retarded children with epilepsy. A new standardized physiotherapy protocol was developed for the heterogeneous population of children with epilepsy; the Cailler-Azusa scale was also found to be useful. For children with cerebral palsy, the gross motor function measure was used. Sensorimotor impairments, resulting in disabilities and handicap, were found to be very common but often overlooked and neglected. Sensorimotor dysfunctions need to be identified in order to provide rational training, understanding and care to children with epilepsy and mental retardation.
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| 11. |
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| 12. |
- Beniczky, Sándor, et al.
(author)
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Ictal EEG source imaging in presurgical evaluation : High agreement between analysis methods
- 2016
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In: Seizure. - : Elsevier BV. - 1059-1311. ; 43, s. 1-5
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Journal article (peer-reviewed)abstract
- Purpose To determine the agreement between five different methods of ictal EEG source imaging, and to assess their accuracy in presurgical evaluation of patients with focal epilepsy. It was hypothesized that high agreement between methods was associated with higher localization-accuracy. Methods EEGs were recorded with a 64-electrode array. Thirty-eight seizures from 22 patients were analyzed using five different methods phase mapping, dipole fitting, CLARA, cortical-CLARA and minimum norm. Localization accuracy was determined at sub-lobar level. Reference standard was the final decision of the multidisciplinary epilepsy surgery team, and, for the operated patients, outcome one year after surgery. Results Agreement between all methods was obtained in 13 patients (59%) and between all but one methods in additional six patients (27%). There was a trend for minimum norm being less accurate than phase mapping, but none of the comparisons reached significance. Source imaging in cases with agreement between all methods was not more accurate than in the other cases. Ictal source imaging achieved an accuracy of 73% (for operated patients: 86%). Conclusion There was good agreement between different methods of ictal source imaging. However, good inter-method agreement did not necessarily imply accurate source localization, since all methods faced the limitations of the inverse solution.
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| 13. |
- Bialek, Fatima, et al.
(author)
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Outcomes after resective epilepsy surgery in patients over 50 years of age in Sweden 1990-2009-A prospective longitudinal study
- 2014
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 23:8, s. 641-645
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Journal article (peer-reviewed)abstract
- Purpose: Most epilepsy surgery candidates are young adults. Outcome reports after epilepsy surgery in patients >= 50 years are few and varying. The aim of this study was to describe patient characteristics of older compared to younger adults and analyse seizure, complication and vocational outcomes in a large population-based series. Methods: We analysed data from the Swedish National Epilepsy Surgery Register for 1990-2009 for patients >= 19 years at resective surgery who had completed two-year follow-up. Variables studied were seizure outcome, histo-pathological diagnoses, complications and vocational outcome. Data from patients >= 50 years and 19-49 years at surgery were compared. Results: 558 Adults underwent resective epilepsy surgery 1990-2009 and had two-year follow-up. 12% of the adults (67 patients) were >= 50 years at surgery. Patients >= 50 had longer epilepsy duration, more often had mesial sclerosis and less often had neurodevelopmental tumours and cortical malformations. The proportion of seizure-free patients at two-year follow-up did not differ between those >= 50 and 1949 years (61% versus 61% seizure-free last year, 48% versus 43% completely seizure-free since surgery), neither did the occurrence of major complications (3% in both groups). The vocational situation was mainly stable between baseline and two-year follow-up in both groups, although older patients were less often employed than younger. Conclusion: 12% of adults in the Swedish series were >= 50 years at epilepsy surgery. Seizure outcome was as good for older as for younger adults, and there was no difference in the occurrence of major complications. This constitutes important information in the presurgical counselling process.
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| 14. |
- Bjurulf, Björn, 1962, et al.
(author)
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Caregiver reported seizure precipitants and measures to prevent seizures in children with Dravet syndrome
- 2022
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In: Seizure. - : Elsevier BV. - 1059-1311. ; 103, s. 3-10
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Journal article (peer-reviewed)abstract
- Objective: The aim of this population-based, cross-sectional study was to describe caregiver-reported seizure precipitants, measures taken to prevent seizures and rescue therapies in children with Dravet Syndrome (DS). Methods: In a population-based study, caregivers of 42/48 Swedish children with DS born between 2000 and 2018 were interviewed. Frequency of precipitants, preventive measures, and rescue therapies were compared between children born 2000-2009 and 2010-2018 and between `severe acute accent and `less severe acute accent epilepsy.Results: All children had experienced precipitants. Preventive measures were employed in all. Seizures had been provoked by a median of seven (range 2-11) out of 13 factors. A median of eight (range 1-17) preventive measures out of 19 were reported. The most common precipitants were fever (n=42, 100%), and afebrile in-fections (n=39/42, 93%). Afebrile infections (p=0.014) and reduced ambient temperature (p=0.006) were more common precipitants in younger children, and bright light in children with severe epilepsy (p=0.013).The most common factors avoided were warm weather (n=35/42, 83%) and physical activity (n=27/42, 64%). It was more common to avoid strong emotions (p=0.035) and reduced temperature (p=0.002) in younger children, and to avoid infections (p=0.024) and crowds (p=0.046) in children with 'severe' epilepsy. Many children (n=28/42, 67%) or their siblings (n=16/34, 47% of individuals with siblings) had stayed home to avoid infections in school/day-care. Use of emergency medicines was more frequent in younger children (p=0.006) and in children with 'severe' epilepsy (p=0.007). Significance: Caregiver-reported seizure precipitants are common in DS. Caregivers employ a range of measures to avoid seizures, restricting family life.
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| 15. |
- Brigo, F, et al.
(author)
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Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: A systematic review with network meta-analysis.
