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In Utero Valproate Exposure May Increase Risk of Autism Symptoms

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In Utero Valproate Exposure May Increase Risk of Autism Symptoms

An elevated rate of autism traits was seen among a cohort of children exposed to antiepileptic drugs (AEDs) in utero. Study findings were reported in the July Epilepsia. “The most important determinant of association with autistic traits was higher doses of sodium valproate exposure,” said Amanda G. Wood, PhD, MPsych, a Senior Lecturer in the School of Psychology at the University of Birmingham in the United Kingdom.

While the use of valproate in women who may become pregnant is generally avoided, there are insufficient data regarding the risk of autism spectrum disorders with low-dose valproate. “If this risk is no greater than with other AEDs, it may enable women with genetic generalized epilepsy to retain optimal seizure control as well as minimize harm to their unborn child,” Dr. Wood said.

Dr. Wood and colleagues conducted a prospective cohort study in children exposed to anticonvulsants during pregnancy, with all assessments conducted by examiners who were blinded to drug-exposure status. Participants were 105 Australian children ages 6 to 8 who were recruited through the Australian Pregnancy Register for Women on Antiepileptic Medication. Maternal epilepsy, pregnancy, and medical history data were obtained prospectively. Autism traits were assessed using the Childhood Autism Rating Scale (CARS).

Among the cohort, 11 children (10.5%) had elevated CARS scores, and this proportion was substantially higher than the estimated prevalence of autism spectrum disorders in age-matched children nationally or internationally. Linear regression analysis showed that the mean valproate dose during pregnancy was a significant predictor of CARS scores after controlling for polytherapy, mean carbamazepine dose, folic acid use, seizures during pregnancy, tobacco and marijuana use, maternal IQ, and socioeconomic status.

Children who had in utero exposure to valproate were most likely to have elevated CARS scores, with 7.7% of the valproate monotherapy group and 46.7% of the valproate polytherapy group displaying autism spectrum disorder symptoms. The dose of valproate taken during pregnancy was found to be an independent risk factor for elevated CARS scores, whereas polytherapy was not. “CARS scores were not elevated in children exposed to polytherapy without valproate, suggesting that valproate, or valproate dose, rather than polytherapy per se, is the critical determinant of the relationship,” the researchers said.

Glenn S. Williams

References

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Wood AG, Nadebaum C, Anderson V, et al. Prospective assessment of autism traits in children exposed to antiepileptic drugs during pregnancy. Epilepsia. 2015;56(7):1047-1055.

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An elevated rate of autism traits was seen among a cohort of children exposed to antiepileptic drugs (AEDs) in utero. Study findings were reported in the July Epilepsia. “The most important determinant of association with autistic traits was higher doses of sodium valproate exposure,” said Amanda G. Wood, PhD, MPsych, a Senior Lecturer in the School of Psychology at the University of Birmingham in the United Kingdom.

While the use of valproate in women who may become pregnant is generally avoided, there are insufficient data regarding the risk of autism spectrum disorders with low-dose valproate. “If this risk is no greater than with other AEDs, it may enable women with genetic generalized epilepsy to retain optimal seizure control as well as minimize harm to their unborn child,” Dr. Wood said.

Dr. Wood and colleagues conducted a prospective cohort study in children exposed to anticonvulsants during pregnancy, with all assessments conducted by examiners who were blinded to drug-exposure status. Participants were 105 Australian children ages 6 to 8 who were recruited through the Australian Pregnancy Register for Women on Antiepileptic Medication. Maternal epilepsy, pregnancy, and medical history data were obtained prospectively. Autism traits were assessed using the Childhood Autism Rating Scale (CARS).

Among the cohort, 11 children (10.5%) had elevated CARS scores, and this proportion was substantially higher than the estimated prevalence of autism spectrum disorders in age-matched children nationally or internationally. Linear regression analysis showed that the mean valproate dose during pregnancy was a significant predictor of CARS scores after controlling for polytherapy, mean carbamazepine dose, folic acid use, seizures during pregnancy, tobacco and marijuana use, maternal IQ, and socioeconomic status.

