-
Epilepsy & Behavior : E&B Apr 2021This systematic review and meta-analysis was aimed to summarize the pooled prevalence of stigma and associated factors among people with epilepsy in Ethiopia. A... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis was aimed to summarize the pooled prevalence of stigma and associated factors among people with epilepsy in Ethiopia. A systematic search of articles was conducted in PubMed, SCOPUS, African Journals Online (AJOL), and Journal Storage (JSTOR). A standardized data extraction format was used to extract data. The analysis was conducted using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis was done. Subgroup analysis was conducted. Funnel plot, Begg's test, and Egger's regression tests were used to measure the presence of publication bias. Since the studies showed heterogeneity, the pooled estimated prevalence of stigma of people with epilepsy was conducted using DerSimonian-Laird's random-effects model. The estimated pooled prevalence of stigma was 44.65(95%CI; 29.37-59.94). Begg's rank correlation test (Z = 0.15, P = 0.881) and Egger's linear regression test (t = 0.14, P = 0.894) showed the absence of publication bias. Factors associated with an increased likelihood of stigma were 6-10 years of duration of illness (p = 0.003), ≥11 years of duration of illness (p = 0.008), and ≥1/month of seizure frequency (p = 0.01). Comprehensive care that involves psychological, social, and medical components is required. Health education on effective coping mechanisms is recommended.
Topics: Epilepsy; Ethiopia; Humans; Prevalence
PubMed: 33740494
DOI: 10.1016/j.yebeh.2021.107872 -
Neuroscience and Biobehavioral Reviews Apr 2016Accumulating evidence suggests a role for inflammation in the pathophysiology of epilepsy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Accumulating evidence suggests a role for inflammation in the pathophysiology of epilepsy.
METHODS
We performed a systematic review and meta-analysis of studies that investigated inflammatory mediators in human epilepsy. Studies reporting on inflammatory mediators in serum, cerebrospinal fluid or brain tissue of epilepsy patients were included. Studies comparing patients to controls were included in a meta-analysis.
RESULTS
66 articles reporting on 1934 patients were included. IL-1ra, IL-1β, IL-6, IL-10, IFN-γ and TNF-α were the most extensively investigated proteins. Elevated levels for IL-1ra, IL-1β, IL-6 and CXCL8/IL-8 were reported in several different epilepsy etiologies and media, while other proteins were specifically increased for one etiology. IL-1α, IL-7 and IL-13, as well as the chemokines CCL2-5, -19 and -22, were increased exclusively in brain tissue. In an aggregate meta-analysis, we found significantly different protein levels for serum IL-6, IL-17 and CSF IL-1β and IL-10.
CONCLUSION
Inflammatory pathways are involved in epilepsy. Future studies may further clarify their role, and prove potential of targeted anti-inflammatory treatment.
Topics: Brain; Epilepsy; Humans; Inflammation; Inflammation Mediators
PubMed: 26877106
DOI: 10.1016/j.neubiorev.2016.02.007 -
PloS One 2022This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa.
METHODS
The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates.
RESULTS
After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23-31) and 34% in clinical settings (95% CI, 30-39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression.
CONCLUSION
Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.
Topics: Humans; Female; Male; Depression; Quality of Life; Epilepsy; Epilepsies, Partial; Seizures
PubMed: 36520790
DOI: 10.1371/journal.pone.0278907 -
Neurology Apr 2015Seizures can cause vestibular symptoms, even without obvious epileptic features. We sought to characterize epileptic vertigo or dizziness (EVD) to improve... (Review)
Review
OBJECTIVE
Seizures can cause vestibular symptoms, even without obvious epileptic features. We sought to characterize epileptic vertigo or dizziness (EVD) to improve differentiation from nonepileptic causes, particularly when vestibular symptoms are the sole manifestation.
METHODS
We conducted a systematic review with electronic (Medline) and manual search for English-language studies (1955-2014). Two independent reviewers selected studies. Study/patient characteristics were abstracted. We defined 3 study population types: (1) seizures, some experiencing vertigo/dizziness (disease cohort); (2) vertigo/dizziness, some due to seizures (symptom cohort); (3) vertigo/dizziness due to seizures in all patients (EVD-only cohort).
RESULTS
We identified 84 studies describing 11,354 patients (disease cohort = 8,129; symptom cohort = 2,965; EVD-only cohort = 260). Among 1,055 EVD patients in whom a distinction could be made, non-isolated EVD was present in 8.5%, isolated EVD in 0.8%. Thorough diagnostic workups (ictal EEG, vestibular testing, and brain MRI to exclude other causes) were rare (<0.1%). Ictal EEG was reported in 487 (4.3%), formal neuro-otologic assessment in 1,107 (9.7%). Localized EEG abnormalities (n = 350) were most frequently temporal (79.8%) and uncommonly parietal (11.8%). Duration of episodic vestibular symptoms varied, but was very brief (<30 seconds) in 69.6% of isolated EVD and 6.9% of non-isolated EVD.