- 2018
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 61, s. 57-62
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Journal article (peer-reviewed)abstract
- To determine the best available evidence on the efficacy and tolerability of antiepileptic drugs (AEDs) used to treat poststroke seizures and epilepsy.MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and Opengrey.eu were searched for RCTs of AEDs used to treat post-stroke epilepsy. The following outcomes were considered: seizure freedom; occurrence of adverse effects (AEs); withdrawal for AEs. The methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Adjusted indirect comparisons were made between each AED using controlled-release carbamazepine (CR-CBZ) as common comparator.Only 2 RCTs were included, one comparing levetiracetam (LEV) with CR-CBZ and the other comparing lamotrigine (LTG) with CR-CBZ. No significant difference was found in seizure freedom between either LEV or LTG and CR-CBZ. Occurrence of AEs were lower for LEV and LTG than for CR-CBZ. Indirect comparisons showed no difference between LEV and LTG for seizure freedom (OR 0.86; 95%CI: 0.15-4.89). Occurrence of AEs was higher for LEV than for LTG (OR 6.87; 95%CI: 1.15-41.1). For withdrawal rates due to AEs, we found a large width and asymmetrical distribution of confidence intervals around the obtained OR of 10.8 (95% CI: 0.78-149.71).Direct and indirect comparisons did not find a difference in seizure freedom between the various AEDs, probably because of the small number of patients included. LEV and LTG appears better tolerated than CR-CBZ and LEV seems associated with more AEs than LTG. Further studies are required to provide robust evidence on efficacy and tolerability of AEDs for treating poststroke epilepsy.
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| 16. |
- Christensen, Jakob, et al.
(author)
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Estimates of epilepsy prevalence, psychiatric co-morbidity and cost
- 2023
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In: Seizure. - : Elsevier. - 1059-1311 .- 1532-2688. ; 107, s. 162-171
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Journal article (peer-reviewed)abstract
- Purpose: This study estimated epilepsy prevalence, psychiatric co-morbidity and annual costs associated with epilepsy.Methods: We used Danish national health registers to identify persons diagnosed with epilepsy and psychiatric disorders, and persons using antiseizure medication and persons using drugs for psychiatric disorders. We calculated the prevalence of epilepsy and co-morbid psychiatric disorders in Denmark on December 31, 2016, using information on epilepsy and psychiatric disorders based on combinations of hospital contacts and use of antiseizure and psychoactive medication. Further, direct and indirect annual costs associated with epilepsy were calculated using individual-level data from a range of socioeconomic registers.Results: There were 5,044,367 persons alive and living in Denmark on December 31, 2016, including 33,628 persons with at least one hospital contact with epilepsy in the previous five years (epilepsy prevalence 0.67% (0.69% males; 0.65% females)). Among these persons with epilepsy, we identified 12,562 (37.4%) persons with a psychiatric disorder or use of drugs used for psychiatric disorders as compared with 801,052 (15.9%) persons in the general population. The estimated total annual individual net costs associated with epilepsy was €30,683. Compared with prevalence estimates on December 31, 2006, the prevalence of epilepsy on December 31, 2016, was slightly higher in the older population and slightly lower in childrenConclusions: Population estimates from national registers provide epilepsy prevalence estimates of approximately 0.6–0.7% - similar to previous reviews of epilepsy prevalence. In addition, the national sample allowed idenitfication of high prevalence of psychiatric disorders and high societal costs associated with epielspy.
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| 17. |
- Dagiasi, Ioanna, et al.
(author)
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Treatment of epilepsy in multiple sclerosis
- 2018
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 58, s. 47-51
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Journal article (peer-reviewed)abstract
- Purpose: The prevalence of epilepsy is increased in multiple sclerosis (MS), but information on AED treatment and seizure outcome is scarce. We describe epilepsy characteristics including the use of AEDs and proportion of seizure-free patients at two tertiary hospitals in Sweden. Method: We retrospectively studied electronic medical records of all patients with a diagnosis of MS and seizures at Sahlgrenska university hospital and Uppsala university hospital. Clinical data were reviewed until 2017. Results: We identified a total of 62 MS patients with at least one seizure. Median age at the first seizure (before or after MS) was 41 years (range 0-80). The most common MS disease course at the first seizure was secondary progressive MS, the neurological disability was considerable, and most patients had several MRI lesions at their first seizure. The first EEG demonstrated epileptiform discharges in 38% and unspecific pathology in 40%. Current seizure status could be determined for 37 patients. Out of these, 46% had been seizure free for more than one year at last follow-up. The majority of patients (65%) were on monotherapy at last follow-up. Carbamazepine was the most commonly used first AED, with a retention rate of 52%. No individual AED was associated with a particularly high rate of seizure freedom. The most common reason for discontinuation of the first AED was side-effects. Conclusion: Seizure freedom rates were low, perhaps indicating a need for higher ambitions in management. Side effects of AEDs may be a particular concern when treating epilepsy in patients with MS. (C) 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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| 18. |
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| 19. |
- Ehrstedt, Christoffer, et al.
(author)
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Somatostatin receptor expression and mTOR pathway activation in glioneuronal tumours of childhood
- 2020
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 76, s. 123-130
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Journal article (peer-reviewed)abstract
- Purpose: To investigate the expression of somatostatin receptors (SSTRs) and markers of mTOR pathway in paediatric glioneuronal tumours and correlate these findings with tumour type, BRAFV600E mutational status and clinical characteristics such as tumour location, seizure frequency and duration, and age.Method: 37 children and adolescents with a neuropathological diagnosis of glioneuronal tumour were identified over a 22-year period. Immunohistochemical analyses for SSTRs type 1, 2A, 3, 5 and ezrin-radixin-moesin (ERM) and phosphorylated S6 (pS6), which are indicators of mTOR pathway activation, were performed in tumour specimens from 33 patients and evaluated using the immunoreactive score (IRS). The IRS were compared to tumour type, BRAFV600E status and clinical characteristics.Results: Ganglioglioma (GG) was the most frequently encountered subgroup (n = 27), followed by dysembryoplastic neuroepithelial tumour (DNET; n=4). GGs expressed SSTR2A and SSTR3 to a high extent, 56 % and 44 % respectively. Expression of SSTR2A was also found in DNETs. Signs of mTOR pathway activation were abundant in GGs, but only present in one DNET. No correlations with BRAFV600E presence or clinical characteristics were found.Conclusions: Expression of SSTRs and activation of mTOR pathway in paediatric glioneuronal tumour suggest that somatostatin analogues and mTOR inhibitors may have potential therapeutic implications in a subset of inoperable childhood glioneuronal tumours causing medically refractory epilepsy and/or tumour growth. Further clinical studies are warranted to validate these findings.
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| 20. |
- Elisak, M., et al.
