130 results on '"Knake, Susanne"'
Search Results
2. Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review
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Rickel, Johanna K., Zeeb, Daria, Knake, Susanne, Urban, Hans, Konczalla, Jürgen, Weber, Katharina J., Zeiner, Pia S., Pagenstecher, Axel, Hattingen, Elke, Kemmling, André, Fokas, Emmanouil, Adeberg, Sebastian, Wolff, Robert, Sebastian, Martin, Rusch, Tillmann, Ronellenfitsch, Michael W., Menzler, Katja, Habermehl, Lena, Möller, Leona, Czabanka, Marcus, Nimsky, Christopher, Timmermann, Lars, Grefkes, Christian, Steinbach, Joachim P., Rosenow, Felix, Kämppi, Leena, and Strzelczyk, Adam
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- 2024
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3. Brivaracetam and topiramate serum levels during pregnancy and delivery: a case report and a review of literature
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Hahn, Wiebke, Möller, Leona, Menzler, Katja, Poeplau, Tobias, Wagner, Uwe, and Knake, Susanne
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- 2024
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4. Clinical characteristics and outcomes of patients with recurrent status epilepticus episodes
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Bauer, Kristina, Rosenow, Felix, Knake, Susanne, Willems, Laurent M., Kämppi, Leena, and Strzelczyk, Adam
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- 2023
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5. Morphometric correlates in patients with functional seizures with and without comorbid epilepsy
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Tsalouchidou, Panagiota-Eleni, Mross, Peter Michael, Gorny, Iris, Belke, Marcus, Habermehl, Lena, Schulze, Maximilian, Zahnert, Felix, Kraeling, Gunter, Fuest, Sven, Menzler, Katja, and Knake, Susanne
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- 2023
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6. Ultra-Rare Genetic Variation in the Epilepsies: A Whole-Exome Sequencing Study of 17,606 Individuals
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Collaborative, Epi25, Feng, Yen-Chen Anne, Howrigan, Daniel P, Abbott, Liam E, Tashman, Katherine, Cerrato, Felecia, Singh, Tarjinder, Heyne, Henrike, Byrnes, Andrea, Churchhouse, Claire, Watts, Nick, Solomonson, Matthew, Lal, Dennis, Heinzen, Erin L, Dhindsa, Ryan S, Stanley, Kate E, Cavalleri, Gianpiero L, Hakonarson, Hakon, Helbig, Ingo, Krause, Roland, May, Patrick, Weckhuysen, Sarah, Petrovski, Slavé, Kamalakaran, Sitharthan, Sisodiya, Sanjay M, Cossette, Patrick, Cotsapas, Chris, De Jonghe, Peter, Dixon-Salazar, Tracy, Guerrini, Renzo, Kwan, Patrick, Marson, Anthony G, Stewart, Randy, Depondt, Chantal, Dlugos, Dennis J, Scheffer, Ingrid E, Striano, Pasquale, Freyer, Catharine, McKenna, Kevin, Regan, Brigid M, Bellows, Susannah T, Leu, Costin, Bennett, Caitlin A, Johns, Esther MC, Macdonald, Alexandra, Shilling, Hannah, Burgess, Rosemary, Weckhuysen, Dorien, Bahlo, Melanie, O’Brien, Terence J, Todaro, Marian, Stamberger, Hannah, Andrade, Danielle M, Sadoway, Tara R, Mo, Kelly, Krestel, Heinz, Gallati, Sabina, Papacostas, Savvas S, Kousiappa, Ioanna, Tanteles, George A, Štěrbová, Katalin, Vlčková, Markéta, Sedláčková, Lucie, Laššuthová, Petra, Klein, Karl Martin, Rosenow, Felix, Reif, Philipp S, Knake, Susanne, Kunz, Wolfram S, Zsurka, Gábor, Elger, Christian E, Bauer, Jürgen, Rademacher, Michael, Pendziwiat, Manuela, Muhle, Hiltrud, Rademacher, Annika, van Baalen, Andreas, von Spiczak, Sarah, Stephani, Ulrich, Afawi, Zaid, Korczyn, Amos D, Kanaan, Moien, Canavati, Christina, Kurlemann, Gerhard, Müller-Schlüter, Karen, Kluger, Gerhard, Häusler, Martin, Blatt, Ilan, Lemke, Johannes R, Krey, Ilona, Weber, Yvonne G, Wolking, Stefan, Becker, Felicitas, Hengsbach, Christian, Rau, Sarah, Maisch, Ana F, Steinhoff, Bernhard J, Schulze-Bonhage, Andreas, Schubert-Bast, Susanne, and Schreiber, Herbert
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Clinical Research ,Human Genome ,Neurosciences ,Epilepsy ,Biotechnology ,Genetics ,Neurodegenerative ,Brain Disorders ,2.1 Biological and endogenous factors ,Aetiology ,Neurological ,Case-Control Studies ,DNA Mutational Analysis ,Exome ,Genetic Markers ,Genetic Predisposition to Disease ,Genetic Variation ,Humans ,Phenotype ,Exome Sequencing ,Epi25 Collaborative. Electronic address: s.berkovic@unimelb.edu.au ,Epi25 Collaborative ,burden analysis ,epilepsy ,epileptic encephalopathy ,exome ,seizures ,sequencing ,Biological Sciences ,Medical and Health Sciences ,Genetics & Heredity - Abstract
Sequencing-based studies have identified novel risk genes associated with severe epilepsies and revealed an excess of rare deleterious variation in less-severe forms of epilepsy. To identify the shared and distinct ultra-rare genetic risk factors for different types of epilepsies, we performed a whole-exome sequencing (WES) analysis of 9,170 epilepsy-affected individuals and 8,436 controls of European ancestry. We focused on three phenotypic groups: severe developmental and epileptic encephalopathies (DEEs), genetic generalized epilepsy (GGE), and non-acquired focal epilepsy (NAFE). We observed that compared to controls, individuals with any type of epilepsy carried an excess of ultra-rare, deleterious variants in constrained genes and in genes previously associated with epilepsy; we saw the strongest enrichment in individuals with DEEs and the least strong in individuals with NAFE. Moreover, we found that inhibitory GABAA receptor genes were enriched for missense variants across all three classes of epilepsy, whereas no enrichment was seen in excitatory receptor genes. The larger gene groups for the GABAergic pathway or cation channels also showed a significant mutational burden in DEEs and GGE. Although no single gene surpassed exome-wide significance among individuals with GGE or NAFE, highly constrained genes and genes encoding ion channels were among the lead associations; such genes included CACNA1G, EEF1A2, and GABRG2 for GGE and LGI1, TRIM3, and GABRG2 for NAFE. Our study, the largest epilepsy WES study to date, confirms a convergence in the genetics of severe and less-severe epilepsies associated with ultra-rare coding variation, and it highlights a ubiquitous role for GABAergic inhibition in epilepsy etiology.
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- 2019
7. Consultation Requests and Satisfaction with a Telehealth Network for Epilepsy: Longitudinal Analysis of the Epilepsy Network Hessen Evaluation.
