Browsing by Subject "Epilepsy"

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  • Berk, Benjamin A; Packer, Rowena M A; Law, Tsz H; Wessmann, Annette; Bathen-Nöthen, Andrea; Jokinen, Tarja S; Knebel, Anna; Tipold, Andrea; Pelligand, Ludovic; Volk, Holger A (BioMed Central, 2019)
    Abstract Background Epilepsy is the most common brain disease in dogs. Recently, diets have been reported to have a positive impact on seizure activity and behaviour in various species including dogs with idiopathic epilepsy (IE). Historically, classic high fat ketogenic diets (KD) and medium chain triglycerides (MCT) KD have been successfully used to manage drug-resistant epilepsy. Similarly, an MCT enriched diet has been shown to improve seizure control and behavioural comorbidities in some dogs with IE. However, it is unknown whether an MCT dietary supplement (DS) may provide similar positive effects. Methods A 6-month prospective, randomised, double-blinded, placebo-controlled, crossover, multicentre dietary trial is designed comparing a 9% metabolic energy based calculated medium-chain triglyceride (MCT) oil supplement to a conventional ‘control’ DS. Only dogs which will have an International Veterinary Epilepsy Task Force Tier II level like diagnosis of IE which satisfied the following inclusion criteria are included: age between 6 months and ≤ 12 years; weighing between 4 and ≤ 65 kg; unremarkable interictal neurological examinations; no clinically significant findings on routine laboratory diagnostics; unremarkable brain MRI scan; have had at least 3 seizures in the previous 3 months prior to enrolment; treated with at least one ASD and being classified as resistant. All dogs are fed initially for 90 ± 2 days with either the control oil or the MCT oil alongside their normal diet, followed by 97 ± 2 days with the other supplement including a 7-day washout period. Overall, the aim is to recruit thirty-six patients at five different centres and to investigate the effect of MCTs as DS on seizure activity, tolerability, behavioural comorbidities and quality of life (QoL). Discussion Dietary interventions are rarely studied in a standardised form in veterinary medicine. The background diet, the cohort of animals and ASD received is standardised in this prospective diet trial to ensure representative data about the potential effect of MCT DS. If the study data confirms former findings, this would provide further evidence for the efficacy of MCTs as a management option for canine epilepsy. This publication should offer a repository of trial conditions and variable description with forecasted statistical analysis.
  • Koskinen, Lotta L. E.; Seppala, Eija H.; Weissl, Jutta; Jokinen, Tarja S.; Viitmaa, Ranno; Hanninen, Reetta L.; Quignon, Pascale; Fischer, Andrea; Andre, Catherine; Lohi, Hannes (2017)
    Background: Idiopathic or genetic adult-onset epilepsy is a common neurological disorder in domestic dogs. Genetic association has been reported only with ADAM23 on CFA 37 in few breeds. To identify novel epilepsy genes, we performed genome-wide association (GWA) analyses in four new breeds, and investigated the association of the previously reported ADAM23 haplotype with the epilepsy phenotype in eight breeds. Results: GWA analysis did not reveal new epilepsy loci. ADAM23 association (p <0.05) was identified in five breeds. Combined analysis of all eight breeds showed significant association (p = 4.6e(-6), OR 1.9). Conclusions: Our results further support the role of ADAM23 in multiple breeds as a common risk gene for epilepsy with low penetrance. The lack of findings in the GWA analyses points towards inefficient capture of genetic variation by the current SNP arrays, causal variant(s) with low penetrance and possible phenocopies. Future work will include studies on ADAM23 function and expression in canine neurons, as well as whole-genome sequencing in order to identify additional IE genes.