(author)
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The prevalence of neural antibodies in temporal lobe epilepsy and the clinical characteristics of seropositive patients
- 2018
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In: Seizure. - : Elsevier BV. - 1059-1311. ; 63, s. 1-6
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Journal article (peer-reviewed)abstract
- Purpose Epileptic seizures are a common manifestation of autoimmune encephalitis, but the role of neural antibodies in long-term epilepsy remains unclear. The aim of this study was to assess the prevalence of neural-surface antibodies (NSAbs) and antibodies against glutamic acid decarboxylase (GAD) in patients with chronic temporal lobe epilepsy (TLE). Method Patients with an electro-clinical diagnosis of TLE and a disease duration longer than one year were included. NSAbs (LGI1, CASPR2, AMPAR1/2, NMDAR, GABABR) and antibodies against GAD were detected. Only patients with significant antibody levels in serum, and/or positivity in CSF (according to antibody subtype), were enrolled in the seropositive group. Cohorts of seropositive and seronegative patients were compared regarding clinical and imaging data. Results Significant serum levels of antibodies were detected in eight out of 163 (5%) TLE patients (CASPR2 n=2, GAD n=3, LGI1 n=2, and GABABR n=1). In four of them, antibodies were detected in the CSF as well (CASPR2 in one, GAD in three). Five seropositive patients had uni- or bilateral temporal lobe lesions on MRI and three patients were non-lesional. All seropositive patients had TLE of unknown cause. Seropositive patients had higher age at epilepsy onset and autoimmune comorbidity, but did not differ in other clinical, EEG or neuroimaging characteristics. Response to immunotherapy (seizure reduction >50%) was observed in three of the six patients treated. Conclusions: Besides older age at epilepsy onset and autoimmune comorbidity, seropositive patients cannot be distinguished from seronegative patients on the basis of clinical, EEG or neuroimaging data.
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| 21. |
- Eriksson, Hanna, et al.
(author)
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Brain injury markers in new-onset seizures in adults: A pilot study
- 2021
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311. ; 92, s. 62-67
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Journal article (peer-reviewed)abstract
- Background: Biochemical markers of brain pathology could potentially contribute to diagnosis and prediction in epilepsy. We describe levels of five brain injury markers in adults with new-onset seizures, and assess group differences in patients with a single seizure, epilepsy, and poststroke epilepsy. Methods: In this prospective observational study, adults with new-onset seizures were recruited at Sahlgrenska University Hospital, Sweden, and concentrations of glial fibrillary acidic protein (GFAP), neurofilament light (NfL), microtubule-associated protein tau (tau), S100 calcium-binding protein (S100B), and neuron-specific enolase (NSE) were measured. Participants were categorized as epilepsy, poststroke epilepsy (PSE), or single seizure (no additional seizures). Patients were followed until a diagnosis of epilepsy or PSE, or for at least two years in single seizure cases. Results: The cohort included 23 (37%) individuals with a single seizure, 24 (39%) with epilepsy, and 15 (24%) with PSE. The concentrations of S100B were higher in patients with epilepsy and PSE than in single seizures (p = 0.0023 and p = 0.0162, respectively). The concentrations of NfL were higher in patients with PSE than in single seizures (p=0.0027). After age-normalization, levels of S100B were higher in patients with epilepsy and levels of NfL were higher in patients with PSE (p = 0.0021 and p = 0.0180). Conclusion: Levels of S100B and NfL were higher in patients with epilepsy or PSE than patients with single seizures. Further studies are needed to investigate the biomarker potential of brain injury markers as predictors of epilepsy course or indicators of epileptogenesis.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
- Forsgren, Lars, et al.
(author)
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On the experience of stigma by persons with epilepsy in Sweden and Iran : a comparative study
- 2013
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In: Seizure. - : Saunders Elsevier. - 1059-1311 .- 1532-2688. ; 22:9, s. 748-751
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of this paper is to compare the experience of stigma by persons with epilepsy in Sweden and Iran.METHOD: An adapted version of the Internalized Stigma of Mental Illness Scale was completed by 130 persons with epilepsy in Tehran and 93 patients at a neurology clinic in Sweden.RESULTS: The Swedish subjects reported a significantly lower level of experienced stigmatization than the Iranian patients, which we think is an effect of a more individualized medical treatment and a longer experience of health education in the Swedish society.CONCLUSION: Improved seizure control, legislative measures and health education are major contributory factors for stigma reduction in a society as regards epilepsy and probably also other medical conditions.
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| 26. |
- Gauffin, Helena, et al.
(author)
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Medical outcome in epilepsy patients of young adulthood-A 5-year follow-up study
- 2009
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In: SEIZURE-EUROPEAN JOURNAL OF EPILEPSY. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 18:4, s. 293-297
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Journal article (peer-reviewed)abstract
- The appearance of new anti-epileptic drugs (AED) during the last decade has provided neurologists and their patients with a greater choice, but the proof for their superiority over traditional AEDs is sparse, especially their use in adolescence and Young adulthood. We studied a group Of Young adults (18-27 years) with epilepsy and compared their Situation in 2004 with those 5 years earlier. Materials and methods: The participants (n = 97) answered questionnaires regarding seizure-frequency, AED, side-effects and quality-of-life. Information was also taken from medical records. Results: The use of new generation AEDs increased during the 5-year study period, particularly among women. However seizure frequency had not changed significantly over time, and compared to men the effectiveness in controlling seizures Was lower in women. The participants reported normal quality-of-life (QOL), which may indicate that the increase in number of AEDs to choose from actually improved the situation for these Young adults with epilepsy. Frequency of seizures and cognitive side-effects of AEDs were associated with a lower QOL. Conclusions: More women than men seem to be treated with new AEDs, and that the increase in use of new AEDs does not reduce seizure frequency in young adulthood. The effectiveness in controlling seizures seems to be lower in women in the age group Studied. Further Studies are required to better understand how epilepsy related factors interact.
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| 27. |
- Goselink, Rianne J. M., et al.