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Zöllner, Johann Philipp, Rosenow, Felix, Schubert-Bast, Susanne, Roth, Christian, Knake, Susanne, Eickhoff, Clemens, Scheuble, Pascal, Martin, Jürgen, Bollensen, Edgar, Teepker, Michael, Singer, Oliver, Schirmer, Svenja, Dietz, Andreas, Henn, Karl-Heinz, Stolz, Erwin, Schüttler-Gahin, Katrin, Fischer, Michaela, Noda, Anna, Mann, Catrin, and Strzelczyk, Adam
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EPILEPSY ,SATISFACTION ,MAGNETIC resonance imaging ,PHYSICIANS ,CHILD patients ,TELEMEDICINE - Abstract
Background: Telemedicine improves access to specialized medical expertise, as required for paroxysmal disorders. The Epilepsy Network Hessen Evaluation (ENHE) is a pilot cross-sectoral teleconsultation network connecting primary neurologists and pediatricians with epilepsy centers in Hessen, a federal German state. Methods: We prospectively and longitudinally evaluated telehealthcare in the ENHE. Participating physicians rated each consultation for satisfaction and impact on further management. The survey was administered at each consultation and 3 months later. Results: We analyzed 129 consultations involving 114 adult and pediatric patients. Their mean age was 34 years (standard deviation: 26, range: 0.1–91 years), 48% were female, and 34% were children and adolescents. The most common consultation requests were co-evaluation of an electroencephalogram (electroencephalogram [EEG]; 76%) and therapeutic (33%) and differential diagnosis (24%) concerns. Physicians transmitted one paraclinical examination on average (range: 1–4), predominantly EEG (85%), followed by magnetic resonance imaging (17%) and written records (9%). Response rates were 72% for the initial and 67% for the follow-up survey. Across respondents, 99% (n = 92) were satisfied with the ENHE. Overall, 80% of the consultations contributed to the diagnosis, and 90% were considered helpful for treatment, influencing it in 71% of cases. Seizure frequency had decreased more often (96%) than increased (4%) at 3 months. The initial diagnosis was confirmed in 78% of patients. Discussion: In this pilot teleconsultation network for paroxysmal disorders, diagnostic and therapeutic advice was perceived as helpful. Clinical outcomes were largely positive, suggesting tele-epileptology is viable for paroxysmal (seizure) disorders. [ABSTRACT FROM AUTHOR]
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- 2024
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8. A multicenter randomized controlled feasibility trial of a digital self‐management intervention for adults with epilepsy.
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Michaelis, Rosa, Knake, Susanne, Rosenow, Felix, Grönheit, Wenke, Hamer, Hajo, Schmitz, Bettina, Accarie, Alison, Dedeken, Peter, Immisch, Ilka, Habermehl, Lena, Zöllner, Johann Philipp, Mann, Catrin, Wehner, Tim, Wellmer, Jörg, Cuny, Jeanne, Gollwitzer, Stephanie, Losch, Florian, Krämer, Kirsten, Voss, Kevin Steffen, and Heinen, Gerd
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RANDOMIZED controlled trials ,EPILEPSY ,PATIENT participation ,PATIENT autonomy ,HEALTH literacy ,TRANSCRANIAL direct current stimulation ,BLACKBERRIES - Abstract
Objective: Self‐management interventions may enhance health‐related quality of life (HRQoL) in epilepsy. However, several barriers often impair their implementation in the real world. Digital interventions may help to overcome some of these barriers. Considering this, the Helpilepsy Plus Prototype was developed as a prototype smartphone‐delivered self‐care treatment program for adults with epilepsy. Methods: The 12‐week Helpilepsy Plus Prototype was evaluated through a randomized controlled feasibility trial with a waiting‐list control (WLC) group. Outcome measurement at baseline and at 12 weeks assessed adherence to the prototype intervention and changes in epilepsy‐related outcomes. The primary endpoint was patient autonomy measured with EASE, and secondary endpoints included HRQoL measured with QOLIE‐31, health literacy measured with HLQ, anxiety, and depression symptoms measured with HADS. Semi‐structured interviews were conducted with a heterogeneous sample of participants to assess user‐friendliness and usefulness. The prototype program was delivered through the Neuroventis Platform (Neuroventis, BV, Overijse, Belgium), a certified medical device (under EU/MDD Class I, and EU/MDR grace period). Results: Ninety‐two patients were included (46 in the intervention group, 46 in WLC). Most participants (63%, 58/92 women, median age 30 years) had pharmacoresistant epilepsy (61%, 56/92). Only 22% of participants (10/46) in the intervention group completed at least half of all intervention sessions. No significant differences between the intervention group and WLC were observed. Although there was a larger proportion of patients in the intervention group with meaningful improvements in HRQoL compared to WLC (19/46 versus 11/46), the difference was not significant (p = 0.119). Qualitative feedback showed that participants would appreciate more personalization, such as adaptation of the content to their current epilepsy knowledge level, a more interactive interface, shorter text sections, and interaction through reminders and notifications. Significance: Digital interventions should allow sufficient scope for personalization and interaction to increase patient engagement and enable benefits from self‐care apps. Feedback loops allow the participatory development of tailored interventions. Plain Language Summary: In this study, we investigated the effectiveness of an app‐based self‐help intervention. Study participants were either randomly assigned to a group that had access to the app or a group that received access to the app after the end of the study. Although a larger proportion of participants in the intervention group showed a relevant improvement in quality of life, the difference between the two groups was not statistically significant. Less than one‐fifth of participants in the intervention group attended at least half of all intervention sessions; patient feedback showed that patients required more personalization and interactive options. [ABSTRACT FROM AUTHOR]
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- 2024
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9. A multicenter, matched case–control analysis comparing burden of illness among patients with tuberous sclerosis complex related epilepsy, generalized idiopathic epilepsy, and focal epilepsy in Germany.