  • Koskinen, Lotta L E; Seppälä, Eija H.; Weissl, Jutta; Jokinen, Tarja S; Viitmaa, Ranno; Hänninen, Reetta L; Quignon, Pascale; Fischer, Andrea; André, Catherine; Lohi, Hannes (BioMed Central, 2017)
    Abstract Background Idiopathic or genetic adult-onset epilepsy is a common neurological disorder in domestic dogs. Genetic association has been reported only with ADAM23 on CFA 37 in few breeds. To identify novel epilepsy genes, we performed genome-wide association (GWA) analyses in four new breeds, and investigated the association of the previously reported ADAM23 haplotype with the epilepsy phenotype in eight breeds. Results GWA analysis did not reveal new epilepsy loci. ADAM23 association (p < 0.05) was identified in five breeds. Combined analysis of all eight breeds showed significant association (p = 4.6e−6, OR 1.9). Conclusions Our results further support the role of ADAM23 in multiple breeds as a common risk gene for epilepsy with low penetrance. The lack of findings in the GWA analyses points towards inefficient capture of genetic variation by the current SNP arrays, causal variant(s) with low penetrance and possible phenocopies. Future work will include studies on ADAM23 function and expression in canine neurons, as well as whole-genome sequencing in order to identify additional IE genes.
  • Roivainen, Reina; Lauronen, Leena; Gaily, Eija; Metsähonkala, Liisa; Peltola, Maria; Laakso, Aki (2018)
  • Project MinE ALS GWAS Consortium I; Schijven, Dick; Stevelink, Remi; McCormack, Mark; van Rheenen, Wouter; Luykx, Jurjen J.; Koeleman, Bobby P. C.; Veldink, Jan H.; Eriksson, Johan G.; Kälviäinen, Reetta; Kantanen, Anne-Mari; Lehesjoki, Anna-Elina; Palotie, Aarno (2020)
  • Partanen, Eino; Laari, Siiri P K; Kantele, Oona Karoliina; Kämppi, Leena S; Nybo, Taina Tuulikki (2022)
    Objectives: Previous studies have shown that younger age, higher education, and seizure freedom after epilepsy surgery are associated with employment. However, very few studies have investigated associations with cognition and employment status in epilepsy surgery patients.Methods: This retrospective study consists of 46 adult patients, who underwent resective epilepsy surgery in the Helsinki University Hospital between 2010 and 2018 and who had been assessed by a neuropsychologist prior to surgery and 6 months after surgery using a systematic test battery. In addition to neuropsychological evaluation, neurologists assessed the patients prior to surgery and followed up the patients up to 24 months after the surgery and evaluated work status of the patients. Logistic regression models were used to assess the effects of cognition on changes in employment status, while controlling for age and education. Results: Out of the 46 patients 38 (82.6%) were seizure free and 7 (15.2%) had their seizures reduced 2 years postsurgically. From prior to surgery to 2 years postsurgery, use of antiseizure medication was reduced in most of the patients, mean reduction of the dosage being 26.9%. Employment status improved in 10 (21.7%) patients, remained unchanged in 27 (58.7%) and worsened in 3 (6.5%). An additional 6 patients were already not working prior to surgery. Subsequent analyses are based on the subsample of 37 patients whose employment status improved or remained unchanged. Mistakes in executive function tasks (p = 0.048) and working memory performance (p = 0.020) differentiated between the group whose employment status remained similar and those who were able to improve their employment status. Epilepsy surgery outcome or changes in antiseizure medication (ASM) use were not associated with changes in employment status.Conclusions: In the subsample of 37 patients, errors in executive function tasks and poorer working memory differentiated patients whose employment status did not change from those patients who could improve their employment status. Problems in executive function and working memory tasks might hinder performance in a complex work environment. When assessing the risks and opportunities in returning to work after surgery, difficulties in working memory and executive function performance should be taken into consideration as they may predispose the patient to challenges at work.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
  • Hietaharju, Aki; Tienari, Pentti (2021)
    Kahdenkymmenen viime vuoden aikana aivojen hermosolujen pintarakenteisiin kohdistuviin vasta-aineisiin liittyvät autoimmuunienkefaliitit ovat nousseet esiin. Ne koskettavat neurologien lisäksi akuuttilääkäreitä, laboratoriodiagnostiikkaa, psykiatreja, neuroradiologeja, gynekologeja ja immunologeja. Yleisimmät tautimuodot ovat synapsien NMDA-reseptoreita ja LGI1-proteiinia kohtaan suuntautuvien vasta-aineiden aiheuttamat enkefaliitit. Näiden lisäksi tunnetaan runsaat kymmenen harvinaisempaa spesifiseen neuronaaliseen vasta-aineeseen liittyvää tautimuotoa. Kuvaamme tämän rajuja oireita aiheuttavan sairausryhmän diagnostiikkaa ja hoitoperiaatteita. Varhain tehty oikea diagnoosi ja immunologisen hoidon aloitus ovat hyvän ennusteen kulmakiviä tässä harvinaisessa sairausryhmässä.