(author)
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Transition to adult care in epilepsy: A systematic review
- 2022
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 101, s. 52-59
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Journal article (peer-reviewed)abstract
- The transfer from paediatric to adult care can be a complex process in children with epilepsy. Inadequate care during this phase can affect long-term medical and psychosocial outcomes. The aim of this study was to review studies on transitional care from paediatric to adult healthcare for young persons with epilepsy in order to synthesize evidence for best practice. We undertook a systematic review following PRISMA guidelines and employed narrative synthesis. A total of 36 articles were included, of which 11 were interventional studies and 25 observational studies. Study quality was rated as 'good' for only four studies. Interventions included joint or multidisciplinary clinics, education (patient and health professional education) and extended service provision (Saturday clinics, peer-groups). All studies observed a positive effect experienced by the participants, regardless of intervention type. Observational studies showed that transition plans/programmes are asked for but frequently not existing or not adapted to subgroups with intellectual disability or other neurodevelopmental conditions. The results of this systematic review on transitional care in epilepsy suggest that a planned transition process likely enhances medical and psychosocial outcomes for young people with epilepsy, but the body of evidence is limited and there are significant gaps in knowledge of what efficacious transition constitutes. More studies are needed employing qualitative and quantitative methods to further explore the needs of young people with epilepsy and their families but also robust study designs to investigate the impact of interventions on medical and psychosocial outcomes.
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| 28. |
- Goselink, Rianne J. M., 1986, et al.
(author)
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Transitioning from paediatric to adult care in epilepsy: A qualitative study of adolescent experiences
- 2024
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In: SEIZURE-EUROPEAN JOURNAL OF EPILEPSY. - : W B SAUNDERS CO LTD. - 1059-1311 .- 1532-2688. ; 119, s. 92-97
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Journal article (peer-reviewed)abstract
- Objective: Transition into adulthood and adult medical care is an important step in the life of young people with epilepsy. We aimed to gain a better insight into the lived experience of the transition to adulthood and adult medical care in epilepsy in Sweden, to improve future transitional care. Methods: A cross-sectional observational study with digital focus-group meetings and interviews with young people with epilepsy (16-22 years, n = 37) prior to, or after the transfer to adult care, or their primary caregivers if they had intellectual disability. We used reflexive thematic analysis to analyse the experiences and expectations on the transition to adulthood and adult medical care. Results: The results of the thematic analysis included four key areas during transition to adulthood and adult care for young persons with epilepsy: (I) worries on coming changes and future, (II) transfers are not smooth and adult care is less integrated, (III) epilepsy is part of a bigger picture, and (IV) parental roles change. In those with intellectual disability, parents experienced a stressful process and had to increase their efforts to coordinate all care contacts in adult care. Here, epilepsy was often experienced as a minor part of a more complex disease picture, where neurodevelopmental issues were often the primary concern. Significance: Transition in epilepsy is often complex due to the large burden of co-occurring disease, specifically intellectual disability and neuropsychiatric diagnoses. Transfer to adult care is experienced as unplanned and participants experience uncertainty, indicating a need for an improved transition process. As effective interventions are known in other chronic diseases, future studies should focus on the evaluation of how these approaches can be feasible and effective in young people with epilepsy.
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| 29. |
- Halawa, Imad, et al.
(author)
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Hypoglycemia and risk of seizures : A retrospective cross-sectional study
- 2015
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 25, s. 147-149
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Journal article (peer-reviewed)abstract
- Purpose: Few studies have been dedicated to assess neurological symptoms in relations to hypoglycemia. In this study we investigated the association between different levels of hypoglycemia and the occurrence of epileptic seizures in patients without a prior diagnosis of epilepsy. Method: A retrospective cross-sectional study. Results: We identified 388 individuals from a laboratory database in Swedish regional hospital who had been found to have a glucose value of <= 3.5 mM between January and December 2009. Medical records were reviewed. Hypoglycemia was defined at three different categories: 0-2 mM (40 patients), 2.1-3 mM (154 patients) and 3.1-3.5 mM (194 patients). 14 patients had disturbance of consciousness including 3 with seizures. The majority of cases had coma, a generalized tonic-clonic seizure was seen only when s-glucose dropped below 2.0 mM. Two cases with focal seizure were noted, one at s-glucose 2.0 mM, and one at s-glucose 3.3 mM. The absolute risks (95% confidence interval) for having major neurological symptoms at glucose levels of <= 2.0 mM were 0.25 (0.13-0.41), 0.02 (0-0.06) at 2.1-3.0 mM and 0.01 (0-0.03) at 3.1-3.5 mM. Conclusion: Coma is the most common neurological symptom related to hypoglycemia. Epileptic seizures are rare and not as common as previously assumed.
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| 30. |
- Hallböök, Tove, et al.
(author)
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Long term effects on epileptiform activity with vagus nerve stimulation in children.
- 2005
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 14:8, s. 527-533
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Journal article (peer-reviewed)abstract
- Purpose: We report tong-term effects of vagus nerve stimulation (VNS) on epileptiform activity in 15 children, and how these changes are related to activity stage and to clinical effects on seizure reduction, seizure severity (NHS3) and quality of life (QOL). Methods: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with 24 h ambulatory EEG monitoring for spike detection. The number of interictal epiteptiform discharges (IEDs) and the inter spike intervals (ISIs) were analysed during 2 h in the awake state, and 1 h of rapid eye movement (REM)-, spindle- and delta-steep, respectively. Total number and duration of electrographic seizure episodes were also analysed. Results: At 9 months the total number of IEDs was significantly reduced (p = 0.04). There was a tendency of reduction in all activity stages, and significantly so in delta-steep (p = 0.008). Total etectrographic seizure number was significantly reduced in the 24 h EEG at 3 and 9 months (p = 0.03, 0.05). There was a significant concordance in direction of changes in epileptiform activity and etectrographic seizures at 9 months (p = 0.04). Concordance in direction of changes was seen in 9 of 15 children between clinical seizures and IED (p > 0.3), in 10 of 15 children between QOL and IED (p = 0.3) and in 8 of 15 children between NHS3 and IED (p > 0.3). There was no direct correlation between the extent of improvement in these clinical data and the degree of spike reduction. Conclusion: This study shows that VNS reduces IEDs especially in REM and delta steep, as well as the number of electrographic seizures. It also shows a concordance between reduction in IEDs and etectrographic seizures.
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| 31. |
- Hallböök, Tove, et al.
(author)
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Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood.