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Lappe, Lisa, Hertzberg, Christoph, Knake, Susanne, Knuf, Markus, von Podewils, Felix, Willems, Laurent M., Kovac, Stjepana, Zöllner, Johann Philipp, Sauter, Matthias, Kurlemann, Gerhard, Mayer, Thomas, Bertsche, Astrid, Marquard, Klaus, Meyer, Sascha, Schäfer, Hannah, Thiels, Charlotte, Zukunft, Bianca, Schubert-Bast, Susanne, Reese, Jens-Peter, and Rosenow, Felix
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TUBEROUS sclerosis ,PARTIAL epilepsy ,IDIOPATHIC diseases ,REPORT cards ,EPILEPSY - Abstract
Background: Depending on the underlying etiology and epilepsy type, the burden of disease for patients with seizures can vary significantly. This analysis aimed to compare direct and indirect costs and quality of life (QoL) among adults with tuberous sclerosis complex (TSC) related with epilepsy, idiopathic generalized epilepsy (IGE), and focal epilepsy (FE) in Germany. Methods: Questionnaire responses from 92 patients with TSC and epilepsy were matched by age and gender, with responses from 92 patients with IGE and 92 patients with FE collected in independent studies. Comparisons were made across the main QoL components, direct costs (patient visits, medication usage, medical equipment, diagnostic procedures, ancillary treatments, and transport costs), indirect costs (employment, reduced working hours, missed days), and care level costs. Results: Across all three cohorts, mean total direct costs (TSC: €7602 [median €2620]; IGE: €1919 [median €446], P < 0.001; FE: €2598 [median €892], P < 0.001) and mean total indirect costs due to lost productivity over 3 months (TSC: €7185 [median €11,925]; IGE: €3599 [median €0], P < 0.001; FE: €5082 [median €2981], P = 0.03) were highest among patients with TSC. The proportion of patients with TSC who were unemployed (60%) was significantly larger than the proportions of patients with IGE (23%, P < 0.001) or FE (34%, P = P < 0.001) who were unemployed. Index scores for the EuroQuol Scale with 5 dimensions and 3 levels were significantly lower for patients with TSC (time-trade-off [TTO]: 0.705, visual analog scale [VAS]: 0.577) than for patients with IGE (TTO: 0.897, VAS: 0.813; P < 0.001) or FE (TTO: 0.879, VAS: 0.769; P < 0.001). Revised Epilepsy Stigma Scale scores were also significantly higher for patients with TSC (3.97) than for patients with IGE (1.48, P < 0.001) or FE (2.45, P < 0.001). Overall Quality of Life in Epilepsy Inventory-31 items scores was significantly lower among patients with TSC (57.7) and FE (57.6) than among patients with IGE (66.6, P = 0.004 in both comparisons). Significant differences between patients with TSC and IGE were also determined for Neurological Disorder Depression Inventory for Epilepsy (TSC: 13.1; IGE: 11.2, P = 0.009) and Liverpool Adverse Events Profile scores (TSC: 42.7; IGE: 37.5, P = 0.017) with higher score and worse results for TSC patients in both questionnaires. Conclusions: This study is the first to compare patients with TSC, IGE, and FE in Germany and underlines the excessive QoL burden and both direct and indirect cost burdens experienced by patients with TSC. Key points: • This is the first analysis to compare QoL and direct/indirect cost burden among patients with TSC, IGE, and FE in Germany. • Generic QoL for patients with TSC was significantly lower than for patients with IGE and FE. • Care grade and disability cards were more frequently obtained by patients with TSC than by patients in the other cohorts. • Drug treatment costs were the highest direct cost component for patients with TSC. • More patients with TSC than with IGE or FE were unemployed, and the mean indirect productivity costs were highest for the TSC cohort. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures
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Frey, Katharina, Zöllner, Johann Philipp, Knake, Susanne, Oganian, Yulia, Kay, Lara, Mahr, Katharina, Keil, Fee, Willems, Laurent M., Menzler, Katja, Bauer, Sebastian, Schubert-Bast, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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- 2020
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11. Direct and indirect costs and cost-driving factors in adults with tuberous sclerosis complex: a multicenter cohort study and a review of the literature
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Zöllner, Johann Philipp, Grau, Janina, Rosenow, Felix, Sauter, Matthias, Knuf, Markus, Kurlemann, Gerhard, Mayer, Thomas, Hertzberg, Christoph, Bertsche, Astrid, Immisch, Ilka, Klein, Karl Martin, Knake, Susanne, Marquard, Klaus, Meyer, Sascha, Noda, Anna H., von Podewils, Felix, Schäfer, Hannah, Thiels, Charlotte, Willems, Laurent M., Zukunft, Bianca, Schubert-Bast, Susanne, and Strzelczyk, Adam
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- 2021
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12. Quality of life and its predictors in adults with tuberous sclerosis complex (TSC): a multicentre cohort study from Germany
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Zöllner, Johann Philipp, Conradi, Nadine, Sauter, Matthias, Knuf, Markus, Knake, Susanne, Kurlemann, Gerhard, Mayer, Thomas, Hertzberg, Christoph, Bertsche, Astrid, Immisch, Ilka, Klein, Karl Martin, Marquard, Klaus, Meyer, Sascha, Noda, Anna H., von Podewils, Felix, Schäfer, Hannah, Thiels, Charlotte, Zukunft, Bianca, Schubert-Bast, Susanne, Grau, Janina, Willems, Laurent M., Rosenow, Felix, Reese, Jens-Peter, and Strzelczyk, Adam
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- 2021
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13. In response to commentary on cavernoma‐related epilepsy: Review and recommendations for management—Report of the surgical task force of the ILAE commission on therapeutic strategies
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Rosenow, Felix, Alonso‐Vanegas, Mario A, Baumgartner, Christoph, Blümcke, Ingmar, Carreño, Mar, Gizewski, Elke R, Hamer, Hajo M, Knake, Susanne, Kahane, Philippe, Lüders, Hans O, Mathern, Gary W, Menzler, Katja, Miller, Jonathan, Otsuki, Taisuke, Ozkara, Cigdem, Pitkänen, Asla, Roper, Steven N, Sakamoto, Americo C, Sure, Ulrich, Walker, Matthew C, Steinhoff, Bernhard J, and Force, Commission on Therapeutic Strategies of the ILAE the Surgical Task
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Biomedical and Clinical Sciences ,Clinical Sciences ,Brain Neoplasms ,Epilepsy ,Hemangioma ,Cavernous ,Central Nervous System ,Humans ,Surgical Task Force ,Commission on Therapeutic Strategies of the ILAE ,Neurosciences ,Neurology & Neurosurgery ,Clinical sciences - Published
- 2014
14. Morphometric magnetic resonance imaging (MRI) postprocessing in MRI‐negative patients with first unprovoked seizure.
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Tsalouchidou, Panagiota‐Eleni, Hoffmann, Johanna, Strehlau, Sascha, Linka, Louise, Belke, Marcus, Habermehl, Lena, Schulze, Maximilian, Kemmling, André, Menzler, Katja, and Knake, Susanne
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EPILEPSY ,MAGNETIC resonance imaging ,FOCAL cortical dysplasia ,SEIZURES (Medicine) ,DIAGNOSIS of epilepsy ,PEOPLE with epilepsy - Abstract
Objective: The aim of the study was to evaluate the benefits of morphometric magnetic resonance imaging (MRI) postprocessing in patients presenting with a first seizure and negative MRI results and to investigate these findings in the context of the clinical and electroencephalographic data, seizure recurrence rates, and epilepsy diagnosis in these patients. Methods: We retrospectively reviewed 97 MRI scans of patients with first unprovoked epileptic seizure and no evidence of epileptogenic lesion on clinical routine MRI. Morphometric Analysis Program (MAP; v2018), automated postprocessing software, was used to identify subtle, potentially epileptogenic lesions in the three‐dimensional T1‐weighted MRI data. The resulting probability maps were examined together with the conventional MRI images by a reviewer who remained blinded to the patients' clinical and electroencephalographical data. Clinical data were prospectively collected between February 2018 and May 2023. Results: Among the apparently MRI‐negative patients, a total of 18 of 97 (18.6%) showed cortical changes suggestive of focal cortical dysplasia. Within the population with positive MAP findings (MAP+), seizure recurrence rates were 61.1% and 66.7% at 1 and 2 years after the first unprovoked seizure, respectively. Conversely, patients with negative MAP findings (MAP−) had lower seizure recurrence rates of 27.8% and 34.2% at 1 and 2 years after the first unprovoked seizure, respectively. Patients with MAP+ findings were significantly more likely to be diagnosed with epilepsy than those patients with MAP− findings (χ2 [1, n = 97] = 14.820, p <.001, odds ratio = 21.371, 95% CI = 2.710–168.531) during a mean follow‐up time of 22.51 months (SD = 16.7 months, range = 1–61 months). Significance: MRI postprocessing can be a valuable tool for detecting subtle epileptogenic lesions in patients with a first seizure and negative MRI results. Patients with first seizure and MAP+ findings had high seizure recurrence rates, meeting the criteria for beginning epilepsy. [ABSTRACT FROM AUTHOR]
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- 2024
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15. First seizure in elderly patients: Need to treat? Evidence from a retrospective study.
