RESUMEN

Importance: Traumatic brain injury (TBI), seizures, and dementia increase with age. There is a gap in understanding the associations of TBI, seizures, and medications such as antiseizure and antipsychotics with the progression of cognitive impairment across racial and ethnic groups. Objective: To investigate the association of TBI and seizures with the risk of cognitive impairment among cognitively normal older adults and the role of medications in moderating the association. Design, Setting, and Participants: This multicenter cohort study was a secondary analysis of the Uniform Data Set collected between June 1, 2005, and June 30, 2020, from the National Alzheimer's Coordination Center. Statistical analysis was performed from February 1 to April 3, 2024. Data were collected from participants from 36 Alzheimer's Disease Research Centers in the US who were 65 years or older at baseline, cognitively normal at baseline (Clinical Dementia Rating of 0 and no impairment based on a presumptive etiologic diagnosis of AD), and had complete information on race and ethnicity, age, sex, educational level, and apolipoprotein E genotype. Exposure: Health history of TBI, seizures, or both conditions. Main Outcomes and Measures: Progression to cognitive impairment measured by a Clinical Dementia Rating greater than 0. Results: Among the cohort of 7180 older adults (median age, 74 years [range, 65-102 years]; 4729 women [65.9%]), 1036 were African American or Black (14.4%), 21 were American Indian or Alaska Native (0.3%), 143 were Asian (2.0%), 332 were Hispanic (4.6%), and 5648 were non-Hispanic White (78.7%); the median educational level was 16.0 years (range, 1.0-29.0 years). After adjustment for selection basis using propensity score weighting, seizure was associated with a 40% higher risk of cognitive impairment (hazard ratio [HR], 1.40; 95% CI, 1.19-1.65), TBI with a 25% higher risk of cognitive impairment (HR, 1.25; 95% CI, 1.17-1.34), and both seizure and TBI were associated with a 57% higher risk (HR, 1.57; 95% CI, 1.23-2.01). The interaction models indicated that Hispanic participants with TBI and seizures had a higher risk of cognitive impairment compared with other racial and ethnic groups. The use of antiseizure medications (HR, 1.23; 95% CI, 0.99-1.53), antidepressants (HR, 1.32; 95% CI, 1.17-1.50), and antipsychotics (HR, 2.15; 95% CI, 1.18-3.89) was associated with a higher risk of cognitive impairment, while anxiolytic, sedative, or hypnotic use (HR, 0.88; 95% CI, 0.83-0.94) was associated with a lower risk. Conclusions and Relevance: This study highlights the importance of addressing TBI and seizures as risk factors for cognitive impairment among older adults. Addressing the broader social determinants of health and bridging the health divide across various racial and ethnic groups are essential for the comprehensive management and prevention of dementia.

Asunto(s)

Lesiones Traumáticas del Encéfalo , Disfunción Cognitiva , Convulsiones , Humanos , Femenino , Masculino , Anciano , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Lesiones Traumáticas del Encéfalo/complicaciones , Lesiones Traumáticas del Encéfalo/epidemiología , Lesiones Traumáticas del Encéfalo/etnología , Convulsiones/epidemiología , Convulsiones/complicaciones , Anciano de 80 o más Años , Estudios de Cohortes , Estados Unidos/epidemiología , Factores de Riesgo , Progresión de la Enfermedad

RESUMEN

CONTEXT: Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. AIMS: The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. SETTINGS AND DESIGN: This was a cross-sectional descriptive study in a Southeast Nigeria local government area. SUBJECTS AND METHODS: PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. STATISTICAL ANALYSIS USED: The Statistical Package for the Social Sciences version 22.0 was used. RESULTS: There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. CONCLUSIONS: Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.

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Résumé Contexte:Les crises d'épilepsie et les chutes imprévisibles résultant des crises d'épilepsie prédisposent les personnes vivant avec l'épilepsie (PLWE) à diverses blessures physiques ainsi que des changements cognitifs et comportementaux post-critiques.Objectifs:Le but de l'étude était de déterminer la fréquence et les caractéristiques des blessures physiques liées aux crises, des déficiences cognitives post-critiques et des changements de comportement. Paramètres et conception: il s'agissait d'une étude descriptive transversale dans une zone de gouvernement local du sud-est du Nigeria. Sujets et méthodes: PLWE identifiées lors d'une enquête porte-à-porte en deux phases et leurs soignants ont été interrogés à l'aide d'un questionnaire semi-structuré. Analyse statistique utilisée: Le progiciel statistique pour les sciences sociales version 22.0 a été utilisé.Résultats:Il y a eu 56 cas de crises convulsives actives comprenant 33 (58,9 %) hommes et 23 (41,1 %) femmes, avec un âge moyen de 32,9 ± 14,2 ans. La prévalence au cours de la vie des blessures physiques, des changements de comportement post-critiques et des troubles cognitifs post-critiques liés aux crises était de 9,8 pour 1 000 (95 % intervalle de confiance [IC]: 9,1 à 10,0), 8,4 pour 1 000 (IC à 95 %: 7,2 à 9,2) et 6,3 pour 1 000 (IC à 95 %: 4,9 à 7,5), respectivement. Blessures de la peau/des tissus mous et les lacérations de la langue étaient les blessures physiques les plus fréquentes trouvées dans 66,1 % (n = 37/56) et 60,7 % ( n = 34/56) des cas, respectivement. La fréquence de les blessures des tissus mous étaient significativement plus élevées (χ 2 = 5,038; P = 0,0248) chez les femmes 78,3 % ( n = 18/23) que chez les hommes 48,5 % ( n = 16/33). Environ un tiers Parmi les femmes, 39,1 % avaient des brûlures, contre 18,1 % des hommes.Conclusions:Les blessures liées aux convulsions sont fréquentes et ont tendance à accroître le fardeau de l'épilepsie et de la stigmatisation liée à l'épilepsie due aux malformations et aux cicatrices défigurantes chroniques résultant de telles blessures.