- 2005
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 14:Feb 19, s. 504-513
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Journal article (peer-reviewed)abstract
- PURPOSE: Vagus nerve stimulation (VNS) is a neurophysiologic treatment for patients with refractory epilepsy. There is growing evidence of additional quality of life (QOL) benefits of VNS. We report the effects of VNS on seizure frequency and severity and how these changes are related to cognitive abilities, QOL, behaviour and mood in 15 children with medically refractory and for surgery not eligible epilepsy. METHODS: Initially, and after 3 and 9 months of VNS-treatment, 15 children were investigated with Bayley Scales of Infant Development (BSID), Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R), Wechlser Intelligence Scales for Children (WISC-III) depending on the child's level of functioning, a Visual Analogue Scale for validating QOL, Child Behaviour Checklist (CBCL) for quantifying behaviour problems, Dodrill Mood Analogue Scale and Birleson Depression Self-Rating Scale, and the National Hospital Seizure Severity Scale (NHS3). A diary of seizure frequency was collected. RESULTS: Six of 15 children showed a 50% or more reduction in seizure frequency; one of these became seizure-free. Two children had a 25-50% seizure reduction. Two children showed increased seizure frequency. In 13 of 15 children there was an improvement in NHS3. The parents reported shorter duration of seizure and recovery phase. There were no changes in cognitive functioning. Twelve children showed an improvement in QOL. Eleven of these also improved in seizure severity and mood and five also in depressive parameters. CONCLUSION: This study has shown a good anti-seizure effect of VNS, an improvement in seizure severity and in QOL and a tendency to improvement over time regarding behaviour, mood and depressive parameters. The improvement in seizure severity, QOL, behaviour, mood and depressive parameters was not related to the anti-seizure effect.
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| 32. |
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| 33. |
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| 34. |
- Johansson, Dongni, 1988, et al.
(author)
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Tonic-clonic seizure detection using accelerometry-based wearable sensors: A prospective, video-EEG controlled study
- 2019
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In: Seizure : the journal of the British Epilepsy Association. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 65, s. 48-54
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Journal article (peer-reviewed)abstract
- Purpose: The aim of this prospective, video-electroencephalography (video-EEG) controlled study was to evaluate the performance of an accelerometry-based wearable system to detect tonic-clonic seizures (TCSs) and to investigate the accuracy of different seizure detection algorithms using separate training and test data sets. Methods: Seventy-five epilepsy surgery candidates undergoing video-EEG monitoring were included. The patients wore one three-axis accelerometer on each wrist during video-EEG. The accelerometer data was band-pass filtered and reduced using a movement threshold and mapped to a time-frequency feature space representation. Algorithms based on standard binary classifiers combined with a TCS specific event detection layer were developed and trained using the training set. Their performance was evaluated in terms of sensitivity and false positive (FP) rate using the test set. Results: Thirty-seven available TCSs in 11 patients were recorded and the data was divided into disjoint training (27 TCSs, three patients) and test (10 TCSs, eight patients) data sets. The classification algorithms evaluated were K-nearest-neighbors (KNN), random forest (RF) and a linear kernel support vector machine (SVM). For the TCSs detection performance of the three algorithms in the test set, the highest sensitivity was obtained for KNN (100% sensitivity, 0.05 FP/h) and the lowest FP rate was obtained for RF (90% sensitivity, 0.01 FP/h). Conclusions: The low FP rate enhances the clinical utility of the detection system for long-term reliable seizure monitoring. It also allows a possible implementation of an automated TCS detection in free-living environment, which could contribute to ascertain seizure frequency and thereby better seizure management.
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| 35. |
- Kahlow, Hannes, et al.
(author)
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Complications of vagal nerve stimulation for drug-resistant epilepsy : A single center longitudinal study of 143 patients
- 2013
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In: Seizure. - : Saunders Elsevier. - 1059-1311 .- 1532-2688. ; 22:10, s. 827-833
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Journal article (peer-reviewed)abstract
- Purpose: To longitudinally study surgical and hardware complications to vagal nerve stimulation (VNS) treatment in patients with drug-resistant epilepsy. Methods: In a longitudinal retrospective study, we analyzed surgical and hardware complications in 143 patients (81 men and 62 women) who between 1994 and 2010 underwent implantation of a VHS-device for drug-resistant epilepsy. The mean follow-up time was 62 +/- 46 months and the total number of patient years 738. Results: 251 procedures were performed on 143 patients. 16.8% of the patients were afflicted by complications related to surgery and 16.8% suffered from hardware malfunctions. Surgical complications were: superficial infection in 3.5%, deep infection needing explantation in 3.5%, vocal cord palsy in 5.6%, which persisted in at least 0.7% for over one year, and other complications in 5.6%. Hardware-related complications were: lead fracture in 11.9% of patients, disconnection in 2.8%, spontaneous turn-off in 1.4% and stimulator malfunction in 1.4%. We noted a tendency to different survival times between the two most commonly used lead models as well as a tendency to increased infection rate with increasing number of stimulator replacements. Conclusion: In this series we report on surgical and hardware complications from our 16 years of experience with VNS treatment. Infection following insertion of the VNS device and vocal cord palsy due to damage to the vagus nerve are the most serious complications related to the surgery. Avoiding unnecessary reoperations in order to reduce the appearances of these complications are of great importance. It is therefore essential to minimize technical malfunctions that will lead to additional surgery. Further studies are needed to evaluate the possible superiority of the modified leads.
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| 36. |
- Kobulashvili, T., et al.
(author)
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Current practices in long-term video-EEG monitoring services: A survey among partners of the E-PILEPSY pilot network of reference for refractory epilepsy and epilepsy surgery
- 2016
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311. ; 38, s. 38-45
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Journal article (peer-reviewed)abstract
- Purpose: The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. Method: A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement. Results: Complete responses were received from all (100%) EMUs surveyed. Continuous observation of patients was performed in 22 (81%) EMUs during regular working hours, and in 17 EMUs (63%) outside of regular working hours. Fifteen (56%) EMUs requested a signed informed consent before admission. All EMUs performed tapering/withdrawal of antiepileptic drugs, 14 (52%) prior to admission to an EMU. Specific protocols on antiepileptic drugs (AED) tapering were available in four (15%) EMUs. Standardized Operating Procedures (SOP) for the treatment of seizure clusters and status epilepticus were available in 16 (59%). Safety measures implemented by EMUs were: alarm seizure buttons in 21 (78%), restricted patient's ambulation in 19 (70%), guard rails in 16 (59%), and specially designated bathrooms in 7 (26%). Average costs for one inpatient day in EMU ranged between 100 and 2200 Euros. Conclusion: This study shows a considerable diversity in the organization and practice patterns across European epilepsy monitoring units. The collected data may contribute to the development and implementation of evidence-based recommended practices in LTM services across Europe. (C) 2016 The Authors. Published by Elsevier Ltd. on behalf of British Epilepsy Association.
