Objective To investigate the effect of anti-seizure medications (ASMs) pregabalin (PGB) monotherapy on sleep structure and quality of patients with focal epilepsy. MethodsAdult patients whom newly diagnosed focal epilepsy were collected and treated with PGB monotherapy. The main outcome measures were the changes of polysomnography and video-electroencephalography (PSG-VEEG), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) in epilepsy patients with PGB and baseline. Results PGB improved significantly sleep structural parameters, including increased total sleep time (P<0.001), decreased sleep latency (P<0.001), improved sleep efficiency (P<0.001), reduced wake time after sleep onset (P<0.001), increased sleep maintenance efficiency (P<0.001) and proportion of N3 sleep stage (P<0.001). In the group with poor sleep efficiency, 86.7% of patients achieved sleep efficiency>85% after PGB treatment. The difference was statistically significant (P<0.01). PGB reduced significantly PSQI score (P<0.001) and ISI score (P<0.001). No significant change in ESS score was observed (P>0.05). ConclusionsPGB could enhance slow-wave sleep (SWS), increase sleep quality and improve insomnia in patients with epilepsy without causing daytime sleepiness.
Objectives To analyze the prevalence and clinical features of depression, anxiety, depression and anxiety in Tibetan patients with epilepsy and to improve the diagnosis and treatment. Methods 102 patients with epilepsy, who had been admitted to the Department of Neurology of the People's Hospital of Tibet Autonomous Region from January 2017 to December 2017, were diagnosed according to the Chinese Standard Classification and Diagnostic Criteria for Mental Disorders (3rd Edition) (CCMD-3). The Hamilton depression scale (HAMD 24 items) and the Hamilton anxiety scale (HAMA 14 items) were used to measure depression and anxiety. Different genders, ages, durations, frequency of attacks, and seizures types were analyzed for depression, anxiety, depression and anxiety. Univariate analysis was used to screen the factors that may cause depression, anxiety, depression and anxiety in patients with epilepsy. Logistic regression was used to analyze the risk factors of depression, anxiety, depression and anxiety in patients with epilepsy. Results Among the 102 patients with epilepsy, 35 (34.31%) comorbid depression, 10 (9.80%) comorbid anxiety, and 54 (52.94%) comorbid depression and anxiety. Univariate analysis showed that there was a significantly statistical difference in the duration of the disease and the frequency of seizures in local patients with epilepsy (P<0.05). There was a statistically significant difference in the frequency of epileptic seizures and anxiety (P<0.05). Multivariate logistic regression analysis showed that the probability of anxiety in patients with a disease duration of ≤2 years was only 10.1% of those with a course >2 years [OR=0.101, 95%CI (0.012, 0.915), P<0.05]; and the frequency of seizures was not an risk factors for epileptic comorbid with anxiety (P>0.05). The rate of depression and anxiety in patients with seizure frequency >2 times per month was 4.853 times higher than that of patients with seizure frequency ≤2 times per month [OR=4.853, 95%CI (2.024, 11.634), P<0.05]. Conclusions Tibetan patients with epilepsy have a high prevalence of depression, anxiety, depression and anxiety. In the diagnosis and treatment, we should strengthen the understanding and provide the appropriate prevention and treatment to improve the diagnosis and treatment level.
Epilepsy is one of the most common neurological disorders, and surgical intervention is usually used for drug-resistant focal epilepsy. Cortical electrical stimulation is widely used in preoperative evaluation of epilepsy to explore the anatomical-clinical electrical correlations between epileptogenic and functional networks through electrical stimulation, and the functional brain maps produced by cortical electrical stimulation depict areas of the functional cortex at an individual level, identifying the functional cortex with greater precision, as well as helping to establish epilepsy network, enabling more precise localization of seizure zones and providing a more accurate localization for surgical resection. Electrical cortical stimulation has become a standard technique for the preoperative assessment of brain region function in brain surgery. It is an indispensable part of preoperative evaluation.The main types of functional mapping by electrical stimulation include stereoelectroencephalography (SEEG) and subdural electrode (SDE), SEEG-guided cortical electrical stimulation is gradually becoming more mainstream compared to subdural electrodes, and is increasingly valuable and important as a preoperative evaluation of epilepsy. It is increasingly demonstrating its value and importance because it avoids craniotomy, takes less time for surgery, has fewer associated complications and infections, and can explore deep lesions, increasing the understanding of human functional neuroanatomy and enabling more precise localization of seizure zones.This article reviews the history of the development of cortical electrical stimulation technology, the intrinsic mechanisms, the value of the application of SEEG, and also provides a comprehensive comparison between SEEG and SDE, despite the irreplaceable advantages of SEEG, attention should be paid to the unresolved clinical and scientific issues of SEEG, and the establishment of a consensus-based clinical guideline, as the application of this technology will be more widely used in both clinical and scientific work.
