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  1. Prevalence of epilepsy: a population-based cohort study in Denmark with comparison to Global Burden of Disease (GBD) prevalence estimates

    Thu, 10 Apr 2025 15:05:22 -0000

    Background

    The Global Burden of Disease Study (GBD) produces prevalence estimates for ‘idiopathic epilepsy’ (ie, of unknown aetiology) and ‘secondary epilepsy’ (ie, with known aetiology) but does not report prevalence by underlying aetiologies for ‘secondary epilepsy’.

    Methods

    We used nationwide, population-based register data from Denmark to identify underlying causes of epilepsy and their contribution to prevalence of ‘secondary epilepsy’ and compared with global prevalence data from GBD 2019. We identified all persons with a hospital-based epilepsy diagnosis and a filled prescription for antiseizure medication between 1 January 2009 and 31 December 2018. Epilepsy was categorised into ‘idiopathic’ or ‘secondary’ and ‘total epilepsy’ as the sum of the two epilepsy categories.

    Results

    On 31 December 2018, a total of 5 784 284 individuals (49.7% males) were living in Denmark including 40 336 with epilepsy (51.5% males). Perinatal conditions, traumatic brain injury, brain tumours and stroke were prominent underlying causes of ‘secondary epilepsy’. The prevalence of ‘total epilepsy’ in Denmark was 697 (95% CI 691 to 704) per 100 000 population (264 (95% CI 260 to 269) for ‘secondary epilepsy’ and 433 (95% CI 428 to 438) for ‘idiopathic epilepsy’). In the GBD 2019 Study, the prevalence of ‘total epilepsy’ in 2018 was 682 (95% uncertainty interval (UI) 586 to 784) per 100 000 population (359 (95% UI 324–397) for ‘secondary epilepsy’ and 324 (95% UI 249 to 404) for ‘idiopathic epilepsy’).

    Conclusions

    Prevalence estimates of ‘total epilepsy’, ‘idiopathic epilepsy’ and ‘secondary epilepsy’ in Denmark align with the GBD 2019 estimates. In future studies, it is suggested to explicitly include all types of epilepsy, including ‘secondary epilepsy’, which is currently estimated as sequelae (consequences) of underlying diseases.

  2. Progressive Myoclonus Epilepsy and Beyond: A Systematic Review of SEMA6B-related Disorders

    Mon, 04 Nov 2024 07:30:51 -0000

    Progressive myoclonus epilepsy (PME) is a rare, clinically and genetically heterogeneous epilepsy syndrome, and pathogenic variants in the semaphorin 6B (SEMA6B) gene have recently been reported to be among the causes of PME. Cases with pathogenic variants in the SEMA6B gene are extremely rare, only a limited number of cases have been reported in the literature. In this systematic review, we aimed to present a summary of a PME case in which a heterozygous nonsense variant of c.2086C > T p.(Gln696*) in the SEMA6B gene was detected in the etiology and other cases with SEMA6B pathogenic variant in the literature. Except for our case, 35 cases from 12 studies were included. The main clinical findings in these patients were cognitive problems, seizures, gait and speech disturbances, and cognitive and/or motor regression, and they had a wide spectrum of severity. Response to antiseizure medications was also highly variable, almost half of the patients had pharmacoresistant seizures. Patients were divided into four different phenotypic groups according to their clinical presentations: PME (18/36), developmental and epileptic encephalopathy (13/36), neurodevelopmental disorder (4/36), and epilepsy (1/36), respectively. In conclusion, although SEMA6B has been associated with PME, it may actually cause a much broader phenotypic spectrum. Due to their extreme rarity, our knowledge of SEMA6B-related disorders is limited. As with all other rare diseases, each new SEMA6B-related disorder case could contribute to a better understanding of the disease. A better understanding of the disease may allow the development of specific treatment options in the future.
    <p align="right">Neuropediatrics<br/>DOI: 10.1055/a-2442-5741</p><p>Progressive myoclonus epilepsy (PME) is a rare, clinically and genetically heterogeneous epilepsy syndrome, and pathogenic variants in the semaphorin 6B (SEMA6B) gene have recently been reported to be among the causes of PME. Cases with pathogenic variants in the SEMA6B gene are extremely rare, only a limited number of cases have been reported in the literature. In this systematic review, we aimed to present a summary of a PME case in which a heterozygous nonsense variant of c.2086C &gt; T p.(Gln696*) in the SEMA6B gene was detected in the etiology and other cases with SEMA6B pathogenic variant in the literature. Except for our case, 35 cases from 12 studies were included. The main clinical findings in these patients were cognitive problems, seizures, gait and speech disturbances, and cognitive and/or motor regression, and they had a wide spectrum of severity. Response to antiseizure medications was also highly variable, almost half of the patients had pharmacoresistant seizures. Patients were divided into four different phenotypic groups according to their clinical presentations: PME (18/36), developmental and epileptic encephalopathy (13/36), neurodevelopmental disorder (4/36), and epilepsy (1/36), respectively. In conclusion, although SEMA6B has been associated with PME, it may actually cause a much broader phenotypic spectrum. Due to their extreme rarity, our knowledge of SEMA6B-related disorders is limited. As with all other rare diseases, each new SEMA6B-related disorder case could contribute to a better understanding of the disease. A better understanding of the disease may allow the development of specific treatment options in the future.<br/><a href="/DOI/DOI?10.1055/a-2442-5741">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000041">Table of contents</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2442-5741">Abstract</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2442-5741">Full text</a></p>
  3. Endoscopic Epilepsy Surgery: Systematic Review and Meta-Analysis