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| 37. |
- Kumlien, Eva, et al.
(author)
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Attitudes towards epilepsy surgery : A nationwide survey among Swedish neurologists
- 2010
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 19:4, s. 253-255
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Journal article (peer-reviewed)abstract
- Purpose: Epilepsy surgery is safe and effective for epilepsy that is refractory to medical treatment. However, only a minority of candidates for epilepsy surgery are referred for surgical evaluation. We investigated Swedish neurologists' views on and criteria for referral for epilepsy surgery. Materials and methods: A survey was sent out to neurologists who treat patients with epilepsy. We received responses from 81% of referring hospitals and 57% of private practices. Results: Sixty-one percent of respondents considered that epilepsy surgery reduced seizure frequency and 53% that it improved quality of life. Surgical treatment was thought to be cost-effective by 90% of respondents. Referral for surgery was considered if three or more antiepileptic drugs had failed. Seizure frequency and severity and, the patient's own wishes were regarded as the most important criteria for surgical referral. MRI and EEG findings were also important whereas duration of illness was considered less important. Age below 65 years and lack of mental retardation were important for considering referral. Conclusion: In general Swedish neurologists have a cautious but positive attitude towards epilepsy surgery. Uncertainties about eligibility criteria among referring clinicians may contribute to the underutilization of epilepsy surgery.
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| 38. |
- Kumlien, Eva, et al.
(author)
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Seizure risk associated with neuroactive drugs : Data from the WHO adverse drug reactions database
- 2010
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 19:2, s. 69-73
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Journal article (peer-reviewed)abstract
- PURPOSE: To explore the association between the use of neuroactive drugs and reports of epileptic seizures. MATERIAL: Using the WHO adverse drug reactions (ADR) database, VigiBase, we surveyed reports of suspected seizures from 1968 until February 2006. Case reports of ADRs, that were classified as convulsions were collected and compared to the total number of ADRs reported. RESULTS: The total number of ADRs was 7,375,325. The number of convulsive events was 71,471. The ratio of convulsive ADRs to the total number of ADRs reported for each drug was evaluated and expressed as a percentage. The 10 drugs most frequently associated with convulsive ADRs were maprotilene (14.42%), escitaloprame (9.78%), buproprione (9.49%), clozapine (9.0%), chlorprothiexene (8.89%), amoxapine (8.74%), donepezil (8.40%), rivastigmine (6.41%), quetiapine (5.90%) and trimipramine (5.69%). CONCLUSIONS: Based on the reports in VigiBase, ADR reports relating to antidepressants, antipsychotic and cholinomimetic drugs included seizures more often than other neuroactive drugs.
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| 39. |
- Larsson, David, 1986, et al.
(author)
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Retention rate of first antiepileptic drug in poststroke epilepsy: A nationwide study
- 2019
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In: Seizure. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 64, s. 29-33
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Journal article (peer-reviewed)abstract
- Purpose: To describe the retention rates of first antiepileptic drugs (AEDs) in patients with poststroke epilepsy on a nationwide scale. Methods: The Swedish Stroke Register, which has 94% coverage and high-resolution data on stroke, comorbidities, and disability, was cross-referenced to the National Patient Register, Drug Register, and Cause-of-Death Register. Patients with onset of AED-treated epilepsy after stroke in 2005–2010 were included. An algorithm based on prescription renewal intervals was used to analyze treatment data until the end of 2014. Results: A total of 4991 patients were included. First AEDs analyzed were carbamazepine (n = 2373), valproic acid (n = 943), levetiracetam (n = 555), lamotrigine (n = 519), phenytoin (n = 176), and oxcarbazepine (n = 89). The five-year retention rate was highest for lamotrigine (75%, 95%CI:70.4–79.4), followed by levetiracetam (69%, 95%CI:62.9–74.3), oxcarbazepine (68%, 95%CI:55.2–79.8), valproic acid (62%, 95%CI:57.8–66.4), carbamazepine (60%, 95%CI:57.6–62.4), and phenytoin (55%, 95%CI:45.2–64.0). There were minor differences in baseline characteristics with low levels of disability being slightly more common in patients treated with lamotrigine and levetiracetam. Atrial fibrillation and hypertension were more common in patients treated with levetiracetam, and atrial fibrillation was less common in patients treated with carbamazepine. In a Cox model adjusted for baseline characteristics, the risk of discontinuation was lower for lamotrigine (HR 0.53, 95%CI:0.43-0.67) and levetiracetam (HR 0.75, 95%CI:0.60-0.94) when compared to carbamazepine. Conclusions: Lamotrigine and levetiracetam have higher retention rates than carbamazepine in poststroke epilepsy. This is in agreement with existing small RCTs in this patient group. © 2018 British Epilepsy Association
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| 40. |
- Larsson, David, 1986, et al.
(author)
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Risk of stroke after new-onset seizures
- 2020
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 83, s. 76-82
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Journal article (peer-reviewed)abstract
- Purpose: Observational cohort studies have reported a potentially increased risk of stroke in patients with epileptic seizures. Whether late-onset seizures merit primary stroke prophylaxis is not known, and more information on stroke risk is needed for the planning of RCTs. We performed a case-control study based on Swedish national registers to quantify the risk of stroke after epileptic seizures. Methods: Cases <= 100 years of age with a first-ever stroke 2001-2009 were identified through the Swedish Stroke Register, and stroke-free controls (matched for age and sex) were obtained from the Population Register. The National Patient Register provided information on diagnostic codes for seizures, epilepsy and comorbidities. 123 105 stroke cases and 250 506 controls were included. Results: Epileptic seizures prior to index stroke date were detected in 1559 (1.27 %) cases and 1806 (0.72 %) controls, yielding an odds ratio (95 % confidence interval) for stroke of 1.77 (1.65-1.89). ORs were similar in men and women, but higher below the age of 75. An onset of seizures in the year preceding stroke date resulted in a higher risk for stroke (OR = 2.21, 95 % CI =1.79-2.72) compared to when more than 5 years had passed since the first seizure (OR = 1.57, 95 % CI = 1.43-1.72). Conclusion: A history of epileptic seizures was associated with an increased risk of subsequent stroke. The risk seems to be particularly high in the first year following seizure diagnosis, which supports the notion that unexplained late-onset seizures may merit swift assessment of vascular risk profile. The nature of stroke prevention requires further study.