Children who had in utero exposure to valproate were most likely to have elevated CARS scores, with 7.7% of the valproate monotherapy group and 46.7% of the valproate polytherapy group displaying autism spectrum disorder symptoms. The dose of valproate taken during pregnancy was found to be an independent risk factor for elevated CARS scores, whereas polytherapy was not. “CARS scores were not elevated in children exposed to polytherapy without valproate, suggesting that valproate, or valproate dose, rather than polytherapy per se, is the critical determinant of the relationship,” the researchers said.

Glenn S. Williams

An elevated rate of autism traits was seen among a cohort of children exposed to antiepileptic drugs (AEDs) in utero. Study findings were reported in the July Epilepsia. “The most important determinant of association with autistic traits was higher doses of sodium valproate exposure,” said Amanda G. Wood, PhD, MPsych, a Senior Lecturer in the School of Psychology at the University of Birmingham in the United Kingdom.

While the use of valproate in women who may become pregnant is generally avoided, there are insufficient data regarding the risk of autism spectrum disorders with low-dose valproate. “If this risk is no greater than with other AEDs, it may enable women with genetic generalized epilepsy to retain optimal seizure control as well as minimize harm to their unborn child,” Dr. Wood said.

Dr. Wood and colleagues conducted a prospective cohort study in children exposed to anticonvulsants during pregnancy, with all assessments conducted by examiners who were blinded to drug-exposure status. Participants were 105 Australian children ages 6 to 8 who were recruited through the Australian Pregnancy Register for Women on Antiepileptic Medication. Maternal epilepsy, pregnancy, and medical history data were obtained prospectively. Autism traits were assessed using the Childhood Autism Rating Scale (CARS).

Among the cohort, 11 children (10.5%) had elevated CARS scores, and this proportion was substantially higher than the estimated prevalence of autism spectrum disorders in age-matched children nationally or internationally. Linear regression analysis showed that the mean valproate dose during pregnancy was a significant predictor of CARS scores after controlling for polytherapy, mean carbamazepine dose, folic acid use, seizures during pregnancy, tobacco and marijuana use, maternal IQ, and socioeconomic status.

Children who had in utero exposure to valproate were most likely to have elevated CARS scores, with 7.7% of the valproate monotherapy group and 46.7% of the valproate polytherapy group displaying autism spectrum disorder symptoms. The dose of valproate taken during pregnancy was found to be an independent risk factor for elevated CARS scores, whereas polytherapy was not. “CARS scores were not elevated in children exposed to polytherapy without valproate, suggesting that valproate, or valproate dose, rather than polytherapy per se, is the critical determinant of the relationship,” the researchers said.

Glenn S. Williams

References

Suggested Reading
Wood AG, Nadebaum C, Anderson V, et al. Prospective assessment of autism traits in children exposed to antiepileptic drugs during pregnancy. Epilepsia. 2015;56(7):1047-1055.

References

Suggested Reading
Wood AG, Nadebaum C, Anderson V, et al. Prospective assessment of autism traits in children exposed to antiepileptic drugs during pregnancy. Epilepsia. 2015;56(7):1047-1055.

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In Utero Valproate Exposure May Increase Risk of Autism Symptoms
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Does Normal Memory Preclude Mesial Temporal Seizure Onset

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Does Normal Memory Preclude Mesial Temporal Seizure Onset
A study of patients with TLE who have nonlesional MRI and normal memory

This study examined 18 patients with video electroencephaolography (EEG) findings suggestive of temporal lobe epilepsy (TLE) who had unremarkable MRI and normal verbal and visual memory scores on neuropsychological tests. Interictal SEEG abnormalities were observed in the mesial temporal structures in 17 patients (94%) and in the temporal tip in 6 patients (33%). The majority of seizure onset was exclusively from the mesial structures (72%); the others were exclusively from the lateral temporal cortex or temporal tip structures (11%) and independently from mesial and neocortical foci (17%). The authors state 3 important findings from the study:

  • Normal memory does not preclude mesial temporal seizure onset
  • Onset of seizures exclusively from mesial temporal structures without early neocortical involvement is common, even in the absence of memory deficits
  • Extratemporal seizure onset is rare when video EEG and semiology are consistent with focal TLE.

Suresh S, Sweet J, Fastenau PS, Lüders H, Landazuri P, Miller J. Temporal lobe epilepsy in patients with nonlesional MRI and normal memory: an SEEG study. J Neurosurg. 2015:1-7.