    Mon, 28 Oct 2024 09:45:53 -0000

    Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or > 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43–0.71, I2 = 77.1%, τ2 = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62–82%, I2 = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32–65%, I2 = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups (p = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92–73.06%), with a moderate level of heterogeneity (I 2 = 62.9%, tau2 = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.
    <p align="right">Asian J Neurosurg<br/>DOI: 10.1055/s-0044-1791996</p><p>Endoscopic epilepsy surgery is a fast emerging minimally invasive alternative to open surgery. The approach minimizes the extent of bone and brain resection and reduces surgical morbidity. This systematic review and meta-analysis sought to evaluate the favorable outcome of seizure improvement in patients undergoing endoscopic epilepsy surgery. The search was conducted by two independent researchers using PubMed and Web of Science until January 2023 to find studies reporting results of patients who underwent endoscopic epilepsy surgery. We extracted data on the clinical profile and outcomes of the patients from the eligible studies. Fifteen studies yielded 340 patients, of which 293 underwent endoscopic epilepsy surgery. The patient cohort consisted of 189 (55.6%) males. A total of 171 (58.3) patients had a favorable outcome of either Engel I or II or &gt; 90% seizure control. Thirteen studies were included in our meta-analysis, and demonstrated improved seizure control after endoscopic epilepsy surgery, with a pooled seizure freedom rate of 58% (95% CI: 0.43–0.71, I2 = 77.1%, τ2 = 0.6836). Studies focusing on pediatric populations reported a higher proportion of positive outcomes, with a rate of 73.27% (95% CI: 62–82%, I2 = 0.0%). In comparison, mixed-age populations showed a lower success rate of 48% (95% CI: 32–65%, I2 = 79.0%). Furthermore, there was significant difference in treatment outcomes between the pediatric and mixed age groups (p = 0.014). The hypothalamic hamartomas (HH) patient population demonstrated a favorable outcome proportion of 61.71% (95% CI: 48.92–73.06%), with a moderate level of heterogeneity (I 2 = 62.9%, tau2 = 0.4266). Five patients developed postoperative complications, and there were three deaths. Our findings suggest that endoscopic epilepsy surgery is particularly effective in pediatric populations and among patients with HH, underscoring the importance of considering patient demographics and disease characteristics in clinical decision-making. The heterogeneity across studies necessitates cautious interpretation of the pooled results, advocating for tailored approaches in treatment planning. Prospective trials are required to establish class I evidence for the role of endoscopic epilepsy surgery compared with the recognized open surgical techniques.<br/><a href="/DOI/DOI?10.1055/s-0044-1791996">[...]</a><br/><br/></p><p>Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00053244">Table of contents</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0044-1791996">Abstract</a>  |  <span style="font-weight: bold; color: #ff0000;">open access</span> <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0044-1791996">Full text</a></p>
  4. The Value of SINO Robot and Angio Render Technology for Stereoelectroencephalography Electrode Implantation in Drug-Resistant Epilepsy

