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JAMA Neurology May 2023Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Pregnant women who have epilepsy need adequate engagement, information, and pregnancy planning and management to improve pregnancy outcomes.
OBJECTIVE
To investigate perinatal outcomes in women with epilepsy compared with women without epilepsy.
DATA SOURCES
Ovid MEDLINE, Embase, CINAHL, and PsycINFO were searched with no language or date restrictions (database inception through December 6, 2022). Searches also included OpenGrey and Google Scholar and manual searching in journals and reference lists of included studies.
STUDY SELECTION
All observational studies comparing women with and without epilepsy were included.
DATA EXTRACTION AND SYNTHESIS
The PRISMA checklist was used for abstracting data and the Newcastle-Ottawa Scale for risk-of-bias assessment. Data extraction and risk-of-bias assessment were done independently by 2 authors with mediation conducted independently by a third author. Pooled unadjusted odds ratios (OR) or mean differences were reported with 95% CI from random-effects (I2 heterogeneity statistic >50%) or fixed-effects (I2 < 50%) meta-analyses.
MAIN OUTCOMES AND MEASURES
Maternal, fetal, and neonatal complications.
RESULTS
Of 8313 articles identified, 76 were included in the meta-analyses. Women with epilepsy had increased odds of miscarriage (12 articles, 25 478 pregnancies; OR, 1.62; 95% CI, 1.15-2.29), stillbirth (20 articles, 28 134 229 pregnancies; OR, 1.37; 95% CI, 1.29-1.47), preterm birth (37 articles, 29 268 866 pregnancies; OR, 1.41; 95% CI, 1.32-1.51) and maternal death (4 articles, 23 288 083 pregnancies; OR, 5.00; 95% CI, 1.38-18.04). Neonates born to women with epilepsy had increased odds of congenital conditions (29 articles, 24 238 334 pregnancies; OR, 1.88; 95% CI, 1.66-2.12), neonatal intensive care unit admission (8 articles, 1 204 428 pregnancies; OR, 1.99; 95% CI, 1.58-2.51), and neonatal or infant death (13 articles, 1 426 692 pregnancies; OR, 1.87; 95% CI, 1.56-2.24). The increased odds of poor outcomes was increased with greater use of antiseizure medication.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis found that women with epilepsy have worse perinatal outcomes compared with women without epilepsy. Women with epilepsy should receive pregnancy counseling from an epilepsy specialist who can also optimize their antiseizure medication regimen before and during pregnancy.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pregnancy Outcome; Pregnancy Complications; Epilepsy; Abortion, Spontaneous
PubMed: 36912826
DOI: 10.1001/jamaneurol.2023.0148 -
Epilepsy & Behavior : E&B Sep 2021The epilepsy surgery treatment gap is well defined and secondary to a broad range of issues, including healthcare professionals' (HCPs') knowledge, attitude, and... (Review)
Review
OBJECTIVE
The epilepsy surgery treatment gap is well defined and secondary to a broad range of issues, including healthcare professionals' (HCPs') knowledge, attitude, and perception (KAP) toward epilepsy surgery. However, no previous systematic reviews investigated this important topic.
METHODS
The systematic review was conducted according to Preferred Reporting Items for the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified a total of 652 articles from multiple databases using database-specific queries and included 65 articles for full-text review after screening the titles and abstracts of the articles. Finally, we selected 11 papers for qualitative analysis. We critically appraised the quality of the studies using the Joanna Briggs critical appraisal tool.
RESULTS
The qualitative analysis of the content identified several key reasons causing healthcare professional-related barriers to epilepsy surgery: inadequate knowledge and awareness about the role of epilepsy surgery in drug-resistant epilepsy (DRE), poor identification and referral of patients with DRE, insufficient selection of candidates for presurgical workup, negative or ambivalent attitudes and perceptions regarding epilepsy surgery, deficient communication practices with patients regarding risk-benefit analysis of epilepsy surgery, and challenging coordination issues with the surgical referral. Neurologists with formal instruction in epilepsy, surgical exposure during training, participation in high volume epilepsy practice, or prior experience in surgical referral may refer more patients for surgical evaluation.
CONCLUSIONS
While significant work has been conducted in a limited number of studies to explore HCPs' knowledge gap and educational need regarding epilepsy surgery, further research is needed in defining the learning goals, assessing and validating specific learning gaps among providers, defining the learning outcomes, optimizing the educational format, content, and outcome measures, and appraising the achieved results following the educational intervention.
Topics: Epilepsy; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Learning; Perception
PubMed: 34273740
DOI: 10.1016/j.yebeh.2021.108199 -
Seizure Oct 2021We systematically reviewed the existing literature on the cosmetic adverse effects of antiseizure medications (ASMs) in order to depict a clear picture of these unwanted... (Review)
Review
BACKGROUND
We systematically reviewed the existing literature on the cosmetic adverse effects of antiseizure medications (ASMs) in order to depict a clear picture of these unwanted side effects of ASMs with a particular attention to hair loss, hirsutism, acne, and gingival hyperplasia.