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| 41. |
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| 42. |
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| 43. |
- Lin, C. -Y, et al.
(author)
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Mindfulness-based cognitive therapy for sexuality (MBCT-S) improves sexual functioning and intimacy among older women with epilepsy : A multicenter randomized controlled trial
- 2019
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In: Seizure. - : Elsevier. - 1059-1311 .- 1532-2688. ; 73, s. 64-74
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Journal article (peer-reviewed)abstract
- Purpose: Women with epilepsy (WWE) frequently experience sexual problems, including sexual dysfunction and sexual distress. Therefore, this study aimed to examine the efficacy of a mindfulness-based cognitive therapy for sexuality (MBCT-S) on sexual function and intimacy among older adult WWE in Iran.Methods: A multicenter randomized controlled trial was conducted at 15 neurology clinics in three Iranian cities. WWE together with their partners and healthcare providers were randomly assigned in patient and partner (PP; n = 220), patient, partner, and healthcare provider (PPHP; n = 220), or treatment as usual (TAU; n = 220) group. WWE and their partners in both the PP and PPHP groups received eight weeks of MBCT-S sessions. In the PPHP group, three individual sessions on sexual counseling were added for healthcare providers. Self-assessment scales were used at baseline, one month and six months after completing the intervention. Mixed linear regression models were developed to determine differences among the three groups. Multilevel mediation analyses were conducted to understand the mediating effects of mindfulness, intimacy, patient-physicians relationship and sexual counseling barriers.Results: Improvements in sexual function, sexual distress, and intimacy were found in both the PP and PPHP groups at one-month and six-month follow-ups. The PPHP group compared with the PP group had greater improvement in intimacy at both follow-ups. Regarding sexual function, the PPHP group performed better than the PP group at the six-month follow-up.Conclusions: The MBCT-S appears efficacious in enhancing sexual function and reducing sex-related distress in Iranian older adult WWE. Future studies should examine its efficacy in other populations.
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| 44. |
- Lin, Chung-Ying, et al.
(author)
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Using Hospital Anxiety and Depression Scale (HADS) on patients with epilepsy : Confirmatory factor analysis and Rasch models
- 2017
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In: Seizure. - : Elsevier. - 1059-1311 .- 1532-2688. ; 45, s. 42-46
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Journal article (peer-reviewed)abstract
- PurposeThe problems of mood disorders are critical in people with epilepsy. Therefore, there is a need to validate a useful tool for the population. The Hospital Anxiety and Depression Scale (HADS) has been used on the population, and showed that it is a satisfactory screening tool. However, more evidence on its construct validity is needed.MethodA total of 1041 people with epilepsy were recruited in this study, and each completed the HADS. Confirmatory factor analysis (CFA) and Rasch analysis were used to understand the construct validity of the HADS. In addition, internal consistency was tested using Cronbachs’ α, person separation reliability, and item separation reliability. Ordering of the response descriptors and the differential item functioning (DIF) were examined using the Rasch models.ResultsThe HADS showed that 55.3% of our participants had anxiety; 56.0% had depression based on its cutoffs. CFA and Rasch analyses both showed the satisfactory construct validity of the HADS; the internal consistency was also acceptable (α = 0.82 in anxiety and 0.79 in depression; person separation reliability = 0.82 in anxiety and 0.73 in depression; item separation reliability = 0.98 in anxiety and 0.91 in depression). The difficulties of the four-point Likert scale used in the HADS were monotonically increased, which indicates no disordering response categories. No DIF items across male and female patients and across types of epilepsy were displayed in the HADS.ConclusionsThe HADS has promising psychometric properties on construct validity in people with epilepsy. Moreover, the additive item score is supported for calculating the cutoff.
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| 45. |
- Lind, Jonas, et al.
(author)
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Intravenous use of valproic acid in status epilepticus is associated with high risk of hyperammonemia
- 2019
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In: Seizure. - : W B SAUNDERS CO LTD. - 1059-1311 .- 1532-2688. ; 69, s. 20-24
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Journal article (peer-reviewed)abstract
- Purpose: The aim of the study was to examine the frequency of hyperammonemia secondary to valproic acid treatment in status epilepticus and to describe the characteristics of the patients. Methods: All patients with established status epilepticus during 2014 to 2016 at Ryhov County Hospital were identified in a retrospective case series. Clinical and laboratory findings were collected from electronic medical files and the Metavision database at the intensive care unit (ICU). Hyperammonemia was defined as a concentration of at least 50 mu mol/L. Results: 11 of 40 patients developed hyperammonemia. These patients had a significantly longer stay at the ICU (12.6 vs 2.5 days) and at the hospital (22 vs 11 days). All patients with hyperammonemia were treated at the ICU and all received antibiotics. 12 patients were treated with intravenous valproic acid outside the ICU. Hyperammonemia was not related to Body Mass Index, time to initiation of therapy or laboratory abnormalities except anemia (Hemoglobin 104 vs 122 g/l). There was no difference in mortality between groups. Conclusion: The risk of hyperammonemia is almost 40% in patients receiving intravenous valproic acid in the ICU setting. The underlying mechanisms are probably either individual susceptibility or high metabolic demands. A high vigilance should be recommended. These data require further research via prospective designs in which multiple variables are controlled to explore the effects of individual factors on treatment outcome.
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| 46. |
- Ljunggren, Sofia, et al.