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Linka, Louise, Magnus, Benedikt, Faiz, Nabard, Habermehl, Lena, Tsalouchidou, Panagiota-Eleni, Zahnert, Felix, Moeller, Leona, Krause, Kristina, Knake, Susanne, and Menzler, Katja
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OLDER patients ,SEIZURES (Medicine) ,EPILEPSY ,CEREBRAL atrophy ,THERAPEUTICS ,NEUROFIBRILLARY tangles - Abstract
Background: The risk of seizure recurrence after a first unprovoked epileptic seizure is reported to be approximately 40%. Little is known about the recurrence risk after a first seizure in elderly patients, who may be at higher risk due to an increased rate of structural lesions, encephalopathy, subcortical arteriosclerotic encephalopathy or brain atrophy. Methods: In a retrospective approach, the recurrence rate in 304 patients aged 60 years and above who presented with a first seizure between 2004 and 2017 was analyzed. Hierarchical Cox regression was used to investigate the impact of EEG and neuroimaging results, age or the prescription of anti-seizure medication (ASM) on seizure recurrence. Results: Seizure recurrence rates were 24.5% and 34.4% after one and two years, respectively. Anti-seizure medication was started in 87.8% of patients, in 28.8% despite the absence of clear epileptogenic lesions on neuroimaging or epileptiform potentials in the EEG. Medical treatment significantly reduced the risk of recurrence (hazard ratio = 0.47). Epileptiform potentials in the EEG, epileptogenic lesions in neuroimaging and age had no significant effect on seizure recurrence. Age and the presence of neurodegenerative and psychiatric comorbidities showed a significant association with ASM prescription. Conclusions: The present data show a strong protective effect of ASM on seizure recurrence in patients above the age of 60, even in the absence of pathologic neuroimaging or EEG results needed for the diagnosis of epilepsy. Treatment with ASM therefore seems beneficial for reducing the recurrence risk in elderly patients. The lack of a significant association between seizure recurrence and epileptogenic lesions might be related to other confounding factors like encephalopathy, subcortical arteriosclerotic encephalopathy, neurodegenerative diseases or brain atrophy. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Cavernoma‐related epilepsy: Review and recommendations for management—Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies
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Rosenow, Felix, Alonso‐Vanegas, Mario A, Baumgartner, Christoph, Blümcke, Ingmar, Carreño, Maria, Gizewski, Elke R, Hamer, Hajo M, Knake, Susanne, Kahane, Philippe, Lüders, Hans O, Mathern, Gary W, Menzler, Katja, Miller, Jonathan, Otsuki, Taisuke, Özkara, Cigdem, Pitkänen, Asla, Roper, Steven N, Sakamoto, Americo C, Sure, Ulrich, Walker, Matthew C, Steinhoff, Bernhard J, and Force, Commission on Therapeutic Strategies of the ILAE The Surgical Task
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Epilepsy ,Neurodegenerative ,Brain Disorders ,Neurosciences ,Neurological ,Anticonvulsants ,Brain ,Brain Neoplasms ,Hemangioma ,Cavernous ,Central Nervous System ,Humans ,Neuroimaging ,Risk Factors ,Cavernous hemangioma ,Epilepsy surgery ,Etiology ,Risk factors ,Outcome ,Surgical Task Force ,Commission on Therapeutic Strategies of the ILAE ,Clinical Sciences ,Neurology & Neurosurgery - Abstract
Cerebral cavernous malformations (CCMs) are well-defined, mostly singular lesions present in 0.4-0.9% of the population. Epileptic seizures are the most frequent symptom in patients with CCMs and have a great impact on social function and quality of life. However, patients with CCM-related epilepsy (CRE) who undergo surgical resection achieve postoperative seizure freedom in only about 75% of cases. This is frequently because insufficient efforts are made to adequately define and resect the epileptogenic zone. The Surgical Task Force of the Commission on Therapeutics of the International League Against Epilepsy (ILAE) and invited experts reviewed the pertinent literature on CRE. Definitions of definitive and probable CRE are suggested, and recommendations regarding the diagnostic evaluation and etiology-specific management of patients with CRE are made. Prospective trials are needed to determine when and how surgery should be done and to define the relations of the hemosiderin rim to the epileptogenic zone.
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- 2013
17. Effect of transcutaneous vagus nerve stimulation on stress‐reactive neuroendocrine measures in a sample of persons with temporal lobe epilepsy.
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Doerr, Johanna M., Juenemann, Martin, Hakel, Lukas, Schmidt, Laura, Menzler, Katja, Krause, Kristina, Linka, Louise, Skoluda, Nadine, Nater, Urs M., and Knake, Susanne
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Objective: Dysregulation of stress‐reactive neuroendocrine measures, as well as subjective stress, have been found to worsen epilepsy. Transcutaneous vagus nerve stimulation (tVNS) is a relatively new treatment option for epilepsy. We were interested in its effect on the activity of the hypothalamic–pituitary–adrenal (HPA) axis and autonomic nervous system (ANS) as well as subjective stress and tiredness in patients with temporal lobe epilepsy (TLE). Methods: Twenty patients (age 44 ± 11 years, 13 women) were enrolled in the study. They were free of seizures for more than 1 year. All took part in two sessions with 4 h of stimulation (tVNS vs. sham) in a randomized order. Saliva samples and subjective stress and tiredness levels were measured at five time points each session (before and after stimulation and three time points every hour in between). Data were analyzed using repeated measures analysis of variance as well as paired t‐tests. Results: There was a dampened salivary cortisol (sCort) decrease during tVNS (time × condition effect: F[2.38, 38.15] = 6.50, P = 0.002, partial η2 = 0.29). Furthermore, we detected a dampened increase in salivary flow rate during tVNS (time × condition effect: F[3.28, 55.67] = 2.82, P = 0.043, partial η2 = 0.14). There was neither a difference in overall sCort or salivary alpha‐amylase (sAA) levels nor in subjective stress or tiredness levels between conditions. sAA levels at the last measurement point were slightly higher during tVNS (t(19) = 2.26, P = 0.035, d = 0.51), but this effect failed to reach significance when controlled for multiple comparisons. Significance: Our results partially support that tVNS influences the regulation of stress‐reactive neuroendocrine systems (namely the HPA axis and ANS) in epilepsy. More research with larger samples is needed on the difference between short‐term and repeated long‐term stimulation. [ABSTRACT FROM AUTHOR]
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- 2023
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18. Antiepileptogenesis after stroke—trials and tribulations: Methodological challenges and recruitment results of a Phase II study with eslicarbazepine acetate.
