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Globally, epilepsy is the most common chronic neurological disorder. The incidence in sub-Saharan Africa is 2-3 times higher than that in high income countries. Infection by Onchocerca volvulus may be an underlying risk factor for the high burden and based upon epidemiological associations, has been proposed to cause a group of disorders-Onchocerca associated epilepsies (OAE) like nodding syndrome (NS). To improve our understanding of the disease spectrum, we described the clinical, electroencephalographic (EEG) and magnetic resonance imaging (MRI) features of children with epilepsy and sero-positive for Onchocerca volvulus (possible OAEs other than nodding syndrome). Twenty-nine children and adolescents with non-nodding syndrome OAE in northern Uganda were enrolled. A diagnosis of OAE was made in patients with epilepsy and seizure onset after age 3 years, no reported exposure to perinatal severe febrile illness or traumatic brain injury, no syndromic epilepsy diagnosis and a positive Ov-16 ELISA test. Detailed clinical evaluation including psychiatric, diagnostic EEG, a diagnostic brain MRI (in 10 patients) and laboratory testing were performed. Twenty participants (69%) were male. The mean age was 15.9 (standard deviation [SD] 1.9) years while the mean age at seizure onset was 9.8 (SD 2.9) years. All reported normal early childhood development. The most common clinical presentation was a tonic-clonic seizure. The median number of seizures was 2 (IQR 1-4) in the previous month. No specific musculoskeletal changes, or cranial nerve palsies were reported, neither were any vision, hearing and speech difficulties observed. The interictal EEG was abnormal in the majority with slow wave background activity in 52% (15/29) while 41% (12/29) had focal epileptiform activity. The brain MRI showed mild to moderate cerebellar atrophy and varying degrees of atrophy of the frontal, parietal and occipital lobes. The clinical spectrum of epilepsies associated with Onchocerca may be broader than previously described. In addition, focal onset tonic-clonic seizures, cortical and cerebellar atrophy may be important brain imaging and clinical features.

Objective: This study was undertaken to assess the clinical utility, safety, and tolerability in epilepsy patients of ultra long‐term monitoring with a novel subcutaneous electroencephalographic (EEG) device (sqEEG). Methods: Five patients with drug‐resistant focal epilepsy were implanted (one patient bilaterally) with sqEEG. In phase 1, we assessed sqEEG sensitivity for seizure recording by recording seizures simultaneously with scalp EEG in the epilepsy monitoring unit (EMU). sqEEG was scored either visually (v‐sqEEG) or by using a semiautomatic algorithm (EpiSight; E‐sqEEG). In phase 2, the patients were monitored as outpatients for 3–6 months. sqEEG data were analyzed monthly, evaluating concordance of data obtained by v‐sqEEG, E‐sqEEG, and patients' diaries. v‐sqEEG data were used to guide treatment adjustments. sqEEG‐related side effects were assessed throughout the study. Results: In phase 1, v‐sqEEG detected all seizures recorded in the EMU in all patients, whereas E‐sqEEG was as effective in three patients. In the other two patients, E‐sqEEG detected only a proportion or none of the seizures, respectively. Sensitivity of E‐sqEEG depended on the ictal EEG features. In phase 2, a 100% concordance between E‐sqEEG and v‐sqEEG in seizure detection was observed for the same three patients as in phase 1. In the other two patients (one implanted bilaterally), effectiveness of E‐sqEEG in detecting seizure as compared to v‐sqEEG ranged from 0% to 83%. v‐sqEEG showed that all patients reported in their diaries fewer seizures than they actually suffered. In four of five patients, v‐sqEEG showed that the treatment adjustments had been ineffective or associated with a seizure increment. The only side effect was an infection at the implantation site in one patient. Significance: The sqEEG system could collect reliable information on seizure activity, thus providing clinically relevant information. Sensitivity of EpiSight in detecting seizures varied across patients, depending on the ictal EEG features. sqEEG ultra long‐term monitoring was feasible and well tolerated. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to evaluate the efficacy of vagus nerve stimulation (VNS) over time, and to determine which patient groups derive the most benefit. Methods: Long‐term outcomes are reported in 436 epilepsy patients from a VNS quality registry (52.8% adults, 47.2% children), with a median follow‐up of 75 months. Patients were stratified according to evolution of response into constant responders, fluctuating responders, and nonresponders. The effect was evaluated at 6, 12, 24, 36, and 60 months. Multivariate regression analysis was used to identify predictors of response. Results: The cumulative probability of ≥50% seizure reduction was 60%; however, 15% of patients showed a fluctuating course. Of those becoming responders, 89.5% (230/257) did so within 2 years. A steady increase in effect was observed among constant responders, with 48.7% (19/39) of those becoming seizure‐free and 29.3% (39/133) with ≥75% seizure reduction achieving these effects within 2–5 years. Some effect (25%–<50%) at 6 months was a positive predictor of becoming a responder (odds ratio [OR] = 10.18, p <.0001) and having ≥75% reduction at 2 years (OR = 3.34, p =.03). Patients without intellectual disability had ORs of 3.34 and 3.11 of having ≥75% reduction at 2 and 5 years, respectively, and an OR of 6.22 of being seizure‐free at last observation. Patients with unchanged antiseizure medication over the observation period showed better responder rates at 2 (63.0% vs. 43.1%, p =.002) and 5 years (63.4% vs. 46.3%, p =.031) than patients whose antiseizure medication was modified. Responder rates were higher for posttraumatic (70.6%, p =.048) and poststroke epilepsies (75.0%, p =.05) than other etiologies (46.5%). Significance: Our data indicate that the effect of VNS increases over time and that there are important clinical decision points at 6 and 24 months for evaluating and adjusting the treatment. There should be better selection of candidates, as certain patient groups and epilepsy etiologies respond more favorably. [ABSTRACT FROM AUTHOR]