(author)
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Cognitive outcome two years after frontal lobe resection for epilepsy - A prospective longitudinal study
- 2015
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311. ; 30, s. 50-56
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Journal article (peer-reviewed)abstract
- Purpose: To investigate cognitive outcomes after frontal lobe resection (FLR) for epilepsy in a consecutive single centre series. Methods: Neuropsychological examinations were performed prior to and two years (mean test interval 2.5 years) after surgery in 30 consecutive patients who underwent FLR. Cognitive outcome was evaluated with particular consideration to the site of surgery (lateral, premotor/SMA [supplementary motor area], mesial/orbital). Cognitive domains assessed were speed, language, memory, attention, executive functions and intelligence. 25 healthy controls were assessed at corresponding time points (mean test interval 3.0 years). Analyses were made both at group and individual levels. Results: At baseline the patients performed below controls in variables depending on speed, executive functions, global and verbal intelligence. Two years after surgery, the analyses at the subgroup level indicated that the lateral resection group had less improvement than the controls in global intelligence, FSIQ (p = .037). However, at the individual level, the majority of the change scores (74-100%) were classified as within the normal range for all but one variable. The exception was the variable "Comprehension" (measuring verbal reasoning ability) with reliable declines in 44% (8/18) of the patients. This pattern of decline was observed in the lateral (4/7 patients) and premotor/SMA (4/7 patients) resection groups. Seizure outcome and side of surgery did not influence these results. Conclusion: The main finding was cognitive stability at group level two years after FLR. A reliable decline in verbal reasoning ability was rather common at an individual level, but only in the lateral and premotor/SMA resection groups. The lateral resection group also had less improvement than the controls in global intelligence. (C) 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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| 47. |
- Mahamud, Zamzam, et al.
(author)
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Risk of epilepsy diagnosis after a first unprovoked seizure in dementia
- 2020
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311 .- 1532-2688. ; 82, s. 118-124
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Journal article (peer-reviewed)abstract
- Purpose: To estimate the risk of an epilepsy diagnosis after a first unprovoked seizure in dementia, in relation to the 60 % cut-off specified in the ILAE definition of epilepsy. Methods: The study was register-based. Individuals with diagnostic codes of a first unprovoked seizure were identified in the Swedish Dementia Register (SveDem) or a three times larger ageand sexmatched pool of controls (n = 1039 in SveDem and 743 controls). The risk of a diagnostic code for epilepsy was estimated by Kaplan Meier analysis. Results: The 5-year risk of a subsequent epilepsy diagnosis after a first unprovoked seizure was 32 % (95 % CI 27-37) in patients with dementia and 31 % (95 % CI 25-38) in controls. The 5-year risk of epilepsy was 48 % (95 % CI 37-59) for individuals age 70 years or below. The dementia subtype with the highest risk of epilepsy was early onset Alzheimer. Conclusion: The risk of an epilepsy diagnosis after a first unprovoked seizure is similar in patients with dementia and in controls. Our results indicate that epilepsy cannot be diagnosed after a first seizure simply on the basis of the patient having dementia. Instead, more studies are needed for individualized prediction of recurrence risk in dementia. Such studies should focus on particular dementia subtypes, younger patients, and identifying biomarkers.
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| 48. |
- Malmgren, Kristina, 1952, et al.
(author)
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Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment.
- 2017
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In: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 44, s. 217-224
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Research review (peer-reviewed)abstract
- There is Class I evidence for short-term efficacy of epilepsy surgery from two randomized controlled studies of temporal lobe resection. Long-term outcome studies are observational. The aim of this narrative review was to summarise long-term outcomes taking the study methodology into account.A PubMed search was conducted identifying articles on long-term outcomes of epilepsy surgery in adults with regard to seizures, antiepileptic drug treatment and employment. Definitions of seizure freedom were examined in order to identify the proportions of patients with sustained seizure freedom. The quality of the long-term studies was assessed.In a number of high-quality studies 40-50% of patients had been continuously free from seizures with impairment of consciousness 10 years after resective surgery, with a higher proportion seizure-free at each annual follow-up. The proportion of seizure-free adults in whom AEDs have been withdrawn varied widely across studies, from 19-63% after around 5 years of seizure freedom. Few long-term vocational outcome studies were identified and results were inconsistent. Some investigators found no postoperative changes, others found decreased employment for patients with continuing seizures, but no change or increased employment for seizure-free patients. Having employment at baseline and postoperative seizure freedom were the strongest predictors of employment after surgery.Long-term studies of outcomes after epilepsy surgery are by necessity observational. There is a need for more prospective longitudinal studies of both seizure and non-seizure outcomes, considering individual patient trajectories in order to obtain valid outcome data needed for counselling patients about epilepsy surgery.
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| 49. |
- Markhus, R., et al.
(author)
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EEG in fitness to drive evaluations in people with epilepsy - Considerable variations across Europe
- 2020
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In: Seizure-European Journal of Epilepsy. - : Elsevier BV. - 1059-1311. ; 79, s. 56-60
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Journal article (peer-reviewed)abstract
- Purpose: Epilepsy patients consider driving issues to be one of their most serious concerns. Ideally, decisions regarding fitness to drive should be based upon thorough evaluations by specialists in epilepsy care. In 2009, an EU directive was published aiming to harmonize evaluation practices within European countries, but, despite these recommendations, whether all epileptologists use the same criteria is unclear. We therefore conducted this study to investigate routine practices on how epileptologists at European epilepsy centers evaluate fitness to drive. Methods: A questionnaire was sent to 63 contact persons identified through the European Epi-Care and the Epilepsy network. The questionnaire addressed how fitness-to-drive evaluations were conducted, the involvement of different professionals, the use and interpretation of EEG, and opinions on existing regulations and guidelines. Results: The questionnaire was completed by 35 participants (56 % response rate). Results showed considerable variation regarding test routines and the emphasis placed on the occurrence and extent of epileptiform discharges revealed by EEG. 82 % of the responders agreed that there was a need for more research on how to better evaluate fitness-to-drive in people with epilepsy, and 89 % agreed that regulations on fitness to drive evaluations should be internationally coordinated. Conclusion: Our survey showed considerable variations among European epileptologists regarding use of EEG and how findings of EEG pathology should be assessed in fitness-to-drive evaluations. There is a clear need for more research on this issue and international guidelines on how such evaluations should be carried out would be of value.
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