METHODS
This systematic review was prepared according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE, and Google Scholar from the inception to 25 March, 2021 were systematically searched. These key words (title/abstract) were used: "hair loss" OR "hirsutism" OR "acne" OR "gingival hyperplasia" AND "seizure" OR "epilepsy" OR "anriseizure" OR "antiepileptic". The exclusion criteria included: non-original studies, articles not in English, and animal studies.
RESULTS
The primary search yielded 3938 studies; 127 studies were related to the topic and were included in the current systematic review. The most robust evidence on cosmetic adverse effects of ASMs were related to phenytoin (causing gingival hyperplasia, hirsutism, and acne) and valproate (causing hair loss and hirsutism); however, many other ASMs were also implicated in causing these cosmetic adverse effects.
CONCLUSION
Antiseizure medications may be associated with various cosmetic adverse effects. Phenytoin and valproate are the most notorious ASMs in this regard; but, other ASMs have also been implicated in causing hair loss, hirsutism, acne, and gingival hyperplasia. Physicians should pay more attention to these significant adverse effects that may affect a patient's facial attractiveness, quality of life, and emotional state.
Topics: Animals; Anticonvulsants; Epilepsy; Humans; Phenytoin; Quality of Life; Valproic Acid
PubMed: 34052629
DOI: 10.1016/j.seizure.2021.05.010 -
Journal of Pediatric Psychology Mar 2020The aim of this systematic review and meta-analysis was to provide an estimate of the prevalence of anxiety and depressive disorders in youth with epilepsy (YWE). It... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this systematic review and meta-analysis was to provide an estimate of the prevalence of anxiety and depressive disorders in youth with epilepsy (YWE). It also aimed to calculate the overall magnitude of observed differences in anxiety and depressive symptoms reported by YWE compared with healthy controls and investigate whether any factors moderated anxiety and depression outcomes in YWE.
METHODS
Following prospective registration, electronic databases were searched up until October 2018. Studies were included if they reported on the rate of anxiety or depression in samples of YWE, and/or if they used valid measures of anxious or depressive symptomatology in YWE compared with a healthy control sample.
RESULTS
Twenty-three studies met inclusion criteria. The overall pooled prevalence of anxiety disorders in YWE was 18.9% (95% confidence interval [CI] 12.0%-28.5%), and for depression the pooled prevalence was 13.5% (95% CI 8.8%-20.2%). In samples of YWE compared with healthy controls, significantly higher anxiety (d = 0.57, 95% CI 0.32-0.83, p < .000) and depressive (d = 0.42, 95% CI 0.16-0.68, p < .000) symptomatology was reported.
CONCLUSIONS
YWE report anxiety and depressive disorders and symptoms to a significantly higher degree than youth without epilepsy. There is also evidence that certain anxiety disorders (e.g. generalized anxiety disorder, separation anxiety disorder) are particularly elevated, perhaps reflecting the unique impact of epilepsy on youth psychopathology. Research is needed to understand the risk factors associated with anxiety and depressive disorders in epilepsy, and better understand how these symptoms change across development.
Topics: Adolescent; Anxiety; Anxiety Disorders; Child; Comorbidity; Depression; Depressive Disorder; Epilepsy; Female; Humans; Male; Prevalence; Prospective Studies; Risk Factors
PubMed: 31904859
DOI: 10.1093/jpepsy/jsz099 -
Epilepsy & Behavior : E&B May 2023Different neurostimulation modalities are available to treat drug-resistant focal epilepsy when surgery is not an option including vagus nerve stimulation (VNS),... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Different neurostimulation modalities are available to treat drug-resistant focal epilepsy when surgery is not an option including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS). Head-to-head comparisons of efficacy do not exist between them nor are likely to be available in the future. We performed a meta-analysis on VNS, RNS, and DBS outcomes to compare seizure reduction efficacy for focal epilepsy.
METHODS
We systematically reviewed the literature for reported seizure outcomes following implantation with VNS, RNS, and DBS in focal-onset seizures and performed a meta-analysis. Prospective or retrospective clinical studies were included.
RESULTS
Sufficient data were available at years one (n = 642, two (n = 480), and three (n = 385) for comparing the three modalities with each other. Seizure reduction for the devices at years one, two, and three respectively were: RNS: 66.3%, 56.0%, 68.4%; DBS- 58.4%, 57.5%, 63.8%; VNS 32.9%, 44.4%, 53.5%. Seizure reduction at year one was greater for RNS (p < 0.01) and DBS (p < 0.01) compared to VNS.