Temporal lobe epilepsy is the most common type of epilepsy in clinic. In recent years, many studies have found that patients with temporal lobe epilepsy have different degrees of influence in executive function related fields. This influence may not only exist in a certain field of executive function, but may be affected in several fields, and may be related to the origin site of seizures. However, up to now, there is no unified standard for the composition of executive function, and it is widely accepted that the three core components of executive function are working memory, inhibitory control and cognitive flexibility/switching. In addition, the International League Against Epilepsy proposed a new definition in 2010, and epilepsy is a brain network disease. There is a close relationship between brain neural network and cognitive impairment. According to the cognitive field, the brain neural network can be divided into six types: default mode network, salience network, executive control network, dorsal attention network, somatic motor network and visual network. In recent years, there has been increasing evidence that four related internal brain networks are series in a range of cognitive processes. The executive dysfunction of temporal lobe epilepsy may be related to the changes of functional connectivity of neural network, and may be related to the left uncinate fasciculus. This article reviews the research progress related to executive function in temporal lobe epilepsy from working memory, inhibitory control and cognitive flexibility, and discusses the correlation between the changes of temporal lobe epilepsy neural network and executive function research.
Epilepsy is a common neurological disorder that affect patients' cognitive function and their mental health, imposing a huge burden on families and society. There are approximately 50 million epilepsy patients worldwide, with a prevalence rate of 4‰~7‰ in China, including about 6 million active epilepsy patients. Although scientists have been devoted to the research and exploration of epilepsy, the causes and pathological mechanisms of epilepsy are still poorly understood. The effectiveness of anti-seizure drugs is limited, and more effective methods is needed. With the deepening of microbiological research, many studies have found significant differences in the composition of the intestinal microbiota of epilepsy patients compared to healthy individuals. Analysis of the intestinal microbiota of epilepsy patients through sequencing has shown significantly lower abundances of Bacteroidetes and Firmicutes compared to the normal population. Many related clinical studies have found that adopting a ketogenic diet, taking probiotics orally, using antibiotics, or fecal microbiota transplantation (FMT) can effectively control epilepsy by normalizing the intestinal microbiota. Various studies suggest a possible connection between the intestinal microbiota and epilepsy, recognizing that the intestinal microbiota can have an impact on the central nervous system. As a result, gut-brain axisis gradually recognized by scientists. Therefore, the role of the intestinal microbiota in epilepsy is gradually being recognized, and recent clinical studies have confirmed that supplementing probiotics can effectively reduce seizure frequency and improve comorbidities, which may become a new method for treating epilepsy.
ObjectiveTo investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy. MethodsFrom June 2012 to June 2021, epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects. The clinical data such as the application of Antiseizure medications (ASMs) during pregnancy, seizure frequency, pregnancy outcomes, delivery ways, offspring feeding ways and the incidence of complications were investigated and analyzed. ResultsAmong 36 epileptics with pregnancy, 20 cases (55.56%) were treated with ASMs alone, 5 cases (13.88%) were treated with combined medication, and 11 cases (30.56%) were treated without ASMs during pregnancy. 15 cases (41.67%) adhered to systematic application of ASMs, 17 cases (47.22%) did not adhere to systematic application of ASMs, and 4 cases (11.11%) had unknown medication history. The frequency of seizures increased in 5 cases, decreased in 7 cases and unchanged in 24 cases during pregnancy. Pregnancy outcomes: full-term delivery in 33 cases (91.67%), preterm delivery in 1 case (2.78%) and abortion in 2 cases (5.56%). Delivery mode: cesarean section in 31 cases (91.18%), vaginal delivery in 3 cases (8.82%). After delivery, 4 cases (11.76%) were fed with milk powder and 30 cases (88.24%) were breast-fed. Complications: There were 6 cases complicated with anemia (16.67%), 5 cases complicated with gestational hypertension (13.89%), 3 cases complicated with gestational diabetes (8.33%), 4 cases complicated with premature rupture of membranes (11.11%), 2 cases complicated with fetal growth restriction (5.56%), 2 cases complicated with oligohydramnios (5.56%), 3 cases complicated with fetal distress (8.33%) and 3 cases complicated with neonatal asphyxia (8.33%). ConclusionsThe proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled. There is a lack of standardized management for such patients in clinical practice.