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Koepp, Matthias J., Trinka, Eugen, Mah, Yee‐Haur, Bentes, Carla, Knake, Susanne, Gigli, Gian Luigi, Serratosa, José M., Zelano, Johan, Magalhães, Luís M., Pereira, Ana, Moreira, Joana, and Soares‐da‐Silva, Patrício
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There is currently no evidence to support the use of antiseizure medications to prevent unprovoked seizures following stroke. Experimental animal models suggested a potential antiepileptogenic effect for eslicarbazepine acetate (ESL), and a Phase II, multicenter, randomized, double‐blind, placebo‐controlled study was designed to test this hypothesis and assess whether ESL treatment for 1 month can prevent unprovoked seizures following stroke. We outline the design and status of this antiepileptogenesis study, and discuss the challenges encountered in its execution to date. Patients at high risk of developing unprovoked seizures after acute intracerebral hemorrhage or acute ischemic stroke were randomized to receive ESL 800 mg/d or placebo, initiated within 120 hours after primary stroke occurrence. Treatment continued until Day 30, then tapered off. Patients could receive all necessary therapies for stroke treatment according to clinical practice guidelines and standard of care, and are being followed up for 18 months. The primary efficacy endpoint is the occurrence of a first unprovoked seizure within 6 months after randomization ("failure rate"). Secondary efficacy assessments include the occurrence of a first unprovoked seizure during 12 months after randomization and during the entire study; functional outcomes (Barthel Index original 10‐item version; National Institutes of Health Stroke Scale); post‐stroke depression (Patient Health Questionnaire‐9; PHQ‐9); and overall survival. Safety assessments include the evaluation of treatment‐emergent adverse events; laboratory parameters; vital signs; electrocardiogram; suicidal ideation and behavior (PHQ‐9 question 9). The protocol aimed to randomize approximately 200 patients (1:1), recruited from 21 sites in seven European countries and Israel. Despite the challenges encountered, particularly during the COVID‐19 pandemic, the study progressed and included a remarkable number of patients, with 129 screened and 125 randomized. Recruitment was stopped after 30 months, the first patient entered in May 2019, and the study is ongoing and following up on patients according to the Clinical Trial Protocol. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Differenzialdiagnose paroxysmaler Bewusstseinsstörungen: Torsade-de-pointes-Tachykardie bei Long‑QT‑Syndrom
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Bergmann, Marc-Philipp, Belke, Marcus, Lüsebrink, Ulrich, Knake, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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- 2017
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20. Focal epilepsy without overt epileptogenic lesions: no evidence of microstructural brain tissue damage in multi-parametric quantitative MRI.
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Hamid, Celona, Maiworm, Michelle, Wagner, Marlies, Knake, Susanne, Nöth, Ulrike, Deichmann, Ralf, Gracien, René-Maxime, and Seiler, Alexander
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PARTIAL epilepsy ,MAGNETIC resonance imaging ,EPILEPSY ,BRAIN damage ,PEOPLE with epilepsy ,CEREBRAL atrophy - Abstract
Background and purpose: In patients with epilepsies of structural origin, brain atrophy and pathological alterations of the tissue microstructure extending beyond the putative epileptogenic lesion have been reported. However, in patients without any evidence of epileptogenic lesions on diagnostic magnetic resonance imaging (MRI), impairment of the brain microstructure has been scarcely elucidated. Using multiparametric quantitative (q) magnetic resonance imaging MRI, we aimed to investigate diffuse impairment of the microstructural tissue integrity in MRI-negative focal epilepsy patients. Methods: 27 MRI-negative patients with focal epilepsy (mean age 33.1 ± 14.2 years) and 27 matched healthy control subjects underwent multiparametric qMRI including T1, T2, and PD mapping at 3 T. After tissue segmentation based on synthetic anatomies, mean qMRI parameter values were extracted from the cerebral cortex, the white matter (WM) and the deep gray matter (GM) and compared between patients and control subjects. Apart from calculating mean values for the qMRI parameters across the respective compartments, voxel-wise analyses were performed for each tissue class. Results: There were no significant differences for mean values of quantitative T1, T2, and PD obtained from the cortex, the WM and the deep GM between the groups. Furthermore, the voxel-wise analyses did not reveal any clusters indicating significant differences between patients and control subjects for the qMRI parameters in the respective compartments. Conclusions: Based on the employed methodology, no indication for an impairment of the cerebralmicrostructural tissue integrity inMRI-negative patients with focal epilepsy was found in this study. Further research will be necessary to identify relevant factors and mechanisms contributing to microstructural brain tissue damage in various subgroups of patients with epilepsy. [ABSTRACT FROM AUTHOR]
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- 2023
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21. Driving regulations for epilepsy in Europe.
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Möller, Leona, Krämer, Günter, Habermehl, Lena, Menzler, Katja, and Knake, Susanne
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Across Europe, there are differences regarding driving restrictions for patients with epilepsies and seizures. In the light of increasing mobility, knowledge about those different regulations is of high importance for counseling patients, and physicians. A structured online survey was sent to the official representatives of the different European ILAE chapters, asking for the local driving restrictions for patients with epilepsies, first seizures, syncopes, and psychogenic non-epileptic seizures. The survey was sent to 38 chapters or representatives of 47 European Countries. 33 chapters answered. The majority of countries require 1 year of seizure-freedom for the ability to drive (Group 1, former categories A, B, B + E, F, G. H, K, L, and P; driving license which authorizes its holder to drive vehicle classes categories of the motor vehicle), usually with the need to continue antiseizure medication (ASM). Some countries have much stricter regulations before allowing for driving. Legal regulations after a first unprovoked seizure differ between 6 months for Group 1 license holders in most European countries, and one year in Luxembourg and Malta. In Serbia, there is no legal regulation for this special situation. The situation after a first seizure is even more complex for Group 2 license holders (former categories C1, C1+E, C, C + E, D1, D1+E, D, D + E). Knowledge of the different recommendations of the individual European countries is of high relevance in the counseling of epilepsy patients. Europe-wide regulations, e.g. following the IBE-recommendations are needed to facilitate the patients' situation. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Adverse Event Profiles of Antiseizure Medications and the Impact of Coadministration on Drug Tolerability in Adults with Epilepsy.
