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Epileptic Disorders : International... Dec 2015The aim of this meta-analysis was to assess the relationship between tumour location and preoperative seizure incidence in patients with gliomas. (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of this meta-analysis was to assess the relationship between tumour location and preoperative seizure incidence in patients with gliomas.
METHODS
Systematic computerised searches of PubMed and the Web of Knowledge were performed. The meta-analysis of pooled odds ratio (OR) and 95% confidence interval (CI) for preoperative seizure risk, stratified by tumour location, were calculated.
RESULTS
Eleven studies with 2,047 patients were included for meta-analysis. For gliomas with or without frontal lobe involvement, the preoperative seizure incidence ranged from 31.7% (19/60) to 85.7% (156/182) and 19.7% (12/61) to 85.7% (12/14), respectively; the pooled OR was 1.560 (95% CI: 1.266-1.923; Z: 4.17; p=0.000). For gliomas with or without temporal lobe involvement, seizure incidence was 22.6% (7/31) to 91.7% (11/12) and 26.7% (24/90) to 78.7% (174/221), respectively; the pooled OR was 1.070 (95% CI: 0.794-1.443; Z: 0.45; p=0.656). For gliomas with or without parietal lobe involvement, seizure incidence was 18.1% (3/16) to 100.0% (3/3) and 26.7% (28/105) to 80.4% (226/281), respectively; the pooled OR was 0.770 (95% CI: 0.570-1.040; Z: 1.71; p=0.088). For gliomas with or without occipital lobe involvement, seizure incidence was 0.0% (0/2) to 100.0% (2/2) and 26.8% (30/112) to 75.7% (56/74), respectively; the pooled OR was 0.336 (95% CI: 0.164-0.686; Z: 2.99; p=0.003). For gliomas with or without insula lobe involvement, seizure incidence was 34.8% (8/23) to 72.0% (77/107) and 34.3% (60/175) to 81.3% (247/304), respectively; the pooled OR was 1.058 (95% CI: 0.765-1.463; Z: 0.34; p=0.732). No significant publication bias was found.
CONCLUSION
Our meta-analysis indicates that frontal lobe gliomas are related to a higher preoperative seizure incidence, while occipital lobe gliomas are related to a lower incidence.
Topics: Brain; Brain Neoplasms; Glioma; Humans; Neurosurgical Procedures; Preoperative Period; Seizures
PubMed: 26643505
DOI: 10.1684/epd.2015.0788 -
Current Medical Research and Opinion Aug 2013This paper compares the efficacy and tolerability of perampanel (PER) relative to other recently approved anti-epileptic drug (AEDs) - lacosamide (LCS), retigabine... (Meta-Analysis)
Meta-Analysis Review
The efficacy and tolerability of perampanel and other recently approved anti-epileptic drugs for the treatment of refractory partial onset seizure: a systematic review and Bayesian network meta-analysis.
OBJECTIVES
This paper compares the efficacy and tolerability of perampanel (PER) relative to other recently approved anti-epileptic drug (AEDs) - lacosamide (LCS), retigabine (RTG), and eslicarbazepine (ESL) for the adjunctive treatment of partial onset seizures with or without secondary generalization and specifically in the secondary generalization subgroup.
MATERIALS AND METHODS
A systematic literature review of all RCTs of PER and selected AEDs in EMBASE, Medline, and the Cochrane Central from 1998 to January 2011 with an update in PubMed in March 2013 was performed. A network meta-analysis was conducted for 50% responder rate for overall seizures; withdrawal due to adverse events; seizure freedom; and 50% responder rate for secondary generalized seizures.
RESULTS
Twelve RCTs (three PER, three LCS, three RTG and three ESL) were included. PER performed significantly better than placebo for 'responder rate' (OR 2.151, 95% CrI 1.348-3.472) and 'seizure freedom' (OR 2.507, 95% CrI 1.067-7.429). When compared to other agents, PER was found to be equally effective. For 'withdrawal due to adverse events', PER had the lowest odds ratio vs. placebo compared with other AEDs. In the analysis for the subgroup of patients with secondary generalization, only four RCTs (three PER and one LCS) met the inclusion criteria for one outcome (responder rate) for LCS. In this subgroup, PER was statistically significantly better than placebo (OR 2.448, 95% CrI 1.088-5.828).
CONCLUSION
PER was statistically significantly superior to placebo in responder rate, seizure freedom, and responder rate in the secondary generalization population. Though PER had statistically significant greater withdrawal compared to placebo, it had the lowest ORs vs. placebo, suggesting a superior safety profile among the comparators included in this analysis. In patients with partial onset seizure with secondary generalization, PER had a statistically significant effect on responder rate compared to placebo.