  • Arnulfo, Gabriele; Narizzano, Massimo; Cardinale, Francesco; Fato, Marco Massimo; Palva, Jaakko Matias (2015)
    Background: Invasive monitoring of brain activity by means of intracerebral electrodes is widely practiced to improve pre-surgical seizure onset zone localization in patients with medically refractory seizures. Stereo-Electroencephalography (SEEG) is mainly used to localize the epileptogenic zone and a precise knowledge of the location of the electrodes is expected to facilitate the recordings interpretation and the planning of resective surgery. However, the localization of intracerebral electrodes on post-implant acquisitions is usually time-consuming (i.e., manual segmentation), it requires advanced 3D visualization tools, and it needs the supervision of trained medical doctors in order to minimize the errors. In this paper we propose an automated segmentation algorithm specifically designed to segment SEEG contacts from a thresholded post-implant Cone-Beam CT volume (0.4 mm, 0.4 mm, 0.8 mm). The algorithm relies on the planned position of target and entry points for each electrode as a first estimation of electrode axis. We implemented the proposed algorithm into DEETO, an open source C++ prototype based on ITK library. Results: We tested our implementation on a cohort of 28 subjects in total. The experimental analysis, carried out over a subset of 12 subjects (35 multilead electrodes; 200 contacts) manually segmented by experts, show that the algorithm: (i) is faster than manual segmentation (i.e., less than 1s/subject versus a few hours) (ii) is reliable, with an error of 0.5 mm +/- 0.06 mm, and (iii) it accurately maps SEEG implants to their anatomical regions improving the interpretability of electrophysiological traces for both clinical and research studies. Moreover, using the 28-subject cohort we show here that the algorithm is also robust (error <0.005 mm) against deep-brain displacements (<12 mm) of the implanted electrode shaft from those planned before surgery. Conclusions: Our method represents, to the best of our knowledge, the first automatic algorithm for the segmentation of SEEG electrodes. The method can be used to accurately identify the neuroanatomical loci of SEEG electrode contacts by a non-expert in a fast and reliable manner.
  • Jokinen, T. S.; Tiira, K.; Metsähonkala, L.; Seppala, E. H.; Hielm-Bjorkman, A.; Lohi, H.; Laitinen-Vapaavuori, O. (2015)
    BackgroundLagotto Romagnolo (LR) dogs with benign juvenile epilepsy syndrome often experience spontaneous remission of seizures. The long-term outcome in these dogs currently is unknown. In humans, behavioral and psychiatric comorbidities have been reported in pediatric and adult-onset epilepsies. Hypothesis/ObjectivesThe objectives of this study were to investigate possible neurobehavioral comorbidities in LR with a history of benign familial juvenile epilepsy (BFJE) and to assess the occurrence of seizures after the remission of seizures in puppyhood. AnimalsA total of 25 LR with a history of BFJE and 91 control dogs of the same breed. MethodsOwners of the LR dogs in the BFJE and control groups completed an online questionnaire about each dog's activity, impulsivity, and inattention. Principal component analysis (PCA) served to extract behavioral factors from the data. We then compared the scores of these factors between the 2 groups in a retrospective case-control study. We also interviewed all dog owners in the BFJE group by telephone to inquire specifically about possible seizures or other neurological problems after remission of seizures as a puppy. ResultsLagotto Romagnolo dogs with BFJE showed significantly higher scores on the factors Inattention and Excitability/Impulsivity than did the control group (P=.003; P=.021, respectively). Only 1 of the 25 BFJE LR exhibited seizures after remission of epilepsy in puppyhood. Conclusions and Clinical ImportanceAlthough the long-term seizure outcome in BFJE LR seems to be good, the dogs exhibit behavioral abnormalities resembling attention deficit hyperactivity disorder (ADHD) in humans, thus suggesting neurobehavioral comorbidities with epilepsy.