CONCLUSIONS
Non-isolated EVD is much more prevalent than isolated EVD, which appears to be rare. Diagnostic evaluations for EVD are often incomplete. EVD is primarily associated with temporal lobe seizures; whether this reflects greater epidemiologic prevalence of temporal lobe seizures or a tighter association with dizziness/vertigo presentations than with other brain regions remains unknown. Consistent with clinical wisdom, isolated EVD spells often last just seconds, although many patients experience longer spells.
Topics: Dizziness; Epilepsy; Humans; Vertigo
PubMed: 25795644
DOI: 10.1212/WNL.0000000000001474 -
Epilepsy & Behavior : E&B May 2019The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The postictal period has many physical, behavioral, and cognitive manifestations associated with it. These signs and symptoms are common, can be quite debilitating, and can have a continued impact long after the seizure has ended. The purpose of this systematic review was to quantify the occurrence of postictal signs and symptoms, along with their frequency and duration in persons with epilepsy.
METHODS
Cochrane Database of Systematic Reviews, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and Scopus were searched from inception to November 29, 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards were followed. Search terms included subject headings and text words such as convulsion, epilepsy, seizure, postictal, post seizure, seizure recovery, seizure end, Todd's paresis, and Todd's paralysis. Standardized forms were used to collect various study variables. Abstract and full-text review, data abstraction, and quality assessment were all done in duplicate. Study heterogeneity was assessed using the I-squared test, and a random effects model was used to determine estimates. Publication bias was evaluated using funnel plots.
RESULTS
From 7811 abstracts reviewed, 78 articles met eligibility criteria, with 31 postictal manifestations (signs and/or symptoms) described and 45 studies included in the meta-analysis. The majority of studies described postictal headaches, migraines, and psychoses, with mean weighted frequency of 33.0% [95% confidence interval (CI) 26.0-40.0], 16.0% [95% CI 10.0-22.0], and 4.0% [95% CI 2.0-5.0], respectively. The mean weighted proportions of manifestations ranged from 0.5% (subacute postictal aggression) to 96.2% (postictal unresponsiveness) with symptom duration usually lasting <24 h but up to 2 months for physical and cognitive/behavioral symptoms respectively.
SIGNIFICANCE
Examining data on the various signs and symptoms of the postictal period will have practical applications for physicians by raising their awareness about these manifestations and informing them about the importance of optimizing their prevention and treatment in epilepsy.
Topics: Epilepsy; Headache; Humans; Migraine Disorders; Psychotic Disorders; Seizures
PubMed: 30978637
DOI: 10.1016/j.yebeh.2019.03.014 -
Child's Nervous System : ChNS :... Mar 2023Drug-resistant epilepsy occurs in up to 30% of children suffering from seizures and about 10% qualify for surgical treatment. The aim of this systematic review and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Drug-resistant epilepsy occurs in up to 30% of children suffering from seizures and about 10% qualify for surgical treatment. The aim of this systematic review and meta-analysis is to analyze the potential benefit of early epilepsy surgery in children concerning primarily seizure and developmental outcome.
METHODS
PubMed and Embase databases were searched using a systematic search strategy to identify studies on pediatric epilepsy surgery under 3 years from their inception up to 2022. Outcome measures were seizure outcome, postoperative complications, seizure onset, and reduction rate of antiepileptic drugs. A meta-analysis was thereafter performed for all included cohort studies. A p-value of < 0.05 was considered as statistically significant.
RESULTS
A total of 532 patients were analyzed with 401 patients (75%) receiving resective or disconnective surgery under the age of 3 years and 80 patients (15%) receiving surgery older than 3 years. The remaining 51 patients (9%) underwent VNS implantation. Pooled outcome analysis for resective/disconnective surgery showed favorable outcome in 68% (95% CI [0.63; 0.73]), while comparative analysis between the age groups showed no significant difference (77% early group and 75% late group; RR 1.03, 95% CI [0.73; 1.46] p = 0.75). Favorable outcome for the VNS cohort was seen in 52%, 65% in the early and 45.1% in the late group (RR 1.4393, 95% CI [0.87; 2.4] z = 1.42, p = 0.16). Developmental outcome was improved in 26%. Morbidity rate was moderate and showed no significant difference comparing the age groups, and overall surgical mortality rate was very low (0.1%).
CONCLUSION
Epilepsy surgery in pediatric age, especially under the age of 3 years, is a feasible and safe way to treat intractable epilepsy. Further comparative studies of prospective nature, analyzing not only seizure but also developmental outcome, should be the focus of future studies.