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A study of patients with TLE who have nonlesional MRI and normal memory
A study of patients with TLE who have nonlesional MRI and normal memory

This study examined 18 patients with video electroencephaolography (EEG) findings suggestive of temporal lobe epilepsy (TLE) who had unremarkable MRI and normal verbal and visual memory scores on neuropsychological tests. Interictal SEEG abnormalities were observed in the mesial temporal structures in 17 patients (94%) and in the temporal tip in 6 patients (33%). The majority of seizure onset was exclusively from the mesial structures (72%); the others were exclusively from the lateral temporal cortex or temporal tip structures (11%) and independently from mesial and neocortical foci (17%). The authors state 3 important findings from the study:

  • Normal memory does not preclude mesial temporal seizure onset
  • Onset of seizures exclusively from mesial temporal structures without early neocortical involvement is common, even in the absence of memory deficits
  • Extratemporal seizure onset is rare when video EEG and semiology are consistent with focal TLE.

Suresh S, Sweet J, Fastenau PS, Lüders H, Landazuri P, Miller J. Temporal lobe epilepsy in patients with nonlesional MRI and normal memory: an SEEG study. J Neurosurg. 2015:1-7.

This study examined 18 patients with video electroencephaolography (EEG) findings suggestive of temporal lobe epilepsy (TLE) who had unremarkable MRI and normal verbal and visual memory scores on neuropsychological tests. Interictal SEEG abnormalities were observed in the mesial temporal structures in 17 patients (94%) and in the temporal tip in 6 patients (33%). The majority of seizure onset was exclusively from the mesial structures (72%); the others were exclusively from the lateral temporal cortex or temporal tip structures (11%) and independently from mesial and neocortical foci (17%). The authors state 3 important findings from the study:

  • Normal memory does not preclude mesial temporal seizure onset
  • Onset of seizures exclusively from mesial temporal structures without early neocortical involvement is common, even in the absence of memory deficits
  • Extratemporal seizure onset is rare when video EEG and semiology are consistent with focal TLE.

Suresh S, Sweet J, Fastenau PS, Lüders H, Landazuri P, Miller J. Temporal lobe epilepsy in patients with nonlesional MRI and normal memory: an SEEG study. J Neurosurg. 2015:1-7.

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Validation of a Seizure-Detection Algorithm for Generalized Tonic-Clonic Seizures

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Validation of a Seizure-Detection Algorithm for Generalized Tonic-Clonic Seizures
How will this algorithm affect patient monitoring and early intervention?

In a study of 33 patients, the Brain Sentinel seizure detection algorithm detected 20 of 21 confirmed generalized tonic-clonic seizures (GTCS) using surface electromyography (sEMG) and video-EEG monitoring. One false-positive detection occurred during the postictal period following a GTCS. This is a positive step for the Brain Sentinel seizure detection algorithm, which aims to facilitate patient monitoring and early intervention. Further studies in large patient groups are needed.

Szabó CA, Morgan LC, Kantar KM, et al. Electromyography-based seizure detector: preliminary results comparing a generalized tonic-clonic seizure detection algorithm to video-EEG recordings [published online ahead of print July 20, 2015]. Epilepsia. 2015; doi:10.1111/epi.13083.

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How will this algorithm affect patient monitoring and early intervention?
How will this algorithm affect patient monitoring and early intervention?

In a study of 33 patients, the Brain Sentinel seizure detection algorithm detected 20 of 21 confirmed generalized tonic-clonic seizures (GTCS) using surface electromyography (sEMG) and video-EEG monitoring. One false-positive detection occurred during the postictal period following a GTCS. This is a positive step for the Brain Sentinel seizure detection algorithm, which aims to facilitate patient monitoring and early intervention. Further studies in large patient groups are needed.

Szabó CA, Morgan LC, Kantar KM, et al. Electromyography-based seizure detector: preliminary results comparing a generalized tonic-clonic seizure detection algorithm to video-EEG recordings [published online ahead of print July 20, 2015]. Epilepsia. 2015; doi:10.1111/epi.13083.

In a study of 33 patients, the Brain Sentinel seizure detection algorithm detected 20 of 21 confirmed generalized tonic-clonic seizures (GTCS) using surface electromyography (sEMG) and video-EEG monitoring. One false-positive detection occurred during the postictal period following a GTCS. This is a positive step for the Brain Sentinel seizure detection algorithm, which aims to facilitate patient monitoring and early intervention. Further studies in large patient groups are needed.