Topics: Anticonvulsants; Bayes Theorem; Humans; Nitriles; Pyridones; Randomized Controlled Trials as Topic; Seizures
PubMed: 23659562
DOI: 10.1185/03007995.2013.803461 -
Epilepsia May 2021Absence seizures (AS), presenting as short losses of consciousness with staring spells, are a common manifestation of childhood epilepsy that is associated with... (Meta-Analysis)
Meta-Analysis
Absence seizures (AS), presenting as short losses of consciousness with staring spells, are a common manifestation of childhood epilepsy that is associated with behavioral, emotional, and social impairments. It has also been suggested that patients with AS are more likely to suffer from mood disorders such as depression and anxiety. This systematic review and meta-analysis synthesizes human and animal models that investigated mood disorders and AS. Of the 1019 scientific publications identified, 35 articles met the inclusion criteria for this review. We found that patients with AS had greater odds of developing depression and anxiety when compared to controls (odds ratio = 4.93, 95% confidence interval = 2.91-8.35, p < .01). The included studies further suggest a strong correlation between AS and depression and anxiety in the form of a bidirectional relationship. The current literature emphasizes that these conditions likely share underlying mechanisms, such as genetic predisposition, neurophysiology, and anatomical pathways. Further research will clarify this relationship and ensure more effective treatment for AS and mood disorders.
Topics: Animals; Anxiety; Depression; Epilepsy, Absence; Humans; Seizures
PubMed: 33751566
DOI: 10.1111/epi.16862 -
Drugs Mar 2010The automatic substitution of bioequivalent generics for brand-name antiepileptic drugs (AEDs) has been linked by anecdotal reports to loss of seizure control. To... (Meta-Analysis)
Meta-Analysis Review
The automatic substitution of bioequivalent generics for brand-name antiepileptic drugs (AEDs) has been linked by anecdotal reports to loss of seizure control. To evaluate studies comparing brand-name and generic AEDs, and determine whether evidence exists of superiority of the brand-name version in maintaining seizure control. English-language human studies identified in searches of MEDLINE, EMBASE and International Pharmaceutical Abstracts (1984 to 2009). Randomized controlled trials (RCTs) and observational studies comparing seizure events or seizure-related outcomes between one brand-name AED and at least one alternative version produced by a distinct manufacturer. We identified 16 articles (9 RCTs, 1 prospective nonrandomized trial, 6 observational studies). We assessed characteristics of the studies and, for RCTs, extracted counts for patients whose seizures were characterized as 'controlled' and 'uncontrolled'. Seven RCTs were included in the meta-analysis. The aggregate odds ratio (n = 204) was 1.1 (95% CI 0.9, 1.2), indicating no difference in the odds of uncontrolled seizure for patients on generic medications compared with patients on brand-name medications. In contrast, the observational studies identified trends in drug or health services utilization that the authors attributed to changes in seizure control. Although most RCTs were short-term evaluations, the available evidence does not suggest an association between loss of seizure control and generic substitution of at least three types of AEDs. The observational study data may be explained by factors such as undue concern from patients or physicians about the effectiveness of generic AEDs after a recent switch. In the absence of better data, physicians may want to consider more intensive monitoring of high-risk patients taking AEDs when any switch occurs.
Topics: Anticonvulsants; Drugs, Generic; Evidence-Based Medicine; Humans; Odds Ratio; Randomized Controlled Trials as Topic; Risk Assessment; Seizures; Therapeutic Equivalency; Treatment Outcome
PubMed: 20329806
DOI: 10.2165/10898530-000000000-00000 -
Journal of Stroke and Cerebrovascular... Oct 2021Cerebrovascular disease is the leading cause of seizures and incident epilepsy of known etiology in older adults. Statins have increasingly garnered attention as a... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Cerebrovascular disease is the leading cause of seizures and incident epilepsy of known etiology in older adults. Statins have increasingly garnered attention as a potential preventive strategy due to their pleiotropic effects beyond lipid-lowering, which may include neuroprotective and anti-epileptogenic properties. We aim to assess the evidence on statin use for prevention of post-stroke early-onset seizures and post-stroke epilepsy.
MATERIALS AND METHODS
We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, which was prospectively registered with PROSPERO (CRD42019144916). PubMed and Embase were searched from database inception to 05/2020 for English-language, full-text studies examining the association between statin use in adults and development of early-onset seizures (≤7 days post-stroke) or post-stroke epilepsy. Pooled analyses were based on random-effects models using the inverse-variance method.
RESULTS
Of 182 citations identified, 175 were excluded due to duplication or ineligibility. The 7 eligible publications were all cohort studies from East Asia or South America, with a total of 53,579 patients. Pre-stroke statin use was not associated with post-stroke epilepsy (3 studies pooled: OR 1.14, CI 0.91-1.42). However, post-stroke statin use was associated with lower risk of both early-onset seizures (3 studies pooled: OR 0.36, CI 0.25-0.53), and post-stroke epilepsy (6 studies pooled: OR 0.64, CI 0.46-0.88).
