Daylight Saving Time Transitions are Not Associated with Increased Seizure Incidence

OBJECTIVE:

Given the known association of daylight saving time (DST) transitions with increased risk of accidents, heart attack, and stroke, this study aimed to determine whether seizures, which are reportedly influenced by sleep and circadian disruption, also increased in frequency following the transition into DST.

METHODS:

Using Seizure Tracker’s self-reported data from 12 401 individuals from 2008-2016, 932 717 seizures were assessed for changes in incidence in relation to DST transitions. Two methods of standardization-z scores and unit-scaled rate ratios (RRs)-were used to compare seizure propensities following DST transitions to other time periods.

RESULTS:

As a percentile relative to all other weeks in a given year, absolute seizure counts in the week of DST fell below the median (DST seizure percentiles mean ± SD: 19.68 ± 16.25, P = 0.01), which was concordant with weekday-specific comparisons. Comparatively, RRs for whole-week (1.06, 95% confidence interval [CI] 1.02-1.10, P = 0.0054) and weekday-to-weekday (RR range 1.04-1.16, all P < 0.001) comparisons suggested a slightly higher incidence of seizures in the DST week compared to all other weeks of the year. However, examining the similar risk of the week preceding and following the DST-transition week revealed no significant weekday-to-weekday differences in seizure incidence, although there was an unexpected, modestly decreased seizure propensity in the DST week relative to the whole week prior (RR 0.94, 95% CI 0.91-0.96, P < 0.001).

SIGNIFICANCE:

Despite expectations that circadian and sleep disruption related to daylight savings time transitions would increase the incidence of seizures, this study found little substantive evidence for such an association in this large, longitudinal cohort. Although large-scale observational/epidemiologic cohorts can be effective at answering such questions, additional covariates (eg, sleep duration, seizure type, and so on) that may underpin the association were not able available, so the association has not definitively been ruled out.

Medication Self-Management and the Quality of Discharge Education Among Parents of Children with Epilepsy

INTRODUCTION: Medication self-management is critical among children with epilepsy. In the present study, researchers aimed to investigate the perceptions regarding the quality of discharge education among parents of children with epilepsy. In addition, they assessed the impact of the families’ perceptions on medication self-management. The quality of discharge education was assessed in two parts: content and delivery. The quality of delivery was defined as the manner in which nurses teach the content regarding hospital discharge.

METHODS: Forty-seven parents of children with epilepsy completed the questionnaires regarding demographics, the quality of discharge education, and medication self-management (the Quality of Discharge Teaching Scale and the Pediatric Epilepsy Medication Self-Management Questionnaire).

RESULTS: Parent-reported quality of discharge education was positively correlated with medication self-management (r = 0.305; p = .037). Parent-reported quality of delivery, but not the amount of content, was positively correlated with medication self-management (r = 0.347; p = .017).

CONCLUSIONS: These data suggest that efforts to improve medication self-management among children with epilepsy should include strategies to develop teaching skills among nurses delivering the discharge education.

Bedside Amplitude-Integrated EEG Not Reliable for Detecting Seizures in Neonates

Bedside amplitude-integrated electroencephalogram (EEG) possesses low sensitivity and specificity for detecting seizures compared with conventional EEG and may be prone to error in seizure classification in neonates, according to study results published in the Journal of Child Neurology.

Neonates from the Children’s Hospital of Eastern Ontario in Ottawa, Canada, who presented with possible seizure activity underwent parallel amplitude-integrated EEG and conventional EEG. Clinicians interpreted clinical events and amplitude-integrated EEG at bedside. Independent assessment of amplitude-integrated EEG and conventional EEG was performed by experienced neonatology and neurology readers. In addition, readers compared bedside amplitude-integrated EEG with amplitude-integrated EEG interpretation and conventional EEG in terms of sensitivity and specificity.

Limitations of the analysis included the small number of neonates in the final cohort, the recruitment of patients from a single center, and the heterogeneity of the sample in terms of age and clinical diagnosis.

The researchers concluded that the combination of amplitude-integrated EEG and conventional EEG remains feasible, yet “in view of the limited sensitivity and specificity of amplitude-integrated EEG, combined monitoring provides limited clinical benefit with regard to seizure detection.”

A Universal Automated Tool for Reliable Detection of Seizures in Rodent Models of Acquired and Genetic Epilepsy

Objective: Prolonged electroencephalographic (EEG) monitoring in chronic epilepsy rodent models has become an important tool in preclinical drug development of new therapies, in particular those for antiepileptogenesis, disease modification, and treating drug-resistant epilepsy. Researchers have developed an easy-to-use, reliable, computational tool for automated detection of electrographic seizures from prolonged EEG recordings in rodent models of epilepsy.

Methods: The team applied a novel method based on advanced time-frequency analysis that detects EEG episodes with excessive activity in certain frequency bands. The method uses an innovative technique of short-term spectral analysis, the Similar Basis Function algorithm. The method was applied for offline seizure detection from long-term EEG recordings from four spontaneously seizing, chronic epilepsy rat models: the fluid percussion injury (n = 5 rats, n = 49 seizures) and post-status epilepticus models (n = 119 rats, n = 993 seizures) of acquired epilepsy, and two genetic models of absence epilepsy, Genetic Absence Epilepsy Rats from Strasbourg and Wistar Albino Glaxo from Rijswijk (n = 41 and 14 rats, n = 8733 and 825 seizures, respectively).

Results: The comparative analysis revealed that the EEG amplitude spectra of these four rat models are remarkably similar during epileptiform activity and have a single expressed peak within the 17- to 25-Hz frequency range. Focusing on this band, our computer program detected all seizures in the 179 rats. A quick semiautomated user inspection of the EEGs for the period of each identified event allowed quick rejection of artifact events. The overall processing time for 12-day-long recordings varied from a few minutes (5-10) to 30 minutes, depending on the number of artifact events, which was strongly correlated with the signal quality of the raw EEG data.