Szabó CA, Morgan LC, Kantar KM, et al. Electromyography-based seizure detector: preliminary results comparing a generalized tonic-clonic seizure detection algorithm to video-EEG recordings [published online ahead of print July 20, 2015]. Epilepsia. 2015; doi:10.1111/epi.13083.

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Treatment of Atonic Seizures: Corpus Callosotomy or Vagus Nerve Stimulation?

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Treatment of Atonic Seizures: Corpus Callosotomy or Vagus Nerve Stimulation?
A systematic review of the literature

A literature review showed that patients with atonic seizures and/or drop attacks who underwent corpus callosotomy (CC) were significantly more likely to achieve a greater than 50% reduction in seizure frequency compared with those who underwent vagus nerve stimulation (VNS). Adverse events were more common with VNS but they were typically mild. The most common complication of CC was disconnection syndrome. A direct study comparing both techniques is needed.

Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy Behav. 2015;51:13-17.

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A systematic review of the literature
A systematic review of the literature

A literature review showed that patients with atonic seizures and/or drop attacks who underwent corpus callosotomy (CC) were significantly more likely to achieve a greater than 50% reduction in seizure frequency compared with those who underwent vagus nerve stimulation (VNS). Adverse events were more common with VNS but they were typically mild. The most common complication of CC was disconnection syndrome. A direct study comparing both techniques is needed.

Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy Behav. 2015;51:13-17.

A literature review showed that patients with atonic seizures and/or drop attacks who underwent corpus callosotomy (CC) were significantly more likely to achieve a greater than 50% reduction in seizure frequency compared with those who underwent vagus nerve stimulation (VNS). Adverse events were more common with VNS but they were typically mild. The most common complication of CC was disconnection syndrome. A direct study comparing both techniques is needed.

Rolston JD, Englot DJ, Wang DD, Garcia PA, Chang EF. Corpus callosotomy versus vagus nerve stimulation for atonic seizures and drop attacks: a systematic review. Epilepsy Behav. 2015;51:13-17.

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Somatosensory Auras Following Temporal Lobe Epilepsy Surgery

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Somatosensory Auras Following Temporal Lobe Epilepsy Surgery
What is the relevance of SSA to TLE?

In a retrospective analysis of 333 patients with drug-resistant epilepsy who underwent temporal lobe epilepsy surgery, 26 (7.8%) had somatosensory aura (SSA). Nearly half (12) of those with SSA had unilateral sensory symptoms; the rest had bilateral symptoms. Patients with SSA showed no differences in clinical and imaging characteristics compared with those without SSA; however they did have a higher rate of breakthrough seizures.

Perven G, Yardi R, Bulacio J, et al. The relevance of somatosensory auras in refractory temporal lobe epilepsies [published online ahead of print August 7, 2015]. Epilepsia. 2015; doi:10.1111/epi.13110.

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What is the relevance of SSA to TLE?
What is the relevance of SSA to TLE?

In a retrospective analysis of 333 patients with drug-resistant epilepsy who underwent temporal lobe epilepsy surgery, 26 (7.8%) had somatosensory aura (SSA). Nearly half (12) of those with SSA had unilateral sensory symptoms; the rest had bilateral symptoms. Patients with SSA showed no differences in clinical and imaging characteristics compared with those without SSA; however they did have a higher rate of breakthrough seizures.

Perven G, Yardi R, Bulacio J, et al. The relevance of somatosensory auras in refractory temporal lobe epilepsies [published online ahead of print August 7, 2015]. Epilepsia. 2015; doi:10.1111/epi.13110.

In a retrospective analysis of 333 patients with drug-resistant epilepsy who underwent temporal lobe epilepsy surgery, 26 (7.8%) had somatosensory aura (SSA). Nearly half (12) of those with SSA had unilateral sensory symptoms; the rest had bilateral symptoms. Patients with SSA showed no differences in clinical and imaging characteristics compared with those without SSA; however they did have a higher rate of breakthrough seizures.

Perven G, Yardi R, Bulacio J, et al. The relevance of somatosensory auras in refractory temporal lobe epilepsies [published online ahead of print August 7, 2015]. Epilepsia. 2015; doi:10.1111/epi.13110.

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Death and Adverse Outcomes at time of Delivery for Women with Epilepsy

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Death and Adverse Outcomes at time of Delivery for Women with Epilepsy
Are women with epilepsy at greater risk?

