Bassetti and Kallweit shared first authorship. Dauvilliers and Lammers shared last authorship. Bassetti, Kallweit, Dauvilliers and Lammers contributed equally.
Objective
The yield of epileptiform abnormalities in serial EEGs has not been addressed in a population-based setting for subjects with incident epilepsy or a single unprovoked seizure, raising the possibility of methodological limitations such as selection bias. Our aim was to address these limitations by assessing the yield and predictors of epileptiform abnormalities for the first and subsequent EEGs in a study of incident epilepsy or single unprovoked seizure in Rochester, Minnesota.
Methods
We used the resources of the Rochester Epidemiology Project to identify all 619 residents of Rochester, Minnesota born in 1920 or later with a diagnosis of incident epilepsy (N=478) or single unprovoked seizure (N=141) between 1960 and 1994, who had at least one EEG. Information on all EEGs and their results was obtained by comprehensive review of medical records.
Results
Among subjects with epilepsy, the cumulative yield of epileptiform abnormalities was 53% after the first EEG and 72% after the third EEG. Among subjects with single unprovoked seizure, the cumulative yield was 39% after the first EEG and 68% after the third EEG. Young age at diagnosis and idiopathic etiology were risk factors for finding epileptiform abnormalities across all EEGs.
Significance
While the cumulative yield of epileptiform abnormalities increases over successive EEGs, there is a decrease in the increment for each additional EEG after the first EEG. This is most evident in incident epilepsy and in younger subjects. Clinically it may be worthwhile to consider that the probability of finding an epileptiform abnormality after the third non-epileptiform EEG is low.
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disease caused by TYMP mutations and thymidine phosphorylase (TP) deficiency. Thymidine and deoxyuridine accumulate impairing the mitochondrial DNA maintenance and integrity. Clinically, patients show severe and progressive gastrointestinal and neurological manifestations. The onset typically occurs in the second decade of life and mean age at death is 37 years. Signs and symptoms of MNGIE are heterogeneous and confirmatory
Bassetti and Kallweit shared first authorship. Dauvilliers and Lammers shared last authorship. Bassetti, Kallweit, Dauvilliers and Lammers contributed equally.
Markers of stress (i.e., low collective efficacy, lifetime mood disorder, and lifetime generalized anxiety disorder) were associated with an increased risk for seizure recurrence in adults with a single unprovoked seizure or newly diagnosed epilepsy. Stress-reducing interventions, such as mindfulness, may be a useful, safe, and inexpensive adjunctive treatment for epilepsy.
OBJECTIVES
We examined the association between lifetime, current history of psychiatric disorders, suicidal thoughts and behaviors with childhood-onset epilepsies in a community-based cohort of young adults.
METHODS
Cases were neurotypical (normal neurological, cognitive, and imaging exams and no evidence of a brain insult responsible for the epilepsy) young adults with childhood-onset epilepsy followed since the onset of their epilepsy approximately 15 years earlier and recruited as part of a community-based study. They were compared to two different control groups, siblings and external controls from the National Comorbidity Survey-Replication (NCS-R). The Diagnostic Interview Survey assessed lifetime and current DSM-IV-TR diagnoses of mood disorders and anxiety disorders. Suicidal thoughts and suicide attempt were assessed using the Diagnostic Interview Survey for Children-IV and the Diagnostic Interview Survey.
RESULTS
Two hundred fifty-seven cases and 134 sibling controls participated in the DIS portion of the young adult assessment. Comparing cases both to their sibling controls and to the controls drawn from the NCS-R, we did not find any evidence to suggest a higher prevalence of lifetime and current mood or anxiety disorders, suicidal thoughts and suicide attempt in young adults with childhood-onset epilepsies.
SIGNIFICANCE
Our findings, from a community-based sample of neurotypical young adults, do not suggest a substantial or lasting association between childhood epilepsy and psychiatric disorders and suicidal behavior.
These real-world pharmacovigilance findings suggest that DILI might be a common feature of MS drugs and call for (1) formal population-based study to verify the risk of fampridine and (2) awareness by clinicians, who should assess the possible responsibility of MS drugs when they diagnose DILI.
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