CONCLUSIONS
Review of 7 cohort studies suggested post-stroke, but not pre-stroke, statin use may be associated with reduced risk of early-onset seizures and post-stroke epilepsy. Further research is warranted to validate these findings in broader populations and better parse the temporal components of the associations.
Topics: Adult; Aged; Aged, 80 and over; Anticonvulsants; Brain; Epilepsy; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Protective Factors; Risk Assessment; Risk Factors; Seizures; Stroke; Time Factors; Treatment Outcome
PubMed: 34438280
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106024 -
Epilepsia Mar 2017To comprehensively analyze ictal asystole (IA) on a large number of subjects. (Review)
Review
OBJECTIVE
To comprehensively analyze ictal asystole (IA) on a large number of subjects.
METHODS
We performed a systematic review of case report studies of patients diagnosed with IA (1983-2016). Each included case was characterized with respect to patient history, IA seizure characteristics, diagnostic workup, and therapy. In addition, comparative analyses were also carried out: two alignments were developed based on the delay between epilepsy onset and IA onset ("new-onset" if <1 year, "late-onset" if ≥1 year) and asystole duration (asystole was "very prolonged" if lasted >30 s).
RESULTS
One hundred fifty-seven cases were included. All patients had focal epilepsy. In 7% of cases IA developed during a secondary generalized tonic-clonic seizure. Both the seizure-onset zone and the focal seizure activity at asystole beginning were usually temporal (p < 0.001 and p = 0.001, respectively) and were lateralized to the left hemisphere in 62% (p = 0.005 and p = 0.05, respectively). Asystole duration was 18 ± 14 s (mean±SD) (range 3-96 s); 73% of patients had late-onset, 27% had new-onset IA. Compared to late-onset IA, new-onset IA was associated with female gender (p = 0.023), preexisting heart condition (p = 0.014), focal seizure activity at asystole beginning (p = 0.012), normal neuroimaging (p = 0.013), normal interictal EEG (p < 0.001), auditory aura (p = 0.012), and drug-responsive epilepsy (p < 0.001). "Very prolonged" asystole was associated with secondary generalized tonic-clonic seizures (p = 0.003) and tended to occur in extratemporal lobe seizures (p = 0.074). No IA-related death was reported.
SIGNIFICANCE
Characteristics considered to be typical of IA (focal, left temporal seizures appearing on grounds of a long-lasting, intractable epilepsy) seem only partially legitimate. We suggest that in new-onset IA, female gender and a preexisting heart condition could serve as predispositions in an otherwise benign epilepsy. We speculate that in late-onset IA, male-predominant changes in neuronal networks in chronic, intractable epilepsy and an accompanying autonomic dysregulation serve as facilitating factors.
Topics: Adolescent; Adult; Age of Onset; Aged; Child; Child, Preschool; Databases, Bibliographic; Electroencephalography; Female; Functional Laterality; Heart Arrest; Humans; Infant; Male; Middle Aged; Seizures; Young Adult
PubMed: 27988965
DOI: 10.1111/epi.13644 -
The Canadian Journal of Neurological... Jul 2015Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure control.
METHODS
All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to May 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated by two independent reviewers, using both the Oxford and GRADE methodology.
RESULTS
Overall, 13 studies were identified, with 10 manuscripts and 3 meeting abstracts. A total of 40 patients were treated. The common target temperature was 33 degrees Celsius, sustained for a median 48 hours. Patients displayed a 62.5%, 15% and 22.5% rate of seizure cessation, seizure reduction, and failure of treatment respectively. External cooling was utilized in the majority of cases. Deep venous thrombosis, coagulopathy and infections were the commonly reported complications. Two ongoing clinical trials were identified.
CONCLUSIONS
Oxford level 4, GRADE D evidence exists to support the use of therapeutic hypothermia to control seizures in RSE. Further prospective study is warranted.
Topics: Clinical Trials as Topic; Drug Resistant Epilepsy; Evidence-Based Medicine; Humans; Hypothermia, Induced; Seizures; Status Epilepticus; Treatment Outcome
PubMed: 26153039
DOI: 10.1017/cjn.2015.31 -
Seizure Feb 2018Gliomas, particularly low-grade gliomas (LGGs), are highly epileptogenic. Seizure is the most common presenting sign of LGG patients and significantly decreases their... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Gliomas, particularly low-grade gliomas (LGGs), are highly epileptogenic. Seizure is the most common presenting sign of LGG patients and significantly decreases their quality of life. Accordingly, there is a need for a better understanding of the mechanisms and risk factors of glioma-related epilepsy. The current study aimed to perform a comprehensive meta-analysis to investigate the correlation of isocitrate-dehydrogenase 1 (IDH1), an important molecular biomarker for glioma classification and prognosis, to preoperative seizure incidence in LGG.