Pregnant women with epilepsy are at an increased risk of death and many adverse outcomes during their delivery hospitalization. Researchers examined hospitalization records from 2007 to 2011 including 69,385 women with epilepsy and 20,449,532 women without epilepsy. Risk of death during delivery hospitalization was significantly higher for women with epilepsy compared to women without epilepsy (80/100,000 vs 6/100,000). Women with epilepsy were also at a heighted risk for preeclampsia, preterm labor, stillbirth, cesarean delivery, and prolonged hospital stay.

MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States [published online ahead of print July 6, 2015]. Jama Neurol. 2015; doi:10.1001/jamaneurol.2015.1017.

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Are women with epilepsy at greater risk?
Are women with epilepsy at greater risk?

Pregnant women with epilepsy are at an increased risk of death and many adverse outcomes during their delivery hospitalization. Researchers examined hospitalization records from 2007 to 2011 including 69,385 women with epilepsy and 20,449,532 women without epilepsy. Risk of death during delivery hospitalization was significantly higher for women with epilepsy compared to women without epilepsy (80/100,000 vs 6/100,000). Women with epilepsy were also at a heighted risk for preeclampsia, preterm labor, stillbirth, cesarean delivery, and prolonged hospital stay.

MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States [published online ahead of print July 6, 2015]. Jama Neurol. 2015; doi:10.1001/jamaneurol.2015.1017.

Pregnant women with epilepsy are at an increased risk of death and many adverse outcomes during their delivery hospitalization. Researchers examined hospitalization records from 2007 to 2011 including 69,385 women with epilepsy and 20,449,532 women without epilepsy. Risk of death during delivery hospitalization was significantly higher for women with epilepsy compared to women without epilepsy (80/100,000 vs 6/100,000). Women with epilepsy were also at a heighted risk for preeclampsia, preterm labor, stillbirth, cesarean delivery, and prolonged hospital stay.

MacDonald SC, Bateman BT, McElrath TF, Hernández-Díaz S. Mortality and morbidity during delivery hospitalization among pregnant women with epilepsy in the United States [published online ahead of print July 6, 2015]. Jama Neurol. 2015; doi:10.1001/jamaneurol.2015.1017.

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Does a history of secondary generalized tonic-clonic seizures have a role in surgical risk stratification?

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Does a history of secondary generalized tonic-clonic seizures have a role in surgical risk stratification?
Predictors of secondary generalized tonic-clonic seizures in frontal lobe epilepsy

A retrospective analysis of 48 patients with confirmed frontal lobe epilepsy (FLE) examined the occurrence of secondary generalized tonic-clonic seizures (SGTCS). Three independent predictors of a history of SGTCS in FLE were identified:

  • Loss of responsiveness at seizure onset
  • A semiology involving early elementary motor signs
  • Multifocal spikes on EEG.

Seizure-free outcomes were reported in 57% of surgical cases and were more likely in those without SGTCS.

Baud MO, Vulliemoz S, Seeck M. Recurrent secondary generalization in frontal lobe epilepsy: predictors and a potential link to surgical outcome [published online ahead of print July 25, 2015]? Epilepsia. 2015; doi: 10.1111/epi.13086.

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Predictors of secondary generalized tonic-clonic seizures in frontal lobe epilepsy
Predictors of secondary generalized tonic-clonic seizures in frontal lobe epilepsy

A retrospective analysis of 48 patients with confirmed frontal lobe epilepsy (FLE) examined the occurrence of secondary generalized tonic-clonic seizures (SGTCS). Three independent predictors of a history of SGTCS in FLE were identified:

  • Loss of responsiveness at seizure onset
  • A semiology involving early elementary motor signs
  • Multifocal spikes on EEG.

Seizure-free outcomes were reported in 57% of surgical cases and were more likely in those without SGTCS.

Baud MO, Vulliemoz S, Seeck M. Recurrent secondary generalization in frontal lobe epilepsy: predictors and a potential link to surgical outcome [published online ahead of print July 25, 2015]? Epilepsia. 2015; doi: 10.1111/epi.13086.