Topics: Child; Humans; Child, Preschool; Prospective Studies; Epilepsy; Seizures; Drug Resistant Epilepsy; Anticonvulsants; Treatment Outcome
PubMed: 36219224
DOI: 10.1007/s00381-022-05699-x -
Epilepsy & Behavior : E&B Mar 2024This study aimed to evaluate the efficacy and safety of six new antiseizure medications (ASMs) for adjunctive treatment in adult patients with focal epilepsy and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to evaluate the efficacy and safety of six new antiseizure medications (ASMs) for adjunctive treatment in adult patients with focal epilepsy and adolescents with Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), or tuberous sclerosis complex (TSC).
METHODS
A comprehensive literature search was performed using PubMed, Medline, Embase, and Cochrane library databases from inception to October 13, 2023. We included published studies for a systematic review and a network meta-analysis (NMA). The efficacy and safety were reported in terms of a 50% response rate and dropout rate along with serious adverse events (SAEs). The outcomes were ranked with the surface under the cumulative ranking curve (SUCRA).
RESULTS
Twenty eligible trials with 5516 patients and 21 interventions, including placebo, contributed to the analysis. Included ASMs were brivaracetam (BRV), cenobamate (CBM), cannabidiol (CBD), fenfluramine (FFM), everolimus (ELM), and soticlestat (SLT). The six new ASMs were compared in four different epilepsy subtypes. In focal epilepsy treatment, BRV seemed to be safe [vs placebo, risk ratio (RR) = 0.69, 95 % confidence interval (CI): 0.25-1.91] and effective (vs placebo, RR = 2.18, 95 % CI: 1.25-3.81). In treating focal epilepsy, CBM 300 mg was more effective at a 50 % response rate (SUCRA 91.8 %) compared with BRV and CBD. However, with the increase in dosage, more SAEs (SUCRA 85.6 %) appeared compared with other ASMs. CBD had good efficacy on LGS (SUCRA 88.4) and DS (SUCRA 66.2), but the effect on adult focal epilepsy was not better than that of placebo [vs placebo, RR = 0.83 (0.36-1.93)]. The NMA indicated that the likelihood of the most appropriate intervention (SUCRA 91.2 %) with minimum side effects(SUCRA 12.5 %)for the DS was FFM. Compared with CBD, high exposure to ELM demonstrated a more effective treatment of TSC (SUCRA 89.7 %). More high-quality SLT studies are needed to further evaluate the efficacy and safety. The comparison-adjusted funnel plots of annualized relapse rate and side effects in the included studies revealed no significant funnel plot asymmetry.
CONCLUSIONS
This NMA indicated that the most effective treatment strategy for focal epilepsy, DS, Lennox-Gastaut syndrome, and TSC, respectively, included CBM 300 mg, FFM, CBD, and ELM. However, the aforementioned findings need further confirmation.
Topics: Adult; Adolescent; Humans; Lennox Gastaut Syndrome; Network Meta-Analysis; Cannabidiol; Epilepsy; Epilepsies, Myoclonic; Epilepsies, Partial; Everolimus; Anticonvulsants; Carbamates; Chlorophenols; Tetrazoles
PubMed: 38277848
DOI: 10.1016/j.yebeh.2024.109653 -
A systematic review and meta-analysis of heart rate variability in epilepsy and antiepileptic drugs.Epilepsia Feb 2012Epilepsy is associated with near-fatal and fatal arrhythmias, and sudden unexpected death in epilepsy (SUDEP) is partly related to cardiac events. Dysfunction of the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Epilepsy is associated with near-fatal and fatal arrhythmias, and sudden unexpected death in epilepsy (SUDEP) is partly related to cardiac events. Dysfunction of the autonomous nervous system causes arrhythmias and, although previous studies have investigated the effects of epilepsy on the autonomic control of the heart, the results are still mixed regarding whether imbalance of sympathetic, vagal, or both systems is present in epilepsy, and also the importance of anticonvulsant treatment on the autonomic system. Therefore, we aimed to investigate epilepsy and its treatment impact on heart rate variability (HRV), assessed by sympathetic and parasympathetic activity expressed as low-frequency (LF) and high-frequency (HF) power spectrum, respectively.
METHOD
We performed a systematic review from the first date available to July 2011 in Medline and other databases; key search terms were "epilepsy"; "anticonvulsants"; "heart rate variability"; "vagal"; and "autonomous nervous system." Original studies that reported data and/or statistics of at least one HRV value were included, with data being extracted by two independent authors. We used a random-effects model with Hedges's g as the measurement of effect size to perform two main meta-analyses comparing LF and HF HRV values in (1) epilepsy patients versus controls; (2) patients receiving versus not receiving treatment; and (3) well-controlled versus refractory patients. Secondary analyses assessed other time- and frequency-domain measurements (nonlinear methods were not analyzed due to lack of sufficient data sets). Quality assessment of each study was verified and also meta-analytic techniques to identify and control bias. Meta-regression for age and gender was performed.