CONCLUSIONS
Our findings indicate the seizure reduction efficacy of RNS is similar to DBS, and both had greater seizure reductions compared to VNS in the first-year post-implantation, with the differences diminishing with longer-term follow-up.
SIGNIFICANCE
The results help guide neuromodulation treatment in eligible patients with drug-resistant focal epilepsy.
Topics: Humans; Retrospective Studies; Prospective Studies; Deep Brain Stimulation; Epilepsies, Partial; Drug Resistant Epilepsy; Seizures; Vagus Nerve Stimulation; Treatment Outcome
PubMed: 36972642
DOI: 10.1016/j.yebeh.2023.109182 -
Child's Nervous System : ChNS :... Jul 2021Several variations of functional disconnection surgery have been described for the treatment of lateralized, hemispheric, drug-resistant epilepsy in children. The... (Review)
Review
PURPOSE
Several variations of functional disconnection surgery have been described for the treatment of lateralized, hemispheric, drug-resistant epilepsy in children. The purpose of this study is to investigate the existing literature regarding patient selection, approach, and outcomes after hemispherotomy.
METHODS
A systematic review of the English literature through February 2019 was performed in accordance with the PRISMA statement. The articles were classified by level of evidence and summarized in an evidentiary table. Seizure outcomes, functional outcomes, surgical techniques, complications, and patient selection were critically analyzed.
RESULTS
A total of 173 papers were reviewed, of which 37 met criteria of inclusion and exclusion. Thirteen studies were classified as level III evidence, the remaining reached level IV. Vertical and lateral hemispherotomy achieve similar rates of seizure freedom and functional outcomes, though parasagittal and interhemispheric approaches may have shorter operative times and less blood loss. Etiology, bilateral MRI abnormalities, and nonlateralizing EEG did not predict worse seizure or functional outcomes.
CONCLUSIONS
Both vertical and lateral hemispherotomy approaches result in durable, reproducible benefits to epilepsy severity and functional status in appropriately selected pediatric patients.
Topics: Child; Drug Resistant Epilepsy; Epilepsy; Hemispherectomy; Humans; Seizures; Treatment Outcome
PubMed: 33907902
DOI: 10.1007/s00381-021-05176-x -
Epilepsia Jul 2023Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy... (Meta-Analysis)
Meta-Analysis Review
Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre- and post-epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta-analysis assessed the postsurgery change in QoL. Meta-regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre- and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory-31 item (QOLIE-31) meta-analysis included six studies, and QOLIE-89 meta-analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE-31 (95% confidence interval [CI] = 10.9-30.1, I = 95.5) and 12.1 for QOLIE-89 (95% CI = 8.0-16.1, I = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta-regression demonstrated a higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.
Topics: Adult; Humans; Quality of Life; Epilepsy; Seizures; Drug Resistant Epilepsy; Antidepressive Agents
PubMed: 37157209
DOI: 10.1111/epi.17644 -
Epilepsia Nov 2023This study was undertaken to systematically identify and critically appraise all published full economic evaluations assessing the cost-effectiveness of... (Review)
Review
This study was undertaken to systematically identify and critically appraise all published full economic evaluations assessing the cost-effectiveness of nonpharmacological interventions for patients with drug-resistant epilepsy. The Population, Intervention, Comparison, Outcome, Study criteria was used to design search strategies for the identification and selection of relevant studies. Literature search was performed using the MEDLINE (via PubMed), Embase, International Health Technology Assessment, National Institute for Health Research Economic Evaluation Database, and Cost-Effectiveness Analysis Registry databases to identify articles published between January 2000 and May 2023. Web of Science was additionally used to perform forward and backward referencing. Title, abstract, and full-text screening was performed by two independent researchers. The Consensus Health Economic Criteria (CHEC) checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 were applied for quality assessment. A total of 4470 studies were identified, of which 18 met our inclusion criteria. Twelve of the studies conducted model-based economic evaluation, and others were trial-based. Three studies showed that epilepsy surgery was cost-effective in adults, whereas this remained inconclusive for children (two positive, three negative). Three studies showed negative economic outcome for ketogenic diet in children. One of four studies showed positive results for self-management. For vagus nerve stimulation, one study showed positive results in adults and another one negative results in children. One recent study showed cost-effectiveness of responsive neurostimulation (RNS) in adults. Finally, one study showed promising but inconclusive results for deep brain stimulation (DBS). The mean scores for risk of bias assessment (based on CHEC) and for reporting quality (CHEERS 2022) were 95.8% and 80.5%, respectively. This review identified studies that assessed the cost-effectiveness of nonpharmacological treatments in both adults and children with drug-resistant epilepsy, suggesting that in adults, epilepsy surgery, vagus nerve stimulation, and RNS are cost-effective, and that DBS and self-management appear to be promising. In children, the cost-effectiveness of epilepsy surgery remains inconclusive. Finally, the use of ketogenic diet was shown not to be cost-effective. However, limited long-term data were available for newer interventions (i.e., ketogenic diet, DBS, and RNS).