A retrospective analysis of 48 patients with confirmed frontal lobe epilepsy (FLE) examined the occurrence of secondary generalized tonic-clonic seizures (SGTCS). Three independent predictors of a history of SGTCS in FLE were identified:

  • Loss of responsiveness at seizure onset
  • A semiology involving early elementary motor signs
  • Multifocal spikes on EEG.

Seizure-free outcomes were reported in 57% of surgical cases and were more likely in those without SGTCS.

Baud MO, Vulliemoz S, Seeck M. Recurrent secondary generalization in frontal lobe epilepsy: predictors and a potential link to surgical outcome [published online ahead of print July 25, 2015]? Epilepsia. 2015; doi: 10.1111/epi.13086.

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What are the Major Changes in the US Epilepsy Surgery Landscape?

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What are the Major Changes in the US Epilepsy Surgery Landscape?
Data from the National Association of Epilepsy Centers

Researchers examined data from the National Association of Epilepsy Centers’ (NAEC) annual surveys between 2003 and 2012. Highlights include:

  • Average Epilepsy Monitoring Unit (EMU) beds increased from 7 beds in 2008 to 8 beds in 2012
  • Annual EMU admission rates doubled between 2008 and 2012
  • Average number of EMU admissions and epilepsy surgeries per center declined between 2008 and 2012
  • Annual rate of anterior temporal lobectomies (ATL) for mesial temporal sclerosis (MTS) declined by >65% between 2006 and 2010
  • Annual rate of extratemporal surgery exceeded that of ATL for MTS from 2008 to 2012 and comprised 38% of all resective surgeries in 2012
  • Vagus nerve stimulator implant rates increased steadily every year and exceeded resective surgeries in 2011 and 2012.

Kaiboriboon K, Malkhachroum AM, Zrik A, et al. Epilepsy surgery in the United States: analysis of data from the National Association of Epilepsy Centers [published online ahead of print July 26, 2015]. Epilepsy Research. 2015; doi:http://dx.doi.org/10.1016/j.epilepsyres.2015.07.007.

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Data from the National Association of Epilepsy Centers
Data from the National Association of Epilepsy Centers

Researchers examined data from the National Association of Epilepsy Centers’ (NAEC) annual surveys between 2003 and 2012. Highlights include:

  • Average Epilepsy Monitoring Unit (EMU) beds increased from 7 beds in 2008 to 8 beds in 2012
  • Annual EMU admission rates doubled between 2008 and 2012
  • Average number of EMU admissions and epilepsy surgeries per center declined between 2008 and 2012
  • Annual rate of anterior temporal lobectomies (ATL) for mesial temporal sclerosis (MTS) declined by >65% between 2006 and 2010
  • Annual rate of extratemporal surgery exceeded that of ATL for MTS from 2008 to 2012 and comprised 38% of all resective surgeries in 2012
  • Vagus nerve stimulator implant rates increased steadily every year and exceeded resective surgeries in 2011 and 2012.

Kaiboriboon K, Malkhachroum AM, Zrik A, et al. Epilepsy surgery in the United States: analysis of data from the National Association of Epilepsy Centers [published online ahead of print July 26, 2015]. Epilepsy Research. 2015; doi:http://dx.doi.org/10.1016/j.epilepsyres.2015.07.007.

Researchers examined data from the National Association of Epilepsy Centers’ (NAEC) annual surveys between 2003 and 2012. Highlights include:

  • Average Epilepsy Monitoring Unit (EMU) beds increased from 7 beds in 2008 to 8 beds in 2012
  • Annual EMU admission rates doubled between 2008 and 2012
  • Average number of EMU admissions and epilepsy surgeries per center declined between 2008 and 2012
  • Annual rate of anterior temporal lobectomies (ATL) for mesial temporal sclerosis (MTS) declined by >65% between 2006 and 2010
  • Annual rate of extratemporal surgery exceeded that of ATL for MTS from 2008 to 2012 and comprised 38% of all resective surgeries in 2012
  • Vagus nerve stimulator implant rates increased steadily every year and exceeded resective surgeries in 2011 and 2012.

Kaiboriboon K, Malkhachroum AM, Zrik A, et al. Epilepsy surgery in the United States: analysis of data from the National Association of Epilepsy Centers [published online ahead of print July 26, 2015]. Epilepsy Research. 2015; doi:http://dx.doi.org/10.1016/j.epilepsyres.2015.07.007.

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Does Engagement in an Online Patient Community Improved Epilepsy Management?