Significance: The automated seizure detection tool provides high sensitivity, with acceptable specificity, for long- and short-term EEG recordings from both acquired and genetic chronic epilepsy rat models. This tool has the potential to improve the efficiency and rigor of preclinical research and therapy development using these models.

ADHD Meds Safe With Epilepsy, Study Finds

Attention-deficit/hyperactivity disorder (ADHD) often occurs in people with epilepsy. Now, new research provides reassurance that taking ADHD medications won’t raise their risk of seizures.

For the study, researchers analyzed data from thousands of epilepsy patients in Sweden. Taking ADHD medications such as Ritalin (methylphenidate), was associated with a 27 percent reduction in seizures, compared with not taking the medications, the investigators found.

“When you compare risk between individuals, there’s a lot of factors that might explain associations that have nothing to do with the medication itself,” said study author Kelsey Wiggs, a Ph.D. candidate at Indiana University, in Bloomington.

The study was published online recently in the journal Epilepsia.

Biomarkers of Cardiac Stress After Generalized Convulsive Seizures Identified

Biomarkers such as high?sensitive troponin T (hsTNT), copeptin, and soluble urokinase plasminogen activator receptor (suPAR) may be helpful to identify cardiac stress after generalized convulsive seizures (GCS) in patients with refractory epilepsy, according to study results published in Epilepsia.

A total of 36 patients with refractory epilepsy (generalized-onset tonic clonic seizures [n=6] and focal to bilateral tonic-clonic seizures [n=30]) were enrolled in the study after undergoing video-electroencephalography monitoring with simultaneous one?lead electrocardiography recordings. At study enrollment and at various time points after GCS, researchers measured catecholamines and several cardiac biomarkers: cardiac troponin I (cTNI), hsTNT, N-terminal pro-brain natriuretic peptide, copeptin, suppression of tumorigenicity?2, growth differentiation factor 15, suPAR, and heart-type fatty acid binding protein. In addition, the investigators analyzed heart rate, heart rate variability (HRV), and corrected QT intervals to assess periictal cardiac properties.

The Spectrum of Neuroimaging Findings in Febrile Infection-Related Epilepsy Syndrome (FIRES): A Literature Review

Febrile infection-related epilepsy syndrome (FIRES) is a rare severe epileptic syndrome occurring in previously healthy children and characterized by refractory status epilepticus (SE) following a febrile illness. Brain imaging findings in affected patients have been reported in few case series and some case reports. This article is a comprehensive review of the magnetic resonance imaging (MRI) characteristics in all reported patients with a diagnosis of FIRES, describing the findings in the acute and chronic phases of the disease, and discussing possible pathogenesis and radiologic differential diagnoses.

Most of the patients had normal brain scans in the acute phase (61%) and about 25% of the patients reported in literature had abnormalities in the temporal lobes. Changes in the basal ganglia and rarely in thalami or brainstem have also been described, as well as diffuse cerebral edema in a minority of patients during the acute phase. The chronic phase of the disease was characterized by atrophic changes and evidence of mesiotemporal sclerosis. An understanding of these MRI abnormalities is necessary to support the diagnosis of FIRES and exclude mimics.

White Matter, Cortical Volume May Predict Risk for Late-Onset Epilepsy

According to study results published in Neurology, white matter hyperintensities and lower cortical volume scores are associated with a higher risk for late-onset epilepsy in older adults.

A total of 1920 individuals (median age, 62.7) who participated in the Atherosclerosis Risk in Communities (ARIC) Study in 1993 to 1995 were included in the analysis. In the study, participants underwent magnetic resonance imaging (MRI) scan and researchers measured white matter hyperintensities.

According to the investigators, the findings from this study should be integrated into future “studies to develop prediction models to identify patients at risk for late-onset epilepsy” while incorporating “imaging findings as well as medical and social risk factors.”

Review: Management of Epilepsy in Women

Epilepsy is a common neurological condition in women worldwide. Hormonal changes occurring throughout a woman’s life can influence and be influenced by seizure mechanisms and antiepileptic drugs, presenting unique management challenges.

Effective contraception is particularly important for women with epilepsy of childbearing potential because of antiepileptic drug-related teratogenicity and hormonal interactions; although studies reveal many women do not receive contraceptive and preconceptual counselling.

Management challenges in this population include the higher risk of pregnancy complications and peripartum psychiatric problems than in women without epilepsy. Research is needed to clarify the precise role of folic acid supplementation in prevention of congenital malformations in children born to women with epilepsy. To optimise treatment of low bone density in women with epilepsy, studies investigating bone densitometry frequency and calcium and vitamin D supplements are required. Understanding of the mechanisms linking seizures and the menopause will help to develop effective therapeutic strategies, and advances in managing epilepsy could improve quality of life for women with this condition.

Robotics Makes Intractable Epilepsy Surgery More Accurate

A study, published this week in JAMA Neurology, revealed that patients who had the minimally invasive evaluation procedure experienced fewer complications. Those who went on to have brain surgery were more likely to be seizure-free than patients who had the more invasive evaluation procedure.

Researchers reviewed 239 patients with medically intractable epilepsy who had a total of 260 procedures between 2004 and 2017 to locate the source of their seizures and determine their suitability for surgery. All procedures were performed at Memorial Hermann-Texas Medical Center.

Of those 260 procedures, 139 cases involved traditional subdural electrode (SDE) implantation, which includes a large opening of the skull, known as a craniotomy. A sheet of electrodes is placed on the outside of the brain to pinpoint the seizure source before the skull closed back up for an observation period, which usually lasts around a week.