KEY FINDINGS
Initially, 366 references were identified. According to our eligibility criteria, 30 references (39 studies) were included in our analysis. Regarding HF, epilepsy patients presented lower values (g -0.69) than controls, with the 95% confidence interval (CI) ranging from -1.05 to -0.33. No significant differences were observed for LF (g -0.18; 95% CI -0.71 to 0.35). Patients receiving treatment presented HF values to those not receiving treatment (g -0.05; 95% CI -0.37 to 0.27), with a trend for having higher LF values (g 0.1; 95% CI -0.13 to 0.33), which was more pronounced in those receiving antiepileptic drugs (vs. vagus nerve stimulation). No differences were observed for well-controlled versus refractory patients, possibly due to the low number of studies. Regression for age and gender did not influence the results. Finally, secondary time-domain analyses also showed lower HRV and lower vagal activity in patients with epilepsy, as shown by the standard deviation of normal-to-normal interval (SDNN) and the root mean square of successive differences (RMSSD) indexes, respectively.
SIGNIFICANCE
We confirmed and extended the hypothesis of sympathovagal imbalance in epilepsy, as showed by lower HF, SDNN, and RMSSD values when compared to controls. In addition, there was a trend for higher LF values in patients receiving pharmacotherapy. As lower vagal (HF) and higher sympathetic (LF) tone are predictors of morbidity and mortality in cardiovascular samples, our findings highlight the importance of investigating autonomic function in patients with epilepsy in clinical practice. Assessing HRV might also be useful when planning therapeutic interventions, as some antiepileptic drugs can show hazardous effects in cardiac excitability, potentially leading to cardiac arrhythmia.
Topics: Anticonvulsants; Arrhythmias, Cardiac; Autonomic Nervous System; Death, Sudden; Epilepsy; Heart Rate; Humans
PubMed: 22221253
DOI: 10.1111/j.1528-1167.2011.03361.x -
Complementary and Alternative Medicine: The Mozart Effect on Childhood Epilepsy-A Systematic Review.The Journal of School Nursing : the... Feb 2018This systematic review examines the effectiveness of Mozart's music in decreasing seizures in children with epilepsy (Mozart Effect) using the Johns Hopkins Nursing... (Review)
Review
This systematic review examines the effectiveness of Mozart's music in decreasing seizures in children with epilepsy (Mozart Effect) using the Johns Hopkins Nursing Evidence-Based Practice rating scale. A search for articles with "Mozart Effect," "child*," and "epilepsy" was conducted in CINAHL Complete, Science Direct, Cochrane, and PubMed databases. Eight studies were selected based on the exclusion and inclusion criteria after removal of duplicates ( n = 17) and others ( n = 46). Studies included were English language, peer reviewed, published between April 2010 and February 2017, and available in full text with an abstract. Quasi-experimental studies demonstrate that the Mozart Effect May reduce epileptiform discharges or seizures in children and has potential as an adjunct to medical management of seizure activity or alone when medication or surgery is not accepted. A causal relationship between the music of Mozart and decreased seizure activity has yet to be demonstrated.
Topics: Child; Complementary Therapies; Epilepsy; Humans; Music Therapy
PubMed: 29157096
DOI: 10.1177/1059840517740940 -
Neuropsychology Review Dec 2016Psychiatric disorders and associated poor psychosocial outcomes are recognised to be a common sequelae of epilepsy. The extent to which this is true of genetic... (Review)
Review
Psychiatric disorders and associated poor psychosocial outcomes are recognised to be a common sequelae of epilepsy. The extent to which this is true of genetic generalised epilepsies (GGE), particularly syndromes other than juvenile myoclonic epilepsy (JME) is unclear. This systematic review synthesises findings regarding psychiatric and associated comorbidities in adults and children with GGE. Systematic review yielded 34 peer-reviewed studies of psychiatric and psychosocial outcomes in adults and children with GGE. Clinically significant psychiatric comorbidity was reported in over half of all children and up to a third of all adults with GGE. There was no evidence to support the presence of personality traits specific to JME or other syndromes; rather rates mirrored community samples. A small number of studies report poor psychosocial outcomes in GGE, however the interpretation of these findings is limited by paucity of healthy comparison groups. Some evidence suggests that anti-epileptic drug polytherapy in children and seizure burden at all ages may constitute risk factors for psychopathology. Findings highlight the importance of early screening so as not to overlook early or developing symptoms of psychopathology.
Topics: Anticonvulsants; Comorbidity; Epilepsy, Generalized; Humans; Mental Disorders
PubMed: 27726043
DOI: 10.1007/s11065-016-9333-1