Up to one-quarter of people with epilepsy have mental health disorders in addition to seizures. Depression has received the most attention although anxiety disorders occur just as frequently, if not more so. Even though psychiatric symptoms can reduce quality of life more than epileptic seizures, they continue to go unnoticed and untreated.

Background: Epilepsy-related psychoses lie in the border zone between neurology and psychiatry. The aim of this article is to give a brief overview of current knowledge of these psychoses, and to offer recommendations for their treatment., Method: The article is based on a discretionary selection of articles found through a search in PubMed, as well as the authors' own experience with this patient group., Results: Epilepsy-related psychoses may occur during, after or between seizures. In addition, psychoses may occur as a side-effect of antiepileptic drugs, and as so-called alternative psychosis. The latter may arise in patients who, with the aid of treatment (medication or surgery), have become completely seizure-free. Ictal psychoses and the majority of postictal psychoses are often of such short duration that treatment with antipsychotics is not appropriate. In these cases, optimizing antiepileptic treatment is the best prophylaxis. Treatment with antipsychotics may, however, be indicated for interictal psychoses and for some patients with especially long-lasting or recurrent postictal psychoses., Interpretation: Different types of epilepsy-related psychosis require different types of treatment, and some are treated with antipychotics. In those circumstances, we recommend the use of medication that is less likely to lower the seizure threshold, for example risperidone.

Background: Episodic depression is more prevalent among persons with epilepsy than among those without. In many of these patients, depressions affect the quality of life more severely than the seizures themselves., Material and Methods: The article is based on literature identified through a non-systematic search in PubMed, and the authors' own clinical experience with this patient group., Results: Diagnosing depression in patients with epilepsy may be difficult, because the symptoms are somewhat atypical and appear episodically. Depressive symptoms may be temporally related to seizures (ictal or periictal), or more often - independent of them (interictal). The causes may be of neurobiological, psychosocial or iatrogenic nature. Patients who have temporolimbic epilepsy, a focus in the left hemisphere, and/or who take GABAergic drugs, seem to be particularly vulnerable. Antidepressants can in some cases reduce the seizure threshold, but SSRIs and SNRIs do this to little or negligible extent. These drugs are therefore recommended as first-line treatment for depression in patients with epilepsy., Interpretation: There is a bidirectional relationship between epilepsy and depression, as both conditions increase the risk of developing the other. This phenomenon may be explained by accumulating evidence of pathophysiological mechanisms common to them both. Depression is frequently overlooked in patients with epilepsy, and accordingly not treated. We believe measures such as pharmacological treatment and/or cognitive, behavioral, and interpersonal therapy may improve the quality of life for these patients.