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Willems, Laurent M., van der Goten, Milena, von Podewils, Felix, Knake, Susanne, Kovac, Stjepana, Zöllner, Johann Philipp, Rosenow, Felix, and Strzelczyk, Adam
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CARDIOVASCULAR agents ,ADULTS ,DRUGS ,VALPROIC acid ,EPILEPSY ,ANTIDEPRESSANTS ,PHENOBARBITAL - Abstract
Background: Antiseizure medication (ASM) as monotherapy or in combination is the treatment of choice for most patients with epilepsy. Therefore, knowledge about the typical adverse events (AEs) for ASMs and other coadministered drugs (CDs) is essential for practitioners and patients. Due to frequent polypharmacy, it is often difficult to clinically assess the AE profiles of ASMs and differentiate the influence of CDs. Objective: This retrospective analysis aimed to determine typical AE profiles for ASMs and assess the impact of CDs on AEs in clinical practice. Methods: The Liverpool AE Profile (LAEP) and its domains were used to identify the AE profiles of ASMs based on data from a large German multicenter study (Epi2020). Following established classifications, drugs were grouped according to their mode of action (ASMs) or clinical indication (CDs). Bivariate correlation, multivariate ordinal regression (MORA), and artificial neural network (ANNA) analyses were performed. Bivariate correlation with Fisher's z-transformation was used to compare the correlation strength of LAEP with the Hospital Anxiety and Depression Scale (HADS) and Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to avoid LAEP bias in the context of antidepressant therapy. Results: Data from 486 patients were analyzed. The AE profiles of ASM categories and single ASMs matched those reported in the literature. Synaptic vesicle glycoprotein 2A (SV2A) and voltage-gated sodium channel (VGSC) modulators had favorable AE profiles, while brivaracetam was superior to levetiracetam regarding psychobehavioral AEs. MORA revealed that, in addition to seizure frequency, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) modulators and antidepressants were the only independent predictors of high LAEP values. After Fisher's z-transformation, correlations were significantly lower between LAEP and antidepressants than between LAEP and HADS or NDDI-E. Therefore, a bias in the results toward over interpreting the impact of antidepressants on LAEP was presumed. In the ANNA, perampanel, zonisamide, topiramate, and valproic acid were important nodes in the network, while VGSC and SV2A modulators had low relevance for predicting relevant AEs. Similarly, cardiovascular agents, analgesics, and antipsychotics were important CDs in the ANNA model. Conclusion: ASMs have characteristic AE profiles that are highly reproducible and must be considered in therapeutic decision-making. Therapy using perampanel as an AMPA modulator should be considered cautiously due to its relatively high AE profile. Drugs acting via VGSCs and SV2A receptors are significantly better tolerated than other ASM categories or substances (e.g., topiramate, zonisamide, and valproate). Switching to brivaracetam is advisable in patients with psychobehavioral AEs who take levetiracetam. Because CDs frequently pharmacokinetically interact with ASMs, the cumulative AE profile must be considered. Trial registration: DRKS00022024, U1111-1252-5331. [ABSTRACT FROM AUTHOR]
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- 2023
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23. The phenotypic and genotypic spectrum of epilepsy and intellectual disability in adults: Implications for genetic testing.
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von Brauchitsch, Sophie, Haslinger, Denise, Lindlar, Silvia, Thiele, Holger, Bernsen, Natalie, Zahnert, Felix, Reif, Philipp S., Balcik, Yunus, Au, Ping Yee Billie, Josephson, Colin B., Altmüller, Janine, Strzelczyk, Adam, Knake, Susanne, Rosenow, Felix, Chiocchetti, Andreas, and Klein, Karl Martin
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Objective: The phenotypic and genotypic spectrum of adult patients with epilepsy and intellectual disability (ID) is less clear than in children. We investigated an adult patient cohort to further elucidate this and inform the genetic testing approach. Methods: Fifty‐two adult patients (30 male, 22 female) with epilepsy, at least mild ID and no known genetic or acquired cause were included and phenotyped. Variants identified through exome sequencing were evaluated using ACMG criteria. Identified variants were compared with commercially available gene panels. Cluster analysis of two features, age at seizure onset and age at ascertainment of cognitive deficits, was performed. Results: Median age was 27 years (range 20‐57 years) with median seizure onset at 3 years and median ascertainment of cognitive deficits at 1 year. Likely pathogenic/pathogenic variants were identified in 16/52 patients (31%) including 14 (27%) single nucleotide variants and 2 (4%) copy number variants. Simulated yield of commercial gene panels varied between 13% in small (≤144 genes) and 27% in large panels (≥1478 genes). Cluster analysis (optimal number 3 clusters) identified a cluster with early seizure onset and early developmental delay (developmental and epileptic encephalopathy, n = 26), a cluster with early developmental delay but late seizure onset (ID with epilepsy, n = 16) and a third cluster with late ascertainment of cognitive deficits and variable seizure onset (n = 7). The smaller gene panels particularly missed the genes identified in the cluster with early ascertainment of cognitive deficits and later onset of epilepsy (0/4) as opposed to the cluster with developmental and epileptic encephalopathy (7/10). Significance: Our data indicates that adult patients with epilepsy and ID represent a heterogeneous cohort that includes grown‐up patients with DEE but also patients with primary ID and later onset of epilepsy. To maximize diagnostic yield in this cohort either large gene panels or exome sequencing should be used. [ABSTRACT FROM AUTHOR]
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- 2023
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24. Effect of the revised definition of epilepsy on treatment decisions and seizure recurrence after a first epileptic seizure.
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Linka, Louise, Magnus, Benedikt, Habermehl, Lena, Tsalouchidou, Panagiota‐Eleni, Zahnert, Felix, Möeller, Leona, Krause, Kristina, Knake, Susanne, and Menzler, Katja
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EPILEPSY ,SEIZURES (Medicine) ,EPILEPTIFORM discharges ,MAGNETIC resonance imaging ,DIAGNOSIS of epilepsy ,DEFINITIONS - Abstract
Background: Studies on risk factors for epilepsy and seizure recurrence after a first seizure are usually based on the old definition of epilepsy with the need for two unprovoked seizures. The current definition of epilepsy allows diagnosis and treatment of epilepsy after a first seizure if the recurrence risk is >60%. We evaluate treatment decisions, seizure recurrence and risk factors for epilepsy related to the application of the new definition of epilepsy. Methods: Data of 629 patients with a first seizure were analyzed to investigate changes of treatment decisions and seizure recurrence after the revised definition of epilepsy. We used binary logistic regression to investigate the impact of multiple factors influencing seizure recurrence like electroencephalogram (EEG) and magnetic resonance imaging (MRI) results and administration of antiseizure medication (ASM). Results: The proportion of patients receiving ASM significantly increased from 70.4% to 80.5% (p = 0.015) following the new epilepsy definition, without any significant changes in the recurrence rate (40.8% vs. 45.5% after 2 years, p > 0.05). The presence of interictal epileptiform discharges (IED) in the EEG increased (OR = 1.98) and administration of ASM decreased (OR = 0.43) recurrence rates significantly. Conclusions: The new definition of epilepsy was associated with increased application of ASM, but not with reduced recurrence rates. The study confirms the presence of IED as a strong risk factor for seizure recurrence and the protective effect of ASM. The influence of imaging findings, which have a strong impact on the new definition of epilepsy, could not be confirmed. [ABSTRACT FROM AUTHOR]
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- 2023
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25. Erfolgreiche Epilepsiechirurgie bei seit über 20 Jahren therapierefraktärer Temporallappenepilepsie und multiplen Voreingriffen
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Brazel, Hannah, Reif, Philipp S., Bauer, Sebastian, Hermsen, Anke, Pagenstecher, Axel, Hans, Volkmar H., Sure, Ulrich, Knake, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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- 2016
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26. Use of Health-Related Apps and Telehealth in Adults with Epilepsy in Germany: A Multicenter Cohort Study.