Asunto(s)

Epilepsia , Convulsiones , Heridas y Lesiones , Humanos , Masculino , Femenino , Nigeria/epidemiología , Adulto , Estudios Transversales , Prevalencia , Epilepsia/epidemiología , Persona de Mediana Edad , Convulsiones/epidemiología , Adolescente , Adulto Joven , Encuestas y Cuestionarios , Heridas y Lesiones/epidemiología , Heridas y Lesiones/complicaciones , Distribución por Sexo , Anciano , Distribución por Edad , Accidentes por Caídas/estadística & datos numéricos

RESUMEN

OBJECTIVE: We aimed to evaluate epidemiology, seizure type, EEG, and etiology of neonatal seizures (NS) in a tertiary neonatal intensive care unit. METHODS: Data on infants with a neurophysiological confirmation of NS were collected between 2009 and 2022. Seizure types and epileptic syndromes were classified by the ILAE classification and EEG by the Italian Neonatal Seizure Collaborative Network (INNESCO) score. RESULTS: Out of 91,253 neonates, 145 presented with NS; 69.7 % were born at term and 30.3 % were preterm infants. The incidence of NS in neonates born at our center was 1.2 per 1,000 live newborns (96/80697 neonates) while in the entire neonatal population admitted to our center it was 1.6 per 1,000 live births, increasing with lower preterm age. Compared to previous studies, we found a lower proportion of hypoxic-ischemic encephalopathy (HIE) (23.4 %) and a higher rate of genetic contribution (26.2 %). The infection rate was higher in preterm (31.8 %) than in full term (9.9 %) infants. Electrographic seizures were associated with acute provoked seizures (35.9 %), preterm age (52.3 %), and HIE (52.9 %). Vascular etiology was associated with focal clonic seizures (56.8 %). Non-structural neonatal genetic epilepsy was associated with sequential seizures (68.2 %), particularly KCNQ2 and SCN2A epilepsy. Background EEG was abnormal in all HIE, infections (85.7 %) and metabolic NS (83.3 %). In genetic epilepsy, background EEG depended on the epileptic syndrome: normal in 80 % of self-limited neonatal epilepsy and abnormal in 77.8 % of developmental and epileptic encephalopathy. Electroclinical seizures were associated with focal onset, while electrographic seizures correlated with a multifocal onset. CONCLUSIONS: A low incidence of HIE and a high incidence of genetic etiology were observed in our cohort of NS. Seizure type and EEG features are fundamental to address etiology.

Asunto(s)

Electroencefalografía , Convulsiones , Centros de Atención Terciaria , Humanos , Italia/epidemiología , Recién Nacido , Femenino , Masculino , Convulsiones/epidemiología , Estudios Retrospectivos , Incidencia , Unidades de Cuidado Intensivo Neonatal

RESUMEN

Importance: The widespread use of antihistamines in children for treatment of common cold symptoms and their central nervous system effects, like drowsiness, underscore the importance of being aware of the associated risks. Objective: To assess associations between prescriptions of first-generation antihistamines and seizures in children using a comprehensive and nationwide dataset. Design, Setting, and Participants: This cohort study used a self-controlled case-crossover design. Data were obtained from the National Health Insurance Service database in Korea. Children born between January 1, 2002, and December 31, 2005, who visited the emergency department for seizure events (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes R56.8, G40, and G41) during the follow-up period were included. Follow-up was completed on December 31, 2019, and data were analyzed from June 3, 2023, to January 30, 2024. Exposure: First-generation antihistamine prescription. Main Outcomes and Measures: Primary outcome consisted of an index seizure event. Odds ratios (ORs) for seizure events were estimated using a conditional logistic regression model, comparing first-generation antihistamine prescription 1 to 15 days before seizure (hazard period) against control period 1 (31-45 days before the event) and control period 2 (61-75 days before the event) using the same period windows. Stratified analyses were conducted to examine the association with individual participant characteristics. Results: Of 11 729 children who had a seizure event, 3178 (1776 [55.9%] boys) were identified as having been prescribed antihistamines during the hazard or the control period, but not both. Seizure events were predominantly observed in children aged 6 to 24 months (985 [31.0%]) and 25 months to 6 years (1445 [45.5%]). During the hazard period, 1476 first-generation antihistamine prescriptions were recorded, in contrast to 1239 and 1278 prescriptions during control periods 1 and 2, respectively. After multiple confounder adjustments, first-generation antihistamine prescription was associated with an increased seizure event risk during the hazard period (adjusted OR [AOR], 1.22 [95% CI, 1.13-1.31]). Stratified subgroup analyses showed consistent results, particularly in children aged 6 to 24 months who were prescribed first-generation antihistamines having a higher risk (AOR, 1.49 [95% CI, 1.31-1.70]) than children aged 25 months to 6 years (AOR, 1.11 [95% CI, 1.00-1.24]; P = .04 for interaction). Furthermore, sensitivity analyses, including adjustment for exposure window periods, evaluation of new first-generation antihistamine prescriptions, comparison of control points from the same period 1 year prior, and exclusion of individuals using combination drugs, confirmed a similarly high risk. Conclusions and Relevance: In this cohort study, prescriptions for first-generation antihistamines were associated with a 22.0% higher seizure risk in children, especially in those aged 6 to 24 months. These findings emphasize the need for careful and judicious prescription of first-generation antihistamines in young children and underline the need for further research to elucidate associations between antihistamine prescriptions and seizure risk.

Asunto(s)

Antagonistas de los Receptores Histamínicos , Convulsiones , Humanos , Masculino , Femenino , Preescolar , Convulsiones/tratamiento farmacológico , Convulsiones/epidemiología , República de Corea/epidemiología , Lactante , Antagonistas de los Receptores Histamínicos/uso terapéutico , Antagonistas de los Receptores Histamínicos/efectos adversos , Estudios Cruzados , Niño , Estudios de Cohortes , Estudios de Casos y Controles

RESUMEN

BACKGROUND: The rate of spontaneous Intracerebral Hemorrhage (sICH) is rising among young Americans. Trends in acute seizure (AS) incidence in this age group is largely unknown. Further, the association of AS with mortality has not been reported in this age group. The aim of this study is to determine trends in AS among young individuals with sICH. METHODS: The Merative MarketScan® Commercial Claims and Encounters database, for the years 2005 through 2015, served as the data source for this retrospective in-hospital population study. This period was chosen as spontaneous ICH incidence increased among young individuals between 2005 and 2015. Our study population included patients aged 18-64 years with ICH identified using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9/10) codes 430, 431, 432.0, 432.1, 432.9, I61, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, and I61.9, excluding those with a prior diagnosis of seizures (ICD-9/10 codes 345.x,780.3x, G40, G41, and R56.8). We computed yearly AS incidence, mortality (in patients with and without seizures), and analyzed trends. We applied a logistic regression model to determine the independent association of AS with mortality accounting for demographic and clinical variables. RESULTS: AS incidence increased linearly between 2005 (incidence rate: 8.1 %) and 2015 (incidence rate: 11.0 %), which represents a 26 % relative increase (P for trends <0.0001). In-hospital mortality rate was 14.3 % among those who developed AS and 11.5 % among those who did not have AS. Overall, between 2005 and 2015, in-hospital mortality decreased from 13.0 % to 9.7 % among patients without AS but remained unchanged among those with AS. Patients who developed AS were 10 % more likely to die than those who did not (OR: 1.10, 95 % confidence interval: 1.02-1.18). CONCLUSIONS: Between 2005 and 2015, the incidence of AS increased by nearly 26 % among young Americans with sICH. In-patient mortality remained unchanged among those who developed seizures but declined among those who did not. The occurrence of AS was independently associated with a 10 % higher risk of in-hospital death.

Asunto(s)

Hemorragia Cerebral , Convulsiones , Humanos , Masculino , Femenino , Convulsiones/epidemiología , Convulsiones/mortalidad , Adulto , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/complicaciones , Persona de Mediana Edad , Adulto Joven , Adolescente , Estudios Retrospectivos , Incidencia

RESUMEN

IMPORTANCE: In neonates with birth asphyxia (BA) and hypoxic-ischemic encephalopathy, therapeutic hypothermia (TH), initiated within six hours, is the only safe and established neuroprotective measure to prevent secondary brain injury. Infants born outside of TH centers have delayed access to cooling. OBJECTIVE: To compare in-hospital mortality, occurrence of seizures, and functional status at discharge in newborns with BA depending on postnatal transfer for treatment to another hospital within 24 h of admission (transferred (TN) versus non-transferred neonates (NTN)). DESIGN: Nationwide retrospective cohort study from a comprehensive hospital dataset using codes of the International Classification of Diseases, 10th modification (ICD-10). Clinical and outcome information was retrieved from diagnostic and procedural codes. Hierarchical multilevel logistic regression modeling was performed to quantify the effect of being postnatally transferred on target outcomes. SETTING: All discharges from German hospitals from 2016 to 2021. PARTICIPANTS: Full term neonates with birth asphyxia (ICD-10 code: P21) admitted to a pediatric department on their first day of life. EXPOSURES: Postnatal transfer to a pediatric department within 24 h of admission to an external hospital. MAIN OUTCOMES: In-hospital death; secondary outcomes: seizures and pediatric complex chronic conditions category (PCCC) ≥ 2. RESULTS: Of 11,703,800 pediatric cases, 25,914 fulfilled the inclusion criteria. TNs had higher proportions of organ dysfunction, TH, organ replacement therapies, and neurological sequelae in spite of slightly lower proportions of maternal risk factors. In TNs, the adjusted odds ratios (OR) for death, seizures, and PCCC ≥ 2 were 4.08 ((95% confidence interval 3.41-4.89), 2.99 (2.65-3.38), and 1.76 (1.52-2.05), respectively. A subgroup analysis among infants receiving TH (n = 3,283) found less pronounced adjusted ORs for death (1.67 (1.29-2.17)) and seizures (1.26 (1.07-1.48)) and inverse effects for PCCC ≥ 2 (0.81 (0.64-1.02)) in TNs. CONCLUSION AND RELEVANCE: This comprehensive nationwide study found increased odds for adverse outcomes in neonates with BA who were transferred to another facility within 24 h of hospital admission. Closely linking obstetrical units to a pediatric department and balancing geographical coverage of different levels of care facilities might help to minimize risks for postnatal emergency transfer and optimize perinatal care.

Asunto(s)

Asfixia Neonatal , Mortalidad Hospitalaria , Hipotermia Inducida , Transferencia de Pacientes , Humanos , Asfixia Neonatal/terapia , Asfixia Neonatal/complicaciones , Recién Nacido , Femenino , Masculino , Estudios Retrospectivos , Transferencia de Pacientes/estadística & datos numéricos , Alemania/epidemiología , Hipotermia Inducida/métodos , Hipoxia-Isquemia Encefálica/terapia , Hipoxia-Isquemia Encefálica/etiología , Convulsiones/etiología , Convulsiones/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos

RESUMEN

Encephalopathy is a diffuse brain dysfunction that results from systemic disorder. Patients with diffuse encephalopathy are at risk of developing clinical and electrographic seizures. The aim of this study is to assess the prevalence of electrographic seizures in a setting of encephalopathy and the clinical and electroencephalogram predictors. We retrospectively reviewed all continuous electroencephalograms done between 2019 and 2022. Continuous electroencephalograms with diffuse encephalopathy were included in the study. A total of 128 patients with diffuse encephalopathy were included in this study. Patients' ages ranged from 18 to 96 years old with a mean age of 55.3 ±â€…19.2 years old. Nine out of 128 patients had seizures with an incidence of 7%. Sixty-six point six percent were nonconvulsive electrographic seizures. Fourteen point three percent of the female patients with diffuse encephalopathy had seizures as compared to none of the male patients (P = .002). Also, 12% of patients with a history of epilepsy experienced seizures versus 5.8% of patients without this history (P = .049). Among electrographic features, 25% of patients with delta background had seizures versus 2.3% of the other patients (P = .048). Likewise, 90% of patients with periodic discharges developed seizures in comparison with none of the patients without (P = .001). Seizures are seen in 7% of patients with diffuse encephalopathy. Female gender, past history of epilepsy, delta background and periodic discharges are significant predictors of seizure development in patients with diffuse encephalopathy.

Asunto(s)

Electroencefalografía , Unidades de Cuidados Intensivos , Convulsiones , Humanos , Femenino , Masculino , Persona de Mediana Edad , Convulsiones/epidemiología , Estudios Retrospectivos , Adulto , Incidencia , Anciano , Unidades de Cuidados Intensivos/estadística & datos numéricos , Adolescente , Adulto Joven , Anciano de 80 o más Años , Encefalopatías/epidemiología , Encefalopatías/complicaciones , Factores de Riesgo , Factores Sexuales

RESUMEN

OBJECTIVE: Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation's link to binge eating, and to explore psychological characteristics of FS individuals. METHOD: Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders. RESULTS: We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet 'Perseveration' predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people. DISCUSSION: This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.

Asunto(s)

Trastorno por Atracón , Convulsiones , Humanos , Femenino , Masculino , Trastorno por Atracón/psicología , Trastorno por Atracón/epidemiología , Trastorno por Atracón/complicaciones , Estudios Transversales , Adulto , Persona de Mediana Edad , Convulsiones/psicología , Convulsiones/epidemiología , Depresión/epidemiología , Depresión/psicología , Adulto Joven , Ansiedad/epidemiología , Ansiedad/psicología , Escalas de Valoración Psiquiátrica , Encuestas y Cuestionarios , Trastornos Disociativos/epidemiología , Trastornos Disociativos/psicología

RESUMEN

BACKGROUND AND OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) provides lifesaving support to patients with cardiopulmonary failure. Although seizures increase mortality risks among critically ill patients broadly, studies specific to adult ECMO patients have largely been limited to single-center studies. Thus, we aimed to perform a systematic review and meta-analyses of seizure prevalence, mortality, and their associations in adult ECMO patients. METHODS: PubMed, EMBASE, Cochrane trial registry, Web of Science, and SCOPUS were searched on August 5, 2023. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we included studies of adults undergoing venovenous ECMO (VV-ECMO), venoarterial ECMO (VA-ECMO), or extracorporeal cardiopulmonary resuscitation (ECPR) that reported seizures during ECMO. The extracted data included study characteristics, patient demographics, ECMO support, EEG monitoring, and seizures, organized by ECMO types. Forest plot and meta-regression analyses were performed. Bias assessment was performed with the Egger test and Newcastle-Ottawa Scale. RESULTS: Twenty-three studies (n = 40,420, mean age = 51.8 years, male = 62%) were included. Data were extracted by ECMO type as follows: VV-ECMO (n = 16,633), non-ECPR VA-ECMO (n = 11,082), ECPR (n = 3,369), combination of VA-ECMO and ECPR (n = 240), and combination of all types (n = 9,096). The pooled seizure prevalence for all ECMO types was 3.0%, not significantly different across ECMO types (VV-ECMO = 2.0% [95% CI 0.8-4.5]; VA-ECMO = 3.5% [95% CI 1.7-7.0]; ECPR = 4.9% [95% CI 1.3-17.2]). The pooled mortality was lower for VV-ECMO (46.2% [95% CI 39.3-53.2]) than VA-ECMO (63.4% [95% CI 56.6-69.6]) and ECPR (61.5% [95% CI 57.3-65.6]). Specifically, for VV-ECMO, the pooled mortality of patients with and without seizures was 55.1% and 36.7%, respectively (relative risk = 1.5 [95% CI 1.3-1.7]). Similarly, for VA-ECMO, the pooled mortality of patients with and without seizures was 74.4% and 56.1%, respectively (relative risk = 1.3 [95% CI 1.2-1.5]). Meta-regression analyses demonstrated that seizure prevalence was not associated with prior neurologic comorbidities, adjusted for ECMO type and study year. DISCUSSION: Seizures are infrequent during ECMO support. However, they were associated with increased mortality when present. Multi-institutional, larger-scale studies using standardized EEG monitoring are necessary to further understand the risk factors of specific classes of seizures for individual ECMO types, and their effects on mortality. Limitations of our study include missing data for details on seizure types, sedating/antiseizure medications used during ECMO, other ECMO-related complications, and EEG recording protocols.

Asunto(s)

Oxigenación por Membrana Extracorpórea , Convulsiones , Humanos , Convulsiones/epidemiología , Convulsiones/mortalidad , Adulto

RESUMEN

BACKGROUND AND PURPOSE: Various risk factors have been described in the literature that increase the risk of seizures associated with stroke. This study was aimed to determine the occurrence rate of poststroke seizures (PSSs) and the associated risk factors in Arab population. MATERIALS AND METHODS: Study included all stroke patients aged >18 years with a minimum follow-up of 24 months following stroke to identify seizure occurrence. Patient's hospital records for all admissions and clinic visits were reviewed. Seizures were classified into early PSS if they occur within 1 week of stroke, and late PSS if they occur after 1 week of stroke. RESULTS: Out of 594 patients, 380 were males. Seizure occurrence was higher in anterior circulation infarctions (94.8%, P < 0.05), cortical location (80.5%, P < 0.05), large artery atherosclerosis (63.8%, P < 0.05), lower activated partial thromboplastin time (APTT) (P = 0.0007), patients with ischemic heart disease (IHD) (P = 0.01), and those who underwent craniotomy (P = 0.001). Nonhigh-density lipoprotein cholesterol was inversely related to PSS (P = 0.01). Higher stroke severity (89%) and confusion (67%) at the time of presentation were independently related to PSS. CONCLUSIONS: Eighty-two (13.8%) patients had PSS. Greater stroke severity at presentation with altered sensorium was independent risk factors for the development of PSS. Patients with underlying IHD, lower APTT, and undergoing neurosurgical intervention require vigilant monitoring for PSS.

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Résumé Ontexte et objectif:Divers facteurs de risque ont été décrits dans la littérature qui augmentent le risque de convulsions associées à un AVC. Cette étude visait à déterminer le taux d'occurrence des crises post-AVC (PSS) et les facteurs de risque associés dans la population arabe.Matériels et Méthodes:L'étude a inclus tous les patients victimes d'AVC âgés de plus de 18 ans avec un suivi minimum de 24 mois après l'AVC pour identifier la survenue d'une crise. Les dossiers hospitaliers des patients pour toutes les admissions et visites à la clinique ont été examinés. Les saisies ont été classées en premiers PSS s'ils surviennent dans la semaine suivant l'AVC, et PSS tardif s'ils surviennent après 1 semaine de l'AVC.Résultats:Sur 594 patients, 380 étaient des hommes. Crise d'épilepsie la fréquence était plus élevée dans les infarctus de la circulation antérieure (94,8 %, P < 0,05), la localisation corticale (80,5 %, P < 0,05), l'athérosclérose des grandes artères (63,8 %, P < 0,05), un temps de thromboplastine partielle activé (APTT) inférieur (P = 0,0007), les patients atteints de cardiopathie ischémique (IHD) (P = 0,01) et ceux ayant subi une craniotomie (P = 0,001). Le cholestérol des lipoprotéines non de haute densité était inversement lié au PSS (P = 0,01). Course supérieure la gravité (89 %) et la confusion (67 %) au moment de la présentation étaient indépendamment liées au PSS.Conclusions:Quatre-vingt-deux (13,8 %) patients avait PSS. Une plus grande gravité de l'AVC lors de la présentation avec un sensorium altéré était un facteur de risque indépendant pour le développement du PSS. Les patients avec une IHD sous-jacente, un APTT inférieur et une intervention neurochirurgicale nécessitent une surveillance vigilante du PSS.

Asunto(s)

Convulsiones , Accidente Cerebrovascular , Centros de Atención Terciaria , Humanos , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/complicaciones , Convulsiones/epidemiología , Convulsiones/etiología , Centros de Atención Terciaria/estadística & datos numéricos , Anciano , Adulto , Estudios Retrospectivos , Índice de Severidad de la Enfermedad

RESUMEN

Background and purpose:

To evaluate the long-term effects of the COVID-19 pandemic on seizure frequency and levels of mental distress in individuals with epilepsy and identify potential risk factors associated with increased seizure frequency.

. Methods:

This is a cross-sectional study conducted in Türkiye in May 2021 by phone. Information on epilepsy syndromes, antiseizure medications, average seizure frequency, and drug resistance was obtained from medical records. A questionnaire was completed that included demographic and clinical characteristics and Kessler Psychological Distress Scale 10 (K-10). From people with epilepsy (PWE), seizure control in the month before the pandemic and perceived stress, sleep changes, changes in adaptation during this period, and whether there were changes in seizure control after the pandemic were questioned.

. Results:

A total of 227 patients were included, and the K-10 score of 81.9% (186/227) of PWE was found to be ≥30. An increase in seizure frequency was detected in 34 (15%) patients. The factors affecting the increase in seizure frequency were analyzed using logistic regression analysis. In the univariate model hesitate to go to the emergency room despite having seizures during the pandemic (OR= 8.325; 95% CI: [2.943 - 23.551], p=<0.001) was evaluated as the parameter with the highest risk of increased seizure frequency. In multivariate analyses (enter model) only polytherapy (OR= 2.945; 95% CI: [1.152 – 7.532], p=0.024) was detected as the parameter with increased seizure frequency. 

. Conclusion:

One year after the declaration of the pandemic, we found that stress was still common, the frequency of seizures increased. In multivariate analyses, only polytherapy was detected as the parameter with increased seizure frequency. 

.

Asunto(s)

COVID-19 , Epilepsia , Convulsiones , Humanos , COVID-19/complicaciones , COVID-19/psicología , COVID-19/epidemiología , Estudios Transversales , Convulsiones/epidemiología , Convulsiones/psicología , Epilepsia/psicología , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Adulto , Masculino , Femenino , Persona de Mediana Edad , Anticonvulsivantes/uso terapéutico , Encuestas y Cuestionarios , Factores de Riesgo , SARS-CoV-2 , Estrés Psicológico/epidemiología , Distrés Psicológico

RESUMEN

OBJECTIVE: Emerging evidence supports that brain dysfunction may be attributable to environmental factors. This study aims to examine associations of ambient temperature and temperature variability (TV) with seizure incidence in children, which has not been explored. MATERIAL AND METHODS: Data on 2718 outpatient visits due to seizure were collected in Shanghai, China, from 2018 to 2023. Exposure to ambient temperature was estimated at children's residential addresses using spatial-temporal models. A time-stratified case-crossover design with a distributed lag non-linear model (DLNM) was conducted to assess the association between seizure incidence and daily average of ambient temperature over a period of 21 days prior to a case date of disease onset. For a given case date, we selected all dates falling on the same day of the week within the same month as control dates. We calculated a composite index of intra-day and inter-day TV, which was the standard deviation of the daily minimum and maximum temperatures, respectively, over 7 days preceding a case date. We then assessed the association between TV and seizure incidence. Stratified analyses were conducted by age (73.51% < 5 years old and 26.49 % ≥ 5 years old), sex (41.83% female), presence of fever (69.72%), and diagnosis of epilepsy (27.63%). RESULTS: We observed inversed J-shaped temperature-response curves. Lower temperatures had a significant and prolonged effect than higher temperatures. Using 20 °C (with the minimum effect) as the reference, the cumulative odds ratios (ORs) for over 0-21 days preceding the onset at the 5th percentile of the temperature (3 °C) and at the 95th percentile (29 °C) were 3.17 (95% CI: 1.77, 5.68) and 1.54 (95% CI: 0.97, 2.44), respectively. In addition, per 1 °C increases in TV0-7 was associated with OR of 1.08 (95% CI: 1.01, 1.15). Older children and those experiencing seizure with fever exhibited a higher risk of seizure onset at both lower and higher ambient temperatures. CONCLUSION: Both low and high temperatures can contribute to the morbidity related to pediatric seizure. Lower temperatures, however, exerted a longer period of effect prior to seizure onset than higher temperatures. An increased risk for incident seizure was significantly associated with temperature variability during preceding 7 days.

Asunto(s)

Estudios Cruzados , Convulsiones , Temperatura , Humanos , Convulsiones/epidemiología , Femenino , Masculino , Preescolar , China/epidemiología , Niño , Incidencia , Dinámicas no Lineales , Lactante , Exposición a Riesgos Ambientales/efectos adversos

RESUMEN

Extremely low gestational age newborns (ELGANs) are born at or below 28 weeks of gestational age. Despite improved obstetric care, the incidence of preterm birth continues to rise in advanced countries. Preterm birth remains a major cause of infant mortality, and for infants who survive, neonatal seizures are a significant predictor of later neurologic morbidity. However, little is known about risk factors for neonatal seizures in ELGANs. Understanding the association between neonatal seizures and the development of other neurologic disorders is important given the increasing prevalence of ELGANs. Identifying risk factors that contribute to the development of neonatal seizures in ELGANs may offer insights into novel mechanisms of epileptogenesis in the developing brain and improvements in the prevention or treatment of seizures in preterm infants, including ELGANs. In this literature review, we outline the limitations of epidemiologic studies of neonatal seizures in ELGANs and discuss risk factors for neonatal seizures.

Asunto(s)

Recien Nacido Extremadamente Prematuro , Convulsiones , Humanos , Convulsiones/epidemiología , Recién Nacido , Factores de Riesgo , Edad Gestacional

RESUMEN

BACKGROUND AND OBJECTIVES: Generalized convulsive seizures (GCSs) are the main risk factor of sudden unexpected death in epilepsy (SUDEP), which is likely due to peri-ictal cardiorespiratory dysfunction. The incidence of GCS-induced cardiac arrhythmias, their relationship to seizure severity markers, and their role in SUDEP physiopathology are unknown. The aim of this study was to analyze the incidence of seizure-induced cardiac arrhythmias, their association with electroclinical features and seizure severity biomarkers, as well as their specific occurrences in SUDEP cases. METHODS: This is an observational, prospective, multicenter study of patients with epilepsy aged 18 years and older with recorded GCS during inpatient video-EEG monitoring for epilepsy evaluation. Exclusion criteria were status epilepticus and an obscured video recording. We analyzed semiologic and cardiorespiratory features through video-EEG (VEEG), electrocardiogram, thoracoabdominal bands, and pulse oximetry. We investigated the presence of bradycardia, asystole, supraventricular tachyarrhythmias (SVTs), premature atrial beats, premature ventricular beats, nonsustained ventricular tachycardia (NSVT), atrial fibrillation (Afib), ventricular fibrillation (VF), atrioventricular block (AVB), exaggerated sinus arrhythmia (ESA), and exaggerated sinus arrhythmia with bradycardia (ESAWB). A board-certified cardiac electrophysiologist diagnosed and classified the arrhythmia types. Bradycardia, asystole, SVT, NSVT, Afib, VF, AVB, and ESAWB were classified as arrhythmias of interest because these were of SUDEP pathophysiology value. The main outcome was the occurrence of seizure-induced arrhythmias of interest during inpatient VEEG monitoring. Moreover, yearly follow-up was conducted to identify SUDEP cases. Binary logistic generalized estimating equations were used to determine clinical-demographic and peri-ictal variables that were predictive of the presence of seizure-induced arrhythmias of interest. The z-score test for 2 population proportions was used to test whether the proportion of seizures and patients with postconvulsive ESAWB or bradycardia differed between SUDEP cases and survivors. RESULTS: This study includes data from 249 patients (mean age 37.2 ± 23.5 years, 55% female) who had 455 seizures. The most common arrhythmia was ESA, with an incidence of 137 of 382 seizures (35.9%) (106/224 patients [47.3%]). There were 50 of 352 seizure-induced arrhythmias of interest (14.2%) in 41 of 204 patients (20.1%). ESAWB was the commonest in 22 of 394 seizures (5.6%) (18/225 patients [8%]), followed by SVT in 18 of 397 seizures (4.5%) (17/228 patients [7.5%]). During follow-up (48.36 ± 31.34 months), 8 SUDEPs occurred. Seizure-induced bradycardia (3.8% vs 12.5%, z = -16.66, p < 0.01) and ESAWB (6.6% vs 25%; z = -3.03, p < 0.01) were over-represented in patients who later died of SUDEP. There was no association between arrhythmias of interest and seizure severity biomarkers (p > 0.05). DISCUSSION: Markers of seizure severity are not related to seizure-induced arrhythmias of interest, suggesting that other factors such as occult cardiac abnormalities may be relevant for their occurrence. Seizure-induced ESAWB and bradycardia were more frequent in SUDEP cases, although this observation was based on a very limited number of SUDEP patients. Further case-control studies are needed to evaluate the yield of arrhythmias of interest along with respiratory changes as potential SUDEP biomarkers.

Asunto(s)

Arritmias Cardíacas , Electroencefalografía , Humanos , Femenino , Masculino , Adulto , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/fisiopatología , Arritmias Cardíacas/diagnóstico , Incidencia , Persona de Mediana Edad , Estudios Prospectivos , Muerte Súbita e Inesperada en la Epilepsia/epidemiología , Convulsiones/epidemiología , Convulsiones/fisiopatología , Epilepsia Generalizada/epidemiología , Epilepsia Generalizada/fisiopatología , Anciano , Adulto Joven , Electrocardiografía , Adolescente

RESUMEN

BACKGROUND: Although respiratory symptoms are the most prominent manifestations of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and especially the omicron variant, may cause neurological manifestations such as seizures. It remains unclear if specific variants of the virus increase the risk of seizures more than others. MATERIAL AND METHODS: This was a retrospective multicenter study of pediatric (zero to 16 years) patients with COVID-19 who attended five pediatric emergency departments in Madrid, Spain, between March 2020 and July 2022. An analysis of demographics, medical history, and seizure characteristics was conducted. The data obtained were correlated with the incidence of the different strains of SARS-CoV-2 in the Community of Madrid. RESULTS: A total of 2411 seizures (infectious and noninfectious) were recorded, and 35 of them (1.4%) were positive for SARS-CoV-2. Of those 35 patients, 18 (51.4%) reported a history of previous seizures. The highest percentage of cases occurred when the omicron variant was the most prevalent (28 [80%] vs 7 [20%] before omicron variant). Typical febrile seizures accounted for 52.9% of the cases. No treatment was required in more than half (57.1%) of the cases. CONCLUSION: during the emergence of the omicron variant, there has been an increase in the number of COVID-19-associated seizures. These findings highlight the need for SARS-CoV-2 screening in patients with febrile and afebrile seizures, in addition to other microbiological, biochemical, or neuroimaging tests, depending on the patient's age and clinical presentation.

Asunto(s)

COVID-19 , SARS-CoV-2 , Convulsiones , Humanos , COVID-19/complicaciones , Niño , Masculino , Femenino , Preescolar , Estudios Retrospectivos , Convulsiones/etiología , Convulsiones/epidemiología , Adolescente , Lactante , España/epidemiología , Recién Nacido

RESUMEN

Diagnosing a non-epileptic seizure is difficult in the absence of a video electroencephalogram. The expert commission of the international league against epilepsy proposes a diagnostic approach allowing the diagnosis to be made according to a degree of certainty with or in the absence of a video electroencephalogram. Our objective was to determine the hospital frequency of psychogenic non-epileptic seizures in the absence of video-electroencephalogram. Using the outpatient registry, we identified patients followed for epilepsy with two normal interictal electroencephalographies, between January 2020 and October 2021. A review of the patients' medical records and an assessment of the validity of the diagnosis were carried out. Out of 64 patients evaluated with normal interictal electroencephalogram, 19 were included as suffering from psychogenic non-epileptic seizures, i.e. 26.68%. The average age was 23.94 +/- 9.4 years. Women represented 68.4%. Patients followed in neurology represented 84%. A history of childhood trauma was found in (47.4%). The first crisis was preceded by stressful events in 47.36%. Post-traumatic stress disorder was the most represented with 73.7% of cases. The average age was 20.95 +/- 9.8 years for the first crisis and the average duration of evolution of the crises was 3 years +/- 2 years. This study illustrates the possibility of making a presumptive diagnosis of psychogenic non-epileptic seizure in the absence of video-electroencephalogram.

Asunto(s)

Electroencefalografía , Convulsiones , Humanos , Femenino , Masculino , Convulsiones/diagnóstico , Convulsiones/epidemiología , Adulto , Electroencefalografía/métodos , Adulto Joven , Adolescente , Malí , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/diagnóstico , Estudios Retrospectivos , Persona de Mediana Edad

RESUMEN

PURPOSE: Patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds may differ, however, this remains a gap in current literature. Comorbidities can play both a precipitating and a perpetuating role in FS and are important in the planning of individual treatment for this condition. With this study, we aimed to describe and compare the reported medical and psychiatric comorbidities, injuries, somatic and cognitive symptoms, and medical procedures among patients with FS from a private and a public epilepsy monitoring unit (EMU) in Cape Town, South Africa. METHODS: This is a retrospective case-control study. We collected data on the comorbidity and medical procedure histories, as well as symptoms and clinical signs reported by patients with video-electroencephalographically (video-EEG) confirmed FS without comorbid epilepsy. We used digital patient records starting with the earliest available digital record for each hospital until the year 2022. RESULTS: A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Public hospital patients had higher odds of reporting intellectual disability (aOR=15.58, 95% CI [1.80, 134.95]), circulatory system disease (aOR=2.63, 95% CI [1.02, 6.78]) and gait disturbance (aOR=8.52, 95% CI [1.96, 37.08]) compared to patients with FS attending the private hospital. They did, however, have fewer odds of reporting a history of an infectious or parasitic disease (aOR=0.31, 95% CI [0.11, 0.87]), respiratory system disease (aOR=0.23, 95% CI [0.06, 0.82]), or medical procedures in the past (aOR=0.32, 95% CI [0.16, 0.63]). CONCLUSION: The study presents prevalence and comparative data on the medical profiles of patients with FS from different socioeconomic backgrounds which may inform future considerations in FS diagnosis and treatment.