  • Brandt, Claudia; Seja, Patricia; Töllner, Kathrin; Römermann, Kerstin; Hampel, Philip; Kalesse, Markus; Kipper, Andi; Feit, Peter W.; Lykke, Kasper; Toft-Bertelsen, Trine Lisberg; Paavilainen, Pauliina; Spoljaric, Inkeri; Puskarjov, Martin; MacAulay, Nanna; Kaila, Kai; Löscher, Wolfgang (2018)
    Based on the potential role of Na-K-Cl cotransporters (NKCCs) in epileptic seizures, the loop diuretic bumetanide, which blocks the NKCC1 isoforms NKCC1 and NKCC2, has been tested as an adjunct with phenobarbital to suppress seizures. However, because of its physicochemical properties, bumetanide only poorly penetrates through the blood-brain barrier. Thus, concentrations needed to inhibit NKCC1 in hippocampal and neocortical neurons are not reached when using doses (0.1-0.5 mg/kg) in the range of those approved for use as a diuretic in humans. This prompted us to search for a bumetanide derivative that more easily penetrates into the brain. Here we show that bumepamine, a lipophilic benzylamine derivative of bumetanide, exhibits much higher brain penetration than bumetanide and is more potent than the parent drug to potentiate phenobarbital's anticonvulsant effect in two rodent models of chronic difficult-to-treat epilepsy, amygdala kindling in rats and the pilocarpine model in mice. However, bumepamine suppressed NKCC1-dependent giant depolarizing potentials (GDPs) in neonatal rat hippocampal slices much less effectively than bumetanide and did not inhibit GABA-induced Ca2+ transients in the slices, indicating that bumepamine does not inhibit NKCC1. This was substantiated by an oocyte assay, in which bumepamine did not block NKCC1a and NKCC1b after either extra- or intracellular application, whereas bumetanide potently blocked both variants of NKCC1. Experiments with equilibrium dialysis showed high unspecific tissue binding of bumetanide in the brain, which, in addition to its poor brain penetration, further reduces functionally relevant brain concentrations of this drug. These data show that CNS effects of bumetanide previously thought to be mediated by NKCC1 inhibition can also be achieved by a close derivative that does not share this mechanism. Bumepamine has several advantages over bumetanide for CNS targeting, including lower diuretic potency, much higher brain permeability, and higher efficacy to potentiate the anti-seizure effect of phenobarbital.
  • Schwarz, N.; Bast, T.; Gaily, E.; Golla, G.; Gorman, K. M.; Griffiths, L. R.; Hahn, A.; Hukin, J.; King, M.; Korff, C.; Miranda, M. J.; Moller, R. S.; Neubauer, B.; Smith, R. A.; Smol, T.; Striano, P.; Stroud, B.; Vaccarezza, M.; Kluger, G.; Lerche, H.; Fazeli, W. (2019)
    Background: Pathogenic variants in SCN2A are associated with various neurological disorders including epilepsy, autism spectrum disorder and intellectual disability. Few reports have recently described SCN2A-associated episodic ataxia (EA). Our study identifies its broader clinical and genetic spectrum, and describes pharmacological approaches. Results: We report 21 patients with SCN2A-associated EA, of which 9 are unpublished cases. The large majority of patients present with epileptic seizures (18/21, 86%), often starting within the first three months of life (12/18, 67%). In contrast, onset of episodic ataxia ranged from 10 months to 14 years of age. The frequency of EA episodes ranged from brief, daily events up to 1-2 episodes per year each lasting several weeks. Potential triggers include minor head traumas and sleep deprivation. Cognitive outcome is favorable in most patients with normal or mildly impaired cognitive development in 17/21 patients (81%). No clear genotype-phenotype correlations were identified in this cohort. However, two mutational hotspots were identified, i.e. 7/21 patients (33%) harbor the identical pathogenic variant p.A263V, whereas 5/21 (24%) carry pathogenic variants that affect the S4 segment and its cytoplasmic loop within the domain IV. In addition, we identified six novel pathogenic variants in SCN2A. While acetazolamide was previously reported as beneficial in SCN2A-associated EA in one case, our data show a conflicting response in 8 additional patients treated with acetazolamide: three of them profited from acetazolamide treatment, while 5/8 did not. Conclusions: Our study describes the heterogeneous clinical spectrum of SCN2A-associated EA, identifies two mutational hotspots and shows positive effects of acetazolamide in about 50%. (C) 2019 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