METHODS
PUBMED, EMBASE, and Web of Science databases were searched for relevant studies. The odds ratio (OR) and corresponding 95% confidence interval (CI) were used as the primary measures to assess the correlation between IDH1 mutation and preoperative seizure incidence.
RESULTS
A total of 722 LGG patients, including 555 patients with IDH1 mutation and 167 patients with wild-type IDH1 were enrolled in the current meta-analysis. The pooled OR was 2.47 (95% CI 1.70-3.57, Z = 4.78, p < 0.01). No significant heterogeneity was observed among all included studies and no publication bias was identified.
CONCLUSION
The current meta-analysis identified that IDH1 mutation was correlated to a higher preoperative seizure incidence in LGG. This result would generate impetus for research on the mechanisms behind this correlation, and provide a new idea for the individualized treatment of glioma-related epilepsy.
Topics: Brain Neoplasms; Genetic Predisposition to Disease; Glioma; Humans; Incidence; Isocitrate Dehydrogenase; Seizures
PubMed: 29414139
DOI: 10.1016/j.seizure.2018.01.011 -
Multiple Sclerosis and Related Disorders Jul 2020Recent reports have suggested that seizures may be a component of the clinical presentation in myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Recent reports have suggested that seizures may be a component of the clinical presentation in myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease. We aimed to conduct a systematic review and meta-analysis to comprehensively evaluate the occurrence of epileptic seizures in the disease.
METHODS
We searched PubMed, MEDLINE and EMBASE for studies reporting the occurrence of acute symptomatic seizures in MOG-Ab-associated disease. Fixed or random effects model was used to pool results across studies with a meta-analysis.
RESULTS
A total of 14 studies met the inclusion criteria. Overall, acute symptomatic seizures were observed in 20.5% (95% confidence interval [CI] 13.7%-30.7%, I=60.6%) patients with MOG-Ab-associated disease, and in a similar proportion of children respectively (20.0%; 95% CI 14.3%-27.8%, I=7.0%). The pooled probability of seizure occurrence in males was 30.1% (95% CI 17.5%-52%, I=0.0%) while that in females was much lower (12.0%; 95% CI 5.5%-26.4%, I=0.0%). Furthermore, when we focused on those with acute disseminated encephalomyelitis-like phenotype, 37.3% patients experienced seizures (95% CI 21.0%-66.3%, I=55.8%).
CONCLUSIONS
Our study suggested that epileptic seizures were common in MOG-Ab-associated disease and offered insight into associated factors that contribute to the occurrence of seizures. Future studies with explicit evaluation are required.
Topics: Autoantibodies; Child; Encephalomyelitis, Acute Disseminated; Epilepsy; Female; Humans; Male; Myelin-Oligodendrocyte Glycoprotein; Seizures
PubMed: 32222694
DOI: 10.1016/j.msard.2020.102057 -
Epilepsy & Behavior : E&B Sep 2021To investigate whether published studies that identified a causal relationship between psychological stress and seizure worsening in patients with epilepsy during the... (Review)
Review
Considering temporality in causal relationship between seizure worsening and psychological stress in patients with epilepsy during the COVID-19 pandemic: A systematic review.
OBJECTIVE
To investigate whether published studies that identified a causal relationship between psychological stress and seizure worsening in patients with epilepsy during the coronavirus disease 2019 (COVID-19) pandemic considered the temporality of Hill's criteria.
METHOD
A systematic review approach was used to comprehensively search MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov databases for relevant studies. Studies that reported an association between psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic were included accordingly. The quality of assessments in each study was evaluated and an assessment for considering temporality in the causal relationship between the two events in each study was carried out.
RESULTS
Seventeen studies were included in the analysis. Most (14/17) were cross-sectional studies and only four out of these 17 studies (23.5%) considered temporality in the causality. Further, these four studies did not consider temporality in the study design, they only described it as a limitation.
CONCLUSION
We found that many articles reported a causal relationship between psychological stress and seizure worsening without considering temporality. As both researchers and readers, we need to consider temporality when interpreting the causal relationship between increased psychological stress and seizure worsening in patients with epilepsy during the COVID-19 pandemic.
Topics: COVID-19; Cross-Sectional Studies; Epilepsy; Humans; Pandemics; SARS-CoV-2; Seizures; Stress, Psychological
PubMed: 34252833
DOI: 10.1016/j.yebeh.2021.108184