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Does Engagement in an Online Patient Community Improved Epilepsy Management?
A study in US veterans who enrolled an internet-based community

Researchers discovered that engagement in an online patient community significantly improved both self-management and self-efficacy in those with epilepsy. The results are based on a survey of 249 eligible participants of whom 92 completed surveys on self-management and self-efficacy. After 6 weeks in the online patient community:

  • Epilepsy self-management scores improved from 139.7  to 142.7
  • Epilepsy self-efficacy scores improved from 244.2 to 254.4.

Completers of the surveys were more likely to login to the community, post to forums, leave profile comments and send private messages. Patients with chronic conditions, such as epilepsy, should be encouraged to participate in internet-based communities.

Hixson JD, Barnes D, Parko K, et al. Patients optimizing epilepsy management via an online community. Neurology. 2015; 85(2):129-136

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A study in US veterans who enrolled an internet-based community
A study in US veterans who enrolled an internet-based community

Researchers discovered that engagement in an online patient community significantly improved both self-management and self-efficacy in those with epilepsy. The results are based on a survey of 249 eligible participants of whom 92 completed surveys on self-management and self-efficacy. After 6 weeks in the online patient community:

  • Epilepsy self-management scores improved from 139.7  to 142.7
  • Epilepsy self-efficacy scores improved from 244.2 to 254.4.

Completers of the surveys were more likely to login to the community, post to forums, leave profile comments and send private messages. Patients with chronic conditions, such as epilepsy, should be encouraged to participate in internet-based communities.

Hixson JD, Barnes D, Parko K, et al. Patients optimizing epilepsy management via an online community. Neurology. 2015; 85(2):129-136

Researchers discovered that engagement in an online patient community significantly improved both self-management and self-efficacy in those with epilepsy. The results are based on a survey of 249 eligible participants of whom 92 completed surveys on self-management and self-efficacy. After 6 weeks in the online patient community:

  • Epilepsy self-management scores improved from 139.7  to 142.7
  • Epilepsy self-efficacy scores improved from 244.2 to 254.4.

Completers of the surveys were more likely to login to the community, post to forums, leave profile comments and send private messages. Patients with chronic conditions, such as epilepsy, should be encouraged to participate in internet-based communities.

Hixson JD, Barnes D, Parko K, et al. Patients optimizing epilepsy management via an online community. Neurology. 2015; 85(2):129-136

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Heart Rate Changes to Detect Clinical Seizures

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Heart Rate Changes to Detect Clinical Seizures
Are heart rate changes clinically useful to detect seizures?

Researchers evaluated 266 clinical seizures from 72 patients to investigate factors other than ECoG/EEG as detectors of clinical seizures. The probability of utilizing heart rate in clinical seizure detection is multifactorial and clinically useful in most cases. The factors influencing cardiac-based seizure detection include:

  • Gender – probability higher for men than women
  • Seizure class – probability is highest for complex partial seizures
  • Years with epilepsy – probability increases with patient’s years with epilepsy.

Osorio I, Manly BF. Probability of detection of clinical seizures using heart rate changes. Seizure. 2015;30:120-123.

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Are heart rate changes clinically useful to detect seizures?
Are heart rate changes clinically useful to detect seizures?

Researchers evaluated 266 clinical seizures from 72 patients to investigate factors other than ECoG/EEG as detectors of clinical seizures. The probability of utilizing heart rate in clinical seizure detection is multifactorial and clinically useful in most cases. The factors influencing cardiac-based seizure detection include:

  • Gender – probability higher for men than women
  • Seizure class – probability is highest for complex partial seizures
  • Years with epilepsy – probability increases with patient’s years with epilepsy.

Osorio I, Manly BF. Probability of detection of clinical seizures using heart rate changes. Seizure. 2015;30:120-123.

Researchers evaluated 266 clinical seizures from 72 patients to investigate factors other than ECoG/EEG as detectors of clinical seizures. The probability of utilizing heart rate in clinical seizure detection is multifactorial and clinically useful in most cases. The factors influencing cardiac-based seizure detection include:

  • Gender – probability higher for men than women
  • Seizure class – probability is highest for complex partial seizures
  • Years with epilepsy – probability increases with patient’s years with epilepsy.

Osorio I, Manly BF. Probability of detection of clinical seizures using heart rate changes. Seizure. 2015;30:120-123.

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