  • Loescher, Wolfgang; Kaila, Kai (2022)
    The Na-K-2Cl cotransporter NKCC1 and the neuron-specific K-Cl cotransporter KCC2 are considered attractive CNS drug targets because altered neuronal chloride regulation and consequent effects on GABAergic signaling have been implicated in numerous CNS disorders. While KCC2 modulators are not yet clinically available, the loop diuretic bumetanide has been used in clinical studies to treat brain disorders and as a tool for NKCC1 inhibition in preclinical models. Bumetanide is known to have anticonvulsant and neuroprotective effects under some pathophysiological conditions. However, as shown in several species from neonates to adults (mice, rats, dogs, and by extrapolation in humans), at the low clinical doses of bumetanide approved for diuresis, this drug has negligible access into the CNS, reaching levels that are much lower than what is needed to inhibit NKCC1 in cells within the brain parenchyma. Several drug discovery strategies have been used over the last ~15 years to develop brain-permeant compounds that, ideally, should be selective for NKCC1 to eliminate the diuresis mediated by inhibition of renal NKCC2. The strategies employed to improve the pharmacokinetic and pharmacodynamic properties of NKCC1 blockers include evaluation of other clinically approved loop diuretics; development of lipophilic prodrugs of bumetanide; development of side-chain derivatives of bumetanide; and unbiased high-throughput screening approaches of drug discovery based on large chemical compound libraries. The main outcomes are that (1), non-acidic loop diuretics such as azosemide and torasemide may have advantages as NKCC1 inhibitors vs. bumetanide; (2), bumetanide prodrugs achieve significantly higher brain levels of the parent drug and have lower diuretic activity; (3), the novel bumetanide side-chain derivatives do not exhibit any functionally relevant improvement of CNS accessibility or NKCC1 selectivity vs. bumetanide; (4) novel compounds discovered by high-throughput screening may resolve some of the inherent problems of bumetanide, but as yet this has not been achieved. Thus, further research is needed to optimize the design of brain-permeant NKCC1 inhibitors. Another major challenge is to identify the mechanisms whereby various NKCC1-expressing cellular targets of these drug within (e.g., neurons, oligodendrocytes or astrocytes) and outside the brain parenchyma (e.g., blood-brain barrier, choroid plexus, endocrine and immune system), as well as molecular off-target effects, might contribute to their reported therapeutic and adverse effects.
  • Laakso, Sini; Myllykangas, Liisa; Hietaharju, Aki (2021)
    COVID-19-infektion neurologisista ilmentymistä kertynyt tieto on tapausselostusten ja -sarjojen hallitsemaa. Yleisimmät neurologiset ilmentymät ovat olleet haju- ja makuaistin muutokset. Aivoverenkiertohäiriöt, enkefalopatia ja immuunivälitteiset keskushermoston sairaudet tulevat usein esiin COVID-19-infektion komplikaatioina, mutta toisaalta Guillain-Barrén oireyhtymän osalta yhteys tähän infektioon kumottiin laajemmassa epidemiologisessa kohorttitutkimuksessa. Myös enkefaliitin, epileptisten kohtauksien, ääreishermoston sairauksien ja lihassairauksien on kuvattu liittyvän tähän infektioon. Neuropatologisissa tutkimuksissa tärkeimmät löydökset ovat olleet hypoksis-iskeeminen vaurio, verenvuodot ja epäspesifiset tulehdusmuutokset. Vielä odotellaan varmuutta siitä, aiheutuvatko kudosmuutokset viruksen invaasiosta aivoihin vai onko kyse epäsuorista muutoksista. Mekanismi SARS-CoV2-viruksen pääsylle aivokudokseen näyttäisi olevan olemassa. COVID-19-infektion jälkeisestä pitkittyneestä neurologisesta oireilusta tarvitaan lisää tutkimustietoa.