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Zöllner, Johann Philipp, Noda, Anna H., McCoy, Jeannie, Schulz, Juliane, Tsalouchidou, Panagiota-Eleni, Langenbruch, Lisa, Kovac, Stjepana, Knake, Susanne, von Podewils, Felix, Hamacher, Mario, Mann, Catrin, Leyer, Anne-Christine, van Alphen, Natascha, Schubert-Bast, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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PHYSICAL fitness mobile apps ,PEDOMETERS ,TELEMEDICINE ,DATA privacy ,COVID-19 ,MOBILE health ,EPILEPSY ,DEEP brain stimulation - Abstract
Background: Telehealth can improve the treatment of chronic disorders, such as epilepsy. Telehealth prevalence and use increased during the coronavirus disease 2019 (COVID-19) pandemic. However, familiarity with and use of telehealth and health-related mobile applications (apps) by persons with epilepsy remain unknown. Methods: We investigated telehealth use, demographics, and clinical variables within the multicenter Epi2020 cross-sectional study. Between October and December 2020, adults with epilepsy completed a validated questionnaire, including individual questions regarding knowledge and use of apps and telehealth. Results: Of 476 included individuals (58.2% women; mean age 40.2 ± 15.4 years), 41.6% reported using health-related apps. Health apps were used more frequently (pedometer 32.1%, exercise app 17.6%) than medical apps (health insurance 15.1%, menstrual apps 12.2%) or apps designed for epilepsy (medication reminders 10.3%, seizure calendars 4.6%). Few used seizure detectors (i.e., apps as medical devices 1.9%) or mobile health devices (fitness bracelet 11.3%). A majority (60.9%) had heard the term telehealth, 78.6% of whom had a positive view. However, only 28.6% had a concrete idea of telehealth, and only 16.6% reported personal experience with telehealth. A majority (55%) would attend a teleconsultation follow-up, and 41.2% would in a medical emergency. Data privacy and availability were considered equally important by 50.8%, 21.8% considered data privacy more important, and 20.2% considered data availability more important. Current health-related app use was independently associated with younger age (p = 0.003), higher education (p < 0.001), and subjective COVID-19-related challenges (p = 0.002). Persistent seizure occurrence (vs. seizure freedom ≥12 months) did not affect willingness to use teleconsultations on multivariable logistic regression analysis. Conclusions: Despite positive telehealth views, few persons with epilepsy in Germany are familiar with specific apps or services. Socioeconomic factors influence telehealth use more than baseline epilepsy characteristics. Telehealth education and services should target socioeconomically disadvantaged individuals to reduce the digital care gap. German Clinical Trials Register (DRKS00022024; Universal Trial Number: U1111-1252-5331). [ABSTRACT FROM AUTHOR]
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- 2023
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27. Prospective, longitudinal, multicenter study on the provision of information regarding sudden unexpected death in epilepsy to adults with epilepsy.
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Wadle, Nora‐Elena, Schwab, Christina, Seifart, Carola, von Podewils, Felix, Knake, Susanne, Willems, Laurent M., Menzler, Katja, Schulz, Juliane, Conradi, Nadine, Rosenow, Felix, and Strzelczyk, Adam
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SUDDEN death ,WORRY ,EPILEPSY ,QUALITY of life ,PEOPLE with epilepsy ,NEUROLOGICAL disorders - Abstract
Objective: Despite increased awareness of the serious epilepsy complication sudden unexpected death in epilepsy (SUDEP), a substantial population of people with epilepsy (PWE) remain poorly informed. Physicians indicate concern that SUDEP information may adversely affect patients' health and quality of life. We examined SUDEP awareness and the immediate and long‐term effects of providing SUDEP information to PWE. Methods: Baseline knowledge and behaviors among PWE and behavioral adjustments following the provision of SUDEP information were evaluated in a prospective, multicenter survey using the following validated scales: Neurological Disorders Depression Inventory for Epilepsy for depression symptoms, the EuroQoL five‐dimension scale for health‐related quality of life (HRQoL), a visual analog scale for overall health, the revised Epilepsy Stigma Scale for perceived stigma, and the Seizure Worry Scale for seizure‐related worries. The prospective study collected data through semiquantitative interviews before (baseline), immediately after, and 3 months after the provision of SUDEP information. Results: In total, 236 participants (mean age = 39.3 years, range = 18–77 years, 51.7% women) were enrolled, and 205 (86.9%) completed long‐term, 3‐month follow‐up. One patient died from SUDEP before follow‐up. No worsening symptoms from baseline to 3‐month follow‐up were observed on any scale. At baseline, 27.5% of participants were aware of SUDEP. More than 85% of participants were satisfied with receiving SUDEP information. Three quarters of participants were not concerned by the information, and >80% of participants recommended the provision of SUDEP information to all PWE. Although most patients reported no behavioral adjustments, 24.8% reported strong behavioral adjustments at 3‐month follow‐up. Significance: The provision of SUDEP information has no adverse effects on overall health, HRQoL, depressive symptoms, stigma, or seizure worry among PWE, who appreciate receiving information. SUDEP information provision might improve compliance among PWE and reduce but not eliminate the increased mortality risk. [ABSTRACT FROM AUTHOR]
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- 2023
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28. Repetitive Electroencephalography as Biomarker for the Prediction of Survival in Patients with Post-Hypoxic Encephalopathy.
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Willems, Laurent M., Rosenow, Felix, Knake, Susanne, Beuchat, Isabelle, Siebenbrodt, Kai, Strüber, Michael, Schieffer, Bernhard, Karatolios, Konstantinos, and Strzelczyk, Adam
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OVERALL survival ,ELECTROENCEPHALOGRAPHY ,BRAIN diseases ,REGRESSION analysis ,BIOMARKERS - Abstract
Predicting survival in patients with post-hypoxic encephalopathy (HE) after cardiopulmonary resuscitation is a challenging aspect of modern neurocritical care. Here, continuous electroencephalography (cEEG) has been established as the gold standard for neurophysiological outcome prediction. Unfortunately, cEEG is not comprehensively available, especially in rural regions and developing countries. The objective of this monocentric study was to investigate the predictive properties of repetitive EEGs (rEEGs) with respect to 12-month survival based on data for 199 adult patients with HE, using log-rank and multivariate Cox regression analysis (MCRA). A total number of 59 patients (29.6%) received more than one EEG during the first 14 days of acute neurocritical care. These patients were analyzed for the presence of and changes in specific EEG patterns that have been shown to be associated with favorable or poor outcomes in HE. Based on MCRA, an initially normal amplitude with secondary low-voltage EEG remained as the only significant predictor for an unfavorable outcome, whereas all other relevant parameters identified by univariate analysis remained non-significant in the model. In conclusion, rEEG during early neurocritical care may help to assess the prognosis of HE patients if cEEG is not available. [ABSTRACT FROM AUTHOR]
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- 2022
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29. Psychophysiological interaction analysis for the detection of stimulus‐specific networks in reflex epilepsy.