    Wed, 03 Jul 2024 13:59:44 -0000

    Background Stereoelectroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of the SINO robot for SEEG electrode implantation is not yet defined. The aim of the current study was to assess the value of the SINO robot in conjunction with Angio Render technology for SEEG electrode implantation and to assess its efficacy. Methods Between June 2018 and October 2020, 58 patients underwent SEEG electrode implantation to resect or ablate their epileptogenic zone (EZ). The SINO robot and the Angio Render technology was used to guide the electrodes and visualize the individual vasculature in a three-dimensional (3D) fashion. The 3D view functionality was used to increase the safety and accuracy of the electrode implantation, and for reducing the risk of hemorrhage by avoiding blood vessels. Results In this study, 634 SEEG electrodes were implanted in 58 patients, with a mean of 10.92 (range: 5–18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39–1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80–2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 minutes (range: 3.02–14.61 minutes). The mean depth of electrodes was 56.96 ± 3.62 mm (range: 27.23–124.85 mm). At a follow-up of at least 1 year, in total, 81.57% (47/58) patients achieved an Engel class I seizure freedom. There were two patients with asymptomatic intracerebral hematomas following SEEG electrode placement, with no late complications or mortality in this cohort. Conclusions The SINO robot in conjunction with Angio Render technology-in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.
    <p align="right">J Neurol Surg A Cent Eur Neurosurg<br/>DOI: 10.1055/a-2299-7781</p><p> Background Stereoelectroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of the SINO robot for SEEG electrode implantation is not yet defined. The aim of the current study was to assess the value of the SINO robot in conjunction with Angio Render technology for SEEG electrode implantation and to assess its efficacy. Methods Between June 2018 and October 2020, 58 patients underwent SEEG electrode implantation to resect or ablate their epileptogenic zone (EZ). The SINO robot and the Angio Render technology was used to guide the electrodes and visualize the individual vasculature in a three-dimensional (3D) fashion. The 3D view functionality was used to increase the safety and accuracy of the electrode implantation, and for reducing the risk of hemorrhage by avoiding blood vessels. Results In this study, 634 SEEG electrodes were implanted in 58 patients, with a mean of 10.92 (range: 5–18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39–1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80–2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 minutes (range: 3.02–14.61 minutes). The mean depth of electrodes was 56.96 ± 3.62 mm (range: 27.23–124.85 mm). At a follow-up of at least 1 year, in total, 81.57% (47/58) patients achieved an Engel class I seizure freedom. There were two patients with asymptomatic intracerebral hematomas following SEEG electrode placement, with no late complications or mortality in this cohort. Conclusions The SINO robot in conjunction with Angio Render technology-in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.<br/><a href="/DOI/DOI?10.1055/a-2299-7781">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000180">Table of contents</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2299-7781">Abstract</a>  |  <span style="font-weight: bold; color: #ff0000;">open access</span> <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2299-7781">Full text</a></p>
  5. Epilepsy in Association with Giant Skull Base Tumors: A Retrospective Case Series of Giant Skull Base Tumors in the Anterior and Middle Fossa

    Fri, 03 May 2024 07:18:09 -0000

    Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.
    <p align="right">J Neurol Surg B Skull Base<br/>DOI: 10.1055/a-2297-8981</p><p> Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.<br/><a href="/DOI/DOI?10.1055/a-2297-8981">[...]</a><br/><br/></p><p>Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany</p><p>Article in Thieme eJournals:<br/><a href="https://www.thieme-connect.com/products/ejournals/issue/eFirst/10.1055/s-00000181">Table of contents</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2297-8981">Abstract</a>  |  <a href="https://www.thieme-connect.com/products/ejournals/html/10.1055/a-2297-8981">Full text</a></p>