  • De Tiege, Xavier; Lundqvist, Daniel; Beniczky, Sandor; Seri, Stefano; Paetau, Ritva (2017)
    Purpose: This comprehensive survey aims at characterizing the current clinical use of magnetoencephalography (MEG) across European MEG centres. Methods: Forty-four MEG centres across Europe were contacted in May 2015 via personalized e-mail to contribute to survey. The web-based survey was available on-line for 1 month and the MEG centres that did not respond were further contacted to maximize participation. Results: Among the 57% of responders, 12 centres from 10 different countries reported to use MEG for clinical applications. A total of 524 MEG investigations were performed in 2014 for the pre-surgical evaluation of epilepsy, while in the same period 244 MEG investigations were performed for pre-surgical functional brain mapping. Seven MEG centres located in different European countries performed >50 MEG investigations for epilepsy mapping in 2014, both in children and adults. In those centres, time from patient preparation to MEG data reporting tends to be lower than those investigating a lower annual number of patients. Conclusion: This survey demonstrates that there is in Europe an increasing and widespread expertise in the field of clinical MEG. These findings should serve as a basis to harmonize clinical MEG procedures and promote the clinical added value of MEG across Europe. MEG should now be considered in Europe as a mature clinical neurophysiological technique that should be used routinely in two specific clinical indications, i.e, the pre-surgical evaluation of refractory focal epilepsy and functional brain mapping. (C) 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
  • James, F. M. K.; Cortez, M. A.; Monteith, G.; Jokinen, T. S.; Sanders, S.; Wielaender, F.; Fischer, A.; Lohi, H. (2017)
    Background: Poor agreement between observers on whether an unusual event is a seizure drives the need for a specific diagnostic tool provided by video-electroencephalography (video-EEG) in human pediatric epileptology. Objective: That successful classification of events would be positively associated with increasing EEG recording length and higher event frequency reported before video-EEG evaluation; that a novel wireless video-EEG technique would clarify whether unusual behavioral events were seizures in unsedated dogs. Animals: Eighty-one client-owned dogs of various breeds undergoing investigation of unusual behavioral events at 4 institutions. Methods: Retrospective case series: evaluation of wireless video-EEG recordings in unsedated dogs performed at 4 institutions. Results: Electroencephalography achieved/excluded diagnosis of epilepsy in 58 dogs (72%); 25 dogs confirmed with epileptic seizures based on ictal/interictal epileptiform discharges, and 33 dogs with no EEG abnormalities associated with their target events. As reported frequency of the target events decreased (annually, monthly, weekly, daily, hourly, minutes, seconds), EEG was less likely to achieve diagnosis (P <0.001). Every increase in event frequency increased the odds of achieving diagnosis by 2.315 (95% confidence interval: 1.36-4.34). EEG recording length (mean = 3.69 hours, range: 0.17-22.5) was not associated (P = 0.2) with the likelihood of achieving a diagnosis. Conclusions and Clinical Importance: Wireless video-EEG in unsedated dogs had a high success for diagnosis of unusual behavioral events. This technique offered a reliable clinical tool to investigate the epileptic origin of behavioral events in dogs.
  • Markhus, Rune; Henning, Oliver; Molteberg, Ellen; Hecimovic, Hrvoje; Ujvari, Akos; Hirsch, Edouard; Rheims, Sylvain; Surges, Rainer; Malmgren, Kristina; Ruegg, Stephan; Gil-Nagel, Antonio; Roivainen, Reina; Picard, Fabienne; Steinhoff, Bernhard; Marusic, Petr; Mostacci, Barbara; Kimiskidis, Vasilios K.; Mindruta, Ioana; Jagella, Caroline; Mameniskiene, Ruta; Schulze-Bonhage, Andreas; Rosenow, Felix; Kelemen, Anna; Fabo, Daniel; Walker, Matthew C.; Seeck, Margitta; Kraemer, Gunter; Arsene, Oana Tarta; Krestel, Heinz; Lossius, Morten (2020)
    Purpose: Epilepsy patients consider driving issues to be one of their most serious concerns. Ideally, decisions regarding fitness to drive should be based upon thorough evaluations by specialists in epilepsy care. In 2009, an EU directive was published aiming to harmonize evaluation practices within European countries, but, despite these recommendations, whether all epileptologists use the same criteria is unclear. We therefore conducted this study to investigate routine practices on how epileptologists at European epilepsy centers evaluate fitness to drive. Methods: A questionnaire was sent to 63 contact persons identified through the European Epi-Care and the Epilepsy network. The questionnaire addressed how fitness-to-drive evaluations were conducted, the involvement of different professionals, the use and interpretation of EEG, and opinions on existing regulations and guidelines. Results: The questionnaire was completed by 35 participants (56 % response rate). Results showed considerable variation regarding test routines and the emphasis placed on the occurrence and extent of epileptiform discharges revealed by EEG. 82 % of the responders agreed that there was a need for more research on how to better evaluate fitness-to-drive in people with epilepsy, and 89 % agreed that regulations on fitness to drive evaluations should be internationally coordinated. Conclusion: Our survey showed considerable variations among European epileptologists regarding use of EEG and how findings of EEG pathology should be assessed in fitness-to-drive evaluations. There is a clear need for more research on this issue and international guidelines on how such evaluations should be carried out would be of value.