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Zahnert, Felix, Belke, Marcus, Sommer, Jens, Oesterle, Julia, Möschl, Vincent, Nimsky, Christopher, Knake, Susanne, and Menzler, Katja
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PSYCHOPHYSIOLOGY ,AMYGDALOID body ,EPILEPSY ,INDEPENDENT component analysis ,FUNCTIONAL magnetic resonance imaging ,VISUAL cortex ,SOMATOSENSORY cortex - Abstract
We report detailed functional MRI (fMRI) analyses in a patient with reflex seizures elicited by driving along a specific rural crossroad or by watching a video thereof. Semiology consisted of epigastric aura, followed by a sensory seizure of the left hand and sporadic automotor seizures. The right amygdala‐region (rh‐amygdala) was surgically and electroclinically confirmed as the epileptogenic zone. Presurgical task‐fMRI was performed, during which videos of the driving along that specific crossroad (IC), of another crossroad (NC) or noise were presented. Independent component analysis was conducted, and one component was used to aid in selection of a seed region within the rh‐amygdala for subsequent psychophysiological interaction analysis (PPI). Here, the following regions showed stronger connectivity with the rh‐amygdala seed during the IC condition compared to NC: right > left visual cortex, bilateral insulae, and right secondary somatosensory cortex (S2), potentially explaining epigastric aura and left somatosensory seizure semiology. Contralateral analyses did not reproduce these results. Overall, the ictogenic stimulus elicited enhanced connectivity of the epileptogenic rh‐amygdala with visual cortex and further regions of potential seizure spread (S2, insula) as a putative mechanism of ictogenesis. Our results highlight the potential of PPI in the analysis of stimulus‐dependent networks in patients with reflex epilepsies to gain insight into seizure generation. [ABSTRACT FROM AUTHOR]
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- 2022
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30. Persistent knowledge gaps between 2005 and 2020 in women with epilepsy: Comparison of multicenter studies from Germany.
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Mann, Catrin, Zinger, Edna, Schmitz, Bettina, May, Theodor, Rosenow, Felix, Pfäfflin, Margarete, Schulz, Juliane, Menzler, Katja, Langenbruch, Lisa, Bierhansl, Laura, Knake, Susanne, Hamacher, Mario, Süß, Annika, von Podewils, Felix, Schubert-Bast, Susanne, and Strzelczyk, Adam
- Abstract
Objective: Epilepsy is a chronic condition that can affect patients of all ages. Women with epilepsy (WWE) require access to specific counseling and information regarding issues related to contraception, pregnancy, and hormonal effects on seizure control and bone mineral density. This study investigated the knowledge among WWE regarding their condition, and whether epilepsy-specific knowledge has improved over the last 15 years.Methods: A total of 280 WWE aged 18 to 82 years participated in this multicenter, questionnaire-based study. The study was conducted at four epilepsy centers in Germany, between October 2020 and December 2020. Sociodemographic and epilepsy-specific data for participating women were analyzed and compared with the results of a similar survey performed in 2003-2005 among 365 WWE in Germany.Results: The questionnaire-based survey revealed considerable knowledge deficits without significant improvements over the last 15 years, particularly among those with less education and with regards to information on the more pronounced effects of epilepsy in older WWE (>50 years), including interactions with menopause and osteoporosis. In WWE ≤29 years, a significant increase in the knowledge score was observed in 2020 compared with this age group in 2005 (mean 7.42 vs. 6.5, p = .036). Mothers frequently reported epilepsy-related concerns regarding childrearing, particularly of seizures scaring their child and the need to rely on other people.Conclusion: WWE continue to demonstrate inadequate epilepsy-related knowledge. Despite increasing information availability and the aspiration toward better awareness among medical professionals, overall knowledge has not increased sufficiently compared with the levels observed in recent studies. [ABSTRACT FROM AUTHOR]- Published
- 2022
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31. Prevalence, utilization, and costs of antiepileptic drugs for epilepsy in Germany—a nationwide population-based study in children and adults
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Hamer, Hajo M., Dodel, Richard, Strzelczyk, Adam, Balzer-Geldsetzer, Monika, Reese, Jens-Peter, Schöffski, Oliver, Graf, Wolfgang, Schwab, Stefan, Knake, Susanne, Oertel, Wolfgang H., Rosenow, Felix, and Kostev, Karel
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- 2012
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32. Direct and indirect costs and cost-driving factors in adults with tuberous sclerosis complex: a multicenter cohort study and a review of the literature
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Zöllner, Johann Philipp, Grau, Janina, Rosenow, Felix, Sauter, Matthias, Knuf, Markus, Kurlemann, Gerhard, Mayer, Thomas, Hertzberg, Christoph, Bertsche, Astrid, Immisch, Ilka, Klein, Karl Martin, Knake, Susanne, Marquard, Klaus, Meyer, Sascha, Noda, Anna H., von Podewils, Felix, Schäfer, Hannah, Thiels, Charlotte, Willems, Laurent M., Zukunft, Bianca, Schubert-Bast, Susanne, and Strzelczyk, Adam
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Research ,Adult neurology ,TSC ,Angiomyolipoma ,Seizure ,Epilepsy ,Subependymal giant cell astrocytoma ,Costs ,Sociodemographic characteristics ,Genetics ,Anticonvulsant ,MTOR inhibitor ,ddc - Published
- 2020
33. Invasive und transkutane Vagusnervstimulation: Ein Vergleich beider Stimulationsarten hinsichtlich Effizienz sowie lebensqualitativer Aspekte bei therapierefraktärer Epilepsie - Untersuchungen durch das Epilepsiezentrum Marburg
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Cordes, Natascha and Knake, Susanne (Prof. Dr. med.)
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invasive Vagusnervstimulation ,epilepsy ,Medizin, Gesundheit ,vagus nerve stimulation ,Epilepsie ,Vagusnervstimulation ,transkutane Vagusnervstimulation ,Medical sciences, Medicine ,ddc:610 - Abstract
Approximately 50 million people worldwide suffer from epilepsy. Despite anticonvulsive therapy, one third still experience seizures. For such patients, invasive (iVNS) or transcutaneous (tVNS) vagus nerve stimulation presents a therapeutic option. The aim of our study was to analyze, evaluate and compare the long-term outcