Clinical Therapeutic and Management Strategies for Epilepsy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 3 July 2024 | Viewed by 2830

Special Issue Editor

Department of Pediatrics (Sakura), Toho University, Shimoshizu 564-1, Sakura 285-8741, Japan
Interests: pediatric neurology; epilepsy; cognitive neuroscience; neurodevelopmental disorders

Special Issue Information

Dear Colleagues,

The quality of life (QOL) of children suffering from childhood epilepsy may be associated with clinical and social variables. Among these variables, seizure severities, including frequent seizures and status epileptics, have been identified as important predictors of QOL. In addition, frequent interictal epileptiform discharges (IEDs) on EEG may also accompany transient cognitive/behavioral impairments. Moreover, frequent seizures and/or IEDs may play a role as mediators of emotional responses including stigma and fatigue. Thus, seizure severities and IEDs are important QOL-related factors. Though children with epilepsy do not always exhibit neuropsychological problems, seizure severities and IEDs on EEG may be associated with neuropsychological impairments. To prevent these disturbances, we should appropriately treat patients to suppress seizures and EEG abnormalities as early as possible. The optimal treatment strategy should be chosen to mitigate seizures and EEG abnormalities as soon as possible and accomplish the most favorable prognosis for children with epilepsy. There is thus a need for the development of antiseizure medications with novel mechanisms of action that have the potential to improve outcomes. This Special Issue aims to highlight recent advances in the context of QOL-related factors, treatment, and the therapeutic management and strategies for children with epilepsy.

Dr. Hideaki Kanemura
Guest Editor

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Keywords

  • quality of life (QOL)
  • frontal
  • behavior
  • stigma
  • seizure severity
  • interictal epileptiform discharge (IED)
  • antiseizure medication

Published Papers (3 papers)

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Research

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12 pages, 1843 KiB  
Article
Classification Model for Epileptic Seizure Using Simple Postictal Laboratory Indices
J. Clin. Med. 2023, 12(12), 4031; https://doi.org/10.3390/jcm12124031 - 13 Jun 2023
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Abstract
Distinguishing syncope from epileptic seizures in patients with sudden loss of consciousness is important. Various blood tests have been used to indicate epileptic seizures in patients with impaired consciousness. This retrospective study aimed to predict the diagnosis of epilepsy in patients with transient [...] Read more.
Distinguishing syncope from epileptic seizures in patients with sudden loss of consciousness is important. Various blood tests have been used to indicate epileptic seizures in patients with impaired consciousness. This retrospective study aimed to predict the diagnosis of epilepsy in patients with transient loss of consciousness using the initial blood test results. A seizure classification model was constructed using logistic regression, and predictors were selected from a cohort of 260 patients using domain knowledge and statistical methods. The study defined the diagnosis of seizures and syncope based on the consistency of the diagnosis made by an emergency medicine specialist at the first visit to the emergency room and the diagnosis made by an epileptologist or cardiologist at the first outpatient visit using the International Classification of Diseases 10th revision (ICD-10) code. Univariate analysis showed higher levels of white blood cells, red blood cells, hemoglobin, hematocrit, delta neutrophil index, creatinine kinase, and ammonia levels in the seizure group. The ammonia level had the highest correlation with the diagnosis of epileptic seizures in the prediction model. Therefore, it is recommended to be included in the first examination at the emergency room. Full article
(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies for Epilepsy)
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Review

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11 pages, 2101 KiB  
Review
Vagus Nerve Stimulation Therapy for Drug-Resistant Epilepsy in Children—A Literature Review
J. Clin. Med. 2024, 13(3), 780; https://doi.org/10.3390/jcm13030780 - 29 Jan 2024
Viewed by 582
Abstract
Vagus nerve stimulation (VNS) is a palliative treatment for drug-resistant epilepsy (DRE) that has been in use for over two decades. VNS suppresses epileptic seizures, prevents emotional disorders, and improves cognitive function and sleep quality, a parallel effect associated with the control of [...] Read more.
Vagus nerve stimulation (VNS) is a palliative treatment for drug-resistant epilepsy (DRE) that has been in use for over two decades. VNS suppresses epileptic seizures, prevents emotional disorders, and improves cognitive function and sleep quality, a parallel effect associated with the control of epileptic seizures. The seizure suppression rate with VNS increases monthly to annually, and the incidence of side effects reduces over time. This method is effective in treating DRE in children as well as adults, such as epilepsy associated with tuberous sclerosis, Dravet syndrome, and Lennox–Gastaut syndrome. In children, it has been reported that seizures decreased by >70% approximately 8 years after initiating VNS, and the 50% responder rate was reported to be approximately 70%. VNS regulates stimulation and has multiple useful systems, including self-seizure suppression using magnets, additional stimulation using an automatic seizure detection system, different stimulation settings for day and night, and an automatic stimulation adjustment system that reduces hospital visits. VNS suppresses seizures and has beneficial behavioral effects in children with DRE. This review describes the VNS system, the mechanism of the therapeutic effect, the specific stimulation adjustment method, antiepileptic effects, and other clinical effects in patients with childhood DRE. Full article
(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies for Epilepsy)
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12 pages, 969 KiB  
Review
Therapeutic Strategies in Children with Epilepsy: A Quality-of-Life-Related Perspective
J. Clin. Med. 2024, 13(2), 405; https://doi.org/10.3390/jcm13020405 - 11 Jan 2024
Viewed by 518
Abstract
Back ground: Children with epilepsy are affected by several factors, including clinical and social variables. Among these variables, cognitive decline and behavioral disturbances, perceptions of stigma, and fatigue can lead to reductions in quality of life (QOL). Epileptic activities, including seizure severity, frequent [...] Read more.
Back ground: Children with epilepsy are affected by several factors, including clinical and social variables. Among these variables, cognitive decline and behavioral disturbances, perceptions of stigma, and fatigue can lead to reductions in quality of life (QOL). Epileptic activities, including seizure severity, frequent seizures, and status epilepticus (SE), have been identified as important predictors of QOL. In addition, the frequency of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) may also be an important predictor of QOL, because IEDs can lead to cognitive decline and behavioral disturbances. Moreover, frequent seizures and/or IEDs may play a role in emotional mediators, such as stigma and fatigue, in childhood epilepsy. Seizure severity and/or IEDs are, therefore, important QOL-related factors in childhood epilepsy. Seizure severity as a QOL-related factor: Frontal lobe dysfunctions, such as cognitive decline and behavioral disturbances, can result in reduced QOL for both the child and their family. Frontal and prefrontal lobe growth disturbances can be present during active-phase epilepsy in some children with neuropsychological impairments. Recovery from prefrontal lobe growth disturbances may depend on the active seizure period. Children with a shorter active seizure period can recover from disturbances in prefrontal lobe growth more rapidly. In contrast, recovery may be delayed in children with a longer active seizure period. Moreover, frequent seizures can lead to seizure-associated headaches, perceptions of self-stigma and parental stigma, and fatigue. Accordingly, severe seizures can lead to neuropsychological impairments in association with prefrontal lobe growth disturbances in children with epilepsy. EEG abnormalities as QOL-related factors: IEDs on EEG, representing persistent pathological neuronal discharges, may be associated with several pathological aspects. Frontal IEDs can be a risk factor for recurrent seizures, cognitive decline, and behavioral disturbances, and they may also play a role as emotional mediators similar to stigma. In addition, behavioral disturbances may result in the presence of secondary bilateral synchrony (SBS) on EEG. Behavioral disturbances can be improved in association with a reduction in IEDs in children with frontal IEDs and SBS. Therefore, EEG abnormalities, such as frontal IEDs and SBS, can also lead to neuropsychological impairments in children with epilepsy. Therapeutic strategies in children with epilepsy: Seizure severity and IEDs on EEG may be associated with neuropsychological impairments, leading to QOL reduction. Therapeutic management may be desirable to reduce seizures and EEG abnormalities, such as frontal IEDs and SBS, as early as possible to improve QOL in children with epilepsy. During antiseizure medication (ASM) selection and adjustment, physicians should strategize the therapeutic approach to controlling seizures and suppressing EEG abnormalities in children with epilepsy. Among various ASMs, novel ASMs, such as levetiracetam and perampanel, may suppress both clinical seizures and IEDs on EEG; thus, these novel ASMs may represent an important addition to the treatments available for epileptic children presenting with frontal IEDs and SBS. Full article
(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies for Epilepsy)
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