Asunto(s)

Comorbilidad , Hospitales Privados , Hospitales Públicos , Convulsiones , Humanos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Hospitales Públicos/estadística & datos numéricos , Convulsiones/epidemiología , Hospitales Privados/estadística & datos numéricos , Estudios de Casos y Controles , Sudáfrica/epidemiología , Persona de Mediana Edad , Adulto Joven , Trastornos Mentales/epidemiología , Electroencefalografía , Adolescente

RESUMEN

This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1-11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.

Asunto(s)

COVID-19 , Enfermedades del Sistema Nervioso , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , COVID-19/virología , Preescolar , Niño , Masculino , Femenino , Lactante , Adolescente , Enfermedades del Sistema Nervioso/virología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Cefalea/epidemiología , Cefalea/etiología , Recién Nacido , Convulsiones Febriles/epidemiología , Convulsiones Febriles/virología , Convulsiones Febriles/etiología , Convulsiones/epidemiología , Convulsiones/virología , Convulsiones/etiología , Pandemias

RESUMEN

BACKGROUND: While epilepsy-related injuries (ERIs) are frequent in people with epilepsy (PWE), factors associated with hospitalization because of ERIs remain relatively unknown. METHODS: We conducted a cross-sectional anonymous survey at a tertiary epilepsy clinic among adult outpatients with epilepsy. Participants indicated their demographic, clinical characteristics, adverse effects of antiseizure medications (ASMs), somatic comorbidities and whether they were hospitalized because of ERIs in the past. For variables with significantly different distributions between participant subgroups (positive vs negative history of past hospitalisation because of ERI), the association with ERI-linked hospitalization was assessed using univariable and multivariable regression models. RESULTS: Among 600 PWE (312, 52.0 % female) included, 405 (67.5 %) reported at least one ERI in the past and 104 (25.7 %) had been hospitalised because of at least one of the injuries. Age, seizures in the street, focal unaware seizures and adverse ASM effects were associated with ERI-linked hospitalization only in univariable regression models. Male sex (OR = 1.677, 95 % CI = 1.022-2.753), loss of consciousness during seizures (OR = 2.294, 95 % CI = 1.166-4.513), seizure frequency (OR = 1.264, 95 % CI = 1.024-1.559) and ASM-related loss of coordination (OR = 3.496, 95 % CI = 1.670-7.320) were statistically significant predictors in the multivariable model (Nagelkerke R2 = 0.106). CONCLUSION: Our study indicates that, beyond seizure-related factors, adverse effects of ASMs and somatic comorbidities need to be considered when estimating the odds of previous ERI-linked hospitalisations. Alternative determinants of a higher risk of serious ERI, such as lifestyle or occupational variables, should be explored in the future.

Asunto(s)

Anticonvulsivantes , Comorbilidad , Epilepsia , Hospitalización , Convulsiones , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios Transversales , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico , Hospitalización/estadística & datos numéricos , Convulsiones/epidemiología , Adulto Joven , Anciano , Heridas y Lesiones/complicaciones , Heridas y Lesiones/epidemiología , Adolescente

RESUMEN

BACKGROUND: Drug-resistant epilepsy (DRE) in selected individuals with the rare tuberous sclerosis complex (TSC) may benefit from resective epilepsy surgery. Furthermore, associated neuropsychiatric disorders (TAND) are common in patients with TSC; however, long-term data on how surgery affects neuropsychiatric comorbidities are sparse. MATERIALS AND METHODS: Two retrospective approaches were used to identify children with TSC and DRE with onset at < 18 years of age. The study group (surgical) was identified through the Swedish National Epilepsy Surgery Registry (n = 17), a registry with complete national coverage since 1990 and prospective patient enrolment since 1995. The reference group (non-surgical) was identified by searching medical records retrieved from the tertiary hospital of Southern Sweden (n = 52). Eligible participants were invited to complete the validated TAND lifetime checklist. Those who did not complete the checklist, never had DRE, or were aged < 7 years old were excluded from the study. The reference group was balanced with the study group for putative confounders, in the following hierarchical order: DRE at the survey, age at seizure onset, age at follow-up, and sex. RESULTS: After the balancing procedure, both groups comprised 13 participants. The median time from epilepsy onset to the survey was 18.5 (range: 7.75-40.25) and 16.0 (7.33-33.5) years in the study and reference groups, respectively. The median time from surgery to the survey was 13 years (range: 4-22). No significant differences were found in behavioural problems, autism spectrum disorder diagnosis or symptoms, or intellectual disability between the groups, regardless of surgery. Seizure-free individuals (n = 11) performed better in social skills (p = 0.016), intellectual skills (p = 0.029), and overall TAND scores (p = 0.005) than the non-seizure-free group (n = 15). CONCLUSION: This is the first study to evaluate TAND comorbidities during the long-term follow-up after epilepsy surgery in patients with TSC. We found no evidence of the adverse effects of TAND comorbidities after tuberectomy. However, a larger study that allows for a better adjustment for confounders is needed. Following previous studies, seizure-free individuals had fewer symptoms within most TAND domains compared with the group with uncontrolled epilepsy, indicating less severe symptomatology.

Asunto(s)

Epilepsia Refractaria , Esclerosis Tuberosa , Humanos , Esclerosis Tuberosa/cirugía , Esclerosis Tuberosa/complicaciones , Esclerosis Tuberosa/psicología , Esclerosis Tuberosa/epidemiología , Masculino , Femenino , Adolescente , Niño , Epilepsia Refractaria/cirugía , Epilepsia Refractaria/psicología , Epilepsia Refractaria/epidemiología , Estudios Retrospectivos , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Trastornos Mentales/psicología , Convulsiones/cirugía , Convulsiones/epidemiología , Convulsiones/psicología , Epilepsia/cirugía , Epilepsia/psicología , Epilepsia/epidemiología , Suecia/epidemiología , Adulto Joven , Sistema de Registros , Preescolar , Adulto , Resultado del Tratamiento