  • Kämppi, Leena; Rainesalo, Sirpa; Roivainen, Reina (2020)
    Epilepsiapotilaat ohjautuvat päivystykseen ensimmäisen, pitkittyneen, tiheästi toistuvan tai komplisoituneen kohtauksensa vuoksi. Nopea ja oikein kohdennettu hoito parhaassa tapauksessa estää kohtauksen vaikeutumisen status epilepticukseksi. Hoitoketjun eri vaiheiden saumaton eteneminen selkeän hoitoprotokollan mukaan on pitkittyneen epilepsiakohtauksen saaneen potilaan ennusteen kannalta keskeistä. Viiveettömän hoidon toteutuksen lisäksi lääkehoidon valinnassa tulisi huomioida epilepsian ja pitkittyneen kohtauksen tyyppi, etiologia ja niihin liittyvät epävarmuustekijät. Aikuispotilaiden osalta korostuvat liitännäissairaudet, niihin liittyvät hoidot ja kohtaustilanteen vaikeutumisen muut syyt. Vaikeassa kohtaustilanteessa epileptologisen yksikön konsultoiminen on tarpeen. Jos potilaan status epilepticus on vaikeahoitoinen, konsultaation tulisi toteutua kiireellisesti. Päivystyspisteiden osuus on merkittävä paitsi viiveettömässä kohtausten hoidossa myös jatkohoidon toteutuksessa ja ohjauksessa.
  • Suomalaisen Lääkäriseuran Duodecimin ja Suomen Lastenneurologinen yhdistys ry:n asettama työryhmä; Metsähonkala, Liisa; Gaily, Eija; GILBERT, OLGA; Kirjavainen, Jarkko; Komulainen, Jorma; Lahdesmaki, Tuire; Vieira, Päivi (2020)
    LIISA METSÄHONKALA (puheenjohtaja), EIJA GAILY, OLGA GILBERT, JARKKO KIRJAVAINEN, JORMA KOMULAINEN, TUIRE LÄHDESMÄKI, PÄIVI VIEIRA, Suomalaisen Lääkäriseuran Duodecimin ja Suomen Lastenneurologinen Yhdistys ry:n asettama työryhmä
  • Videman, Mari; Stjerna, Susanna; Roivainen, Reina; Nybo, Taina; Vanhatalo, Sampsa; Gaily, Eija; Leppanen, Jukka M. (2016)
    Introduction: Prenatal antiepileptic drug (AED) exposure is associated with an increased risk of cognitive impairment and autism spectrum disorders detected mainly at the age of two to six years. We examined whether the developitiental aberrations associated with prenatal AED exposure-could be-detected already in infancy and whether effects on visual attention can be observed at this early age. Material and methods: We compared a prospective cohort of infants with in utero exposure to AED (n = 56) with infants without drug exposures (n = 62). The assessments performed at the age of seven months included standardized neurodevelopmental scores (Griffiths Mental Developmental Scale and Hammersmith Infant Neurological Examination) as well as a novel eye-tracking-based test for visual attention and orienting to faces. Background information included prospective collection of AED exposure data, pregnancy outcome, neuropsychological evaluation of the mothers, and information on maternal epilepsy type. Results: Carbamazepine, oxcarbazepine, and valproate, but not lamotrigine or levetiracetam, were associated with impaired early language abilities at the age of seven months. The general speed of visuospatial orienting or attentional bias for faces measured by eye-tracker-based tests did not differ between AED-exposed and control infants. Discussion: Our findings support the idea that prenatal AED exposure may impair verbal abilities, and this effect may be detected already in infancy. In contrast, the early development of attention to faces was spared after in utero AED exposure. (C) 2016 Elsevier Inc. All rights reserved.