To improve nursing interventions for patients with epilepsy and intellectual impairment. Epilepsy, as one of the common chronic neurological diseases, often coexists with intellectual impairment. This article reviews the treatment methods and related nursing measures for epilepsy patients with intellectual impairment, and proposes the application of comprehensive nursing concepts in clinical practice. The nursing of patients with epilepsy and intellectual impairment faces multiple challenges. Nursing activities provide personalized care needs, emphasize patient education, simplify medication treatment plans, and promote collaborative relationships between patients, nursing staff, and healthcare providers. Through evidence-based intervention, interdisciplinary collaboration, and innovative nursing models, nursing plays a crucial role in improving patient treatment outcomes and enhancing their quality of life.
Cerebral amyloid angiopathy (CAA) is an age-dependent disease affecting older subjects. CAA is characterized by lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), nontraumatic subarachnoid hemorrhage, and cortical superficial siderosis (cSS), which is the main causes of spontaneous intracranial hemorrhage in the elderly. If a patient had experienced dementia, psychiatric symptoms, recurrent or multiple lobar hemorrhage, the possibility of CAA should be considered. Epilepsy can be associated with CAA. Literature studies had found that CAA-related inflammation are predisposing factors for the development of epilepsy. It is a unique subtype of CAA, which is a form of inflammation and a rare clinical manifestation of sporadic CAA. CAA-ri is a special type of central nervous system vasculitis. Once CAA patients had exhibited atypical clinical manifestations, such as headache, epilepsy, behavioral changes, focal neurological signs, consciousness impairment combined with asymmetric T2 weighted magnetic resonance imaging high signal lesions, clinicians had to consider it maybe CAA-ri. Although CAA- ri is rare, timely diagnosis is important because once seizure had occured, which may indicated the inflammation in CAA patients may had reached a very serious level. Therefore, timely identification and treatment are particularly important. Literature shows that most patients responded well to immunosuppressants. Because of its uncommon, researches on epilepsy in CAA mainly focused on case reports currently, and there were many controversies about its pathological mechanism, treatment and prognosis. This article mainly reviews the incidence rate , pathological mechanism, treatment and prognosis of epilepsy in CAA.
ObjectiveThe risk factors of relapse in 133 epileptic children after withdrawal were analyzed retrospectively and provide reference for clinical withdrawal.MethodsFrom January 2017 to March 2019, 133 children with withdrawal epilepsy were selected as the study object. According to whether there was recurrence during the follow-up period, the children with epilepsy were divided into recurrence group (42 cases) and non recurrence group (91 cases). The gender, age of onset, history of trauma, frequency of seizure before treatment, EEG before drug reduction, imaging, type of medication, family history, time of reaching control, course of disease before treatment, comorbidity, multiple attack types, withdrawal speed and EEG before treatment were observed and compared between the two groups. ResultsThere were significant differences in EEG (χ2 =7.621), medication type (χ2=8.760), time to control (χ2=6.618), course before treatment (χ2=6.435), multiple seizure types (χ2=5.443) and epilepsy comorbidity (χ2=42.795) between the two groups (P < 0.05). The results of Logistic multiple regression analysis showed that the recurrence of epileptic children after drug reduction / withdrawal was correlated with abnormal EEG before drug reduction [OR=9.268, 95%CI (2.255, 38.092)], combined drug treatment [OR=3.205, 95%CI (1.159, 8.866)] and course of disease > 1 year before treatment [OR=5.363, 95%CI (1.781, 16.150)] (P < 0.05).ConclusionsIn order to reduce the possibility of recurrence of epileptic children, the treatment time of epileptic children with abnormal EEG, combined medication and long course before treatment should be prolonged properly.
Objective To investigated the influence of the CYP2C9 polymorphism on lipid profile and blood concentration in epileptic children with VPA. Methods This study collected the information of healthy children and epilepsy children who were treated with VPA in the First Affiliated Hospital of Putian University during June, 2018 to March, 2021. The serum lipids of 184 cases were collected and compared between epilepsy group before and after treatment with VPA with the control group. The polymorphism of CYP2C9 gene in children with epilepsy was detected, and lipid and VPA concentration were compared after classification. Results There was no significant difference in lipid between the control group and the epilepsy group before treatment (P>0.05); The TC, HDL, LDL, TC/HDL, LDL/HDL were statistically different in VPA treatment group from the control group (P<0.05), and there were statistical differences in TG, LDL, TC/HDL, LDL/HDL between the trial group before the initiation and VPA treatment (P<0.05); There is no correlation between VPA blood concentration and lipid (P>0.05). VPA concentration, TC, HDL, LDL, TC/HDL and LDL/HDL in CYP2C9 wild-type were statistically different from heterozygous mutant. Conculsions CYP2C9 polymorphism and long-term use of VPA caused the changes in serum lipid levels in epilepsy children.