Topics: Child; Adult; Humans; Cost-Benefit Analysis; Drug Resistant Epilepsy; Epilepsy; Diet, Ketogenic
PubMed: 37545415
DOI: 10.1111/epi.17742 -
Epilepsy & Behavior : E&B Feb 2021To perform a systematic review and meta-analysis to summarize and quantitatively evaluate the electroencephalogram (EEG) findings in patients with coronavirus disease... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To perform a systematic review and meta-analysis to summarize and quantitatively evaluate the electroencephalogram (EEG) findings in patients with coronavirus disease 2019 (COVID-19).
METHODS
The MEDLINE, CENTRAL, and ClinicalTrials.Gov databases were comprehensively assessed and searched for observational studies with EEG findings in patients with COVID-19. Pooled proportions of EEG findings with 95% confidence intervals (CIs) were assessed using a random effects model. The quality of assessment for each study, heterogeneity between the studies, and publication bias were also evaluated.
RESULTS
In total, 12 studies with 308 patients were included in the meta-analysis. Abnormal background activity and generalized slowing in the pooled proportions were common findings among the patients with COVID-19 (96.1% [95% CI: 89.4-99.9]; I = 60%; p < 0.01 and 92.3% [95% CI: 81.2-99.3]; I = 74%; p < 0.01, respectively). The proportion of patients with epileptiform discharges (EDs) was 20.3% ([95% CI: 9.85-32.9]; I = 78%; p < 0.01). The proportion of EDs varied between patients with a history of epilepsy or seizures (59.5% [95% CI: 33.9-83.2]; I = 0%; p = 0.49) and patients without them (22.4% [95% CI: 10.4-36.4]; I = 46%; p = 0.07). The findings of seizures and status epilepticus on EEG were observed in 2.05% ([95% CI: 0.02-6.04]; I = 39%; p = 0.08) and 0.80% ([95% CI: 0.00.-3.69]; I = 28%; p = 0.17) of the patients, respectively.
CONCLUSION
The proportion of abnormal background activity in patients with COVID-19 was high (96.1%). Epileptiform discharges were present in 20.3% of the cases and the proportion varied between people who had a history of epilepsy/seizure and those who did not. However, the proportion of seizures and status epilepticus on EEG was low (2.05% and 0. 80%, respectively).
Topics: COVID-19; Clinical Trials as Topic; Electroencephalography; Epilepsy; Humans
PubMed: 33342709
DOI: 10.1016/j.yebeh.2020.107682 -
Epilepsy & Behavior : E&B Aug 2022Epilepsy is a global problem that affects all countries and people of all ages. However, the disease burden is high in low- and middle-income countries. Poor public... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epilepsy is a global problem that affects all countries and people of all ages. However, the disease burden is high in low- and middle-income countries. Poor public knowledge of epilepsy increases the rate of stigma and discrimination. However, in our country, there is a scarcity of summarized evidence about the level of public knowledge toward epilepsy. Therefore, to fill this gap, conducting this review and meta-analysis has a preponderant significance.
METHODS
Articles were explored from PubMed, PsycINFO, Hinari, Science Direct, web of science, and African journal of online (AJOL) databases, Google, and Google scholar. For data extraction and analysis purposes, Microsoft Excel spreadsheet and STATA software version 16 were used. To write this report, we used the Preferred Reporting Items for systematic reviews and Meta-Analysis. To assess the pooledmagnitudeof public knowledge toward epilepsy, we used arandom-effects meta-analysis model. We checked the Heterogeneity by I. To detect publication bias, Begg's test, Egger's test, and funnel plot were conducted. Furthermore, subgroup analysis was conducted. Association was expressed through a pooled odds ratio with a 95% confidence interval.
RESULT
Our review and meta-analysis included 9 studies with 5658 participants. The pooled magnitude of poor knowledge toward epilepsy was 48.54% [95% CI (33.57, 63.51)]. I was 99.4% (P < 0.01). Begg's and Egger's test results were 0.92 and 0.06, respectively. Cannot read and write OR: 2.86 [95 CI (2.04, 4.00]) and not witnessing seizure episode OR: 3.00 [95% CI (2.46, 3.66)]) were significant determinants of poor knowledge.
CONCLUSION
In this review and meta-analysis, around half of the participants had poor knowledge about epilepsy. Individuals who cannot read and write, and could not witness seizure episodes had more likely to have poor knowledge toward epilepsy as compared to their counterparts. Health education through different methods should be provided to the public, and our educational system should focus on this global problem. Furthermore, it is better to give training for community key informants.
Topics: Epilepsy; Ethiopia; Humans; Odds Ratio; Prevalence; Seizures
PubMed: 35690571
DOI: 10.1016/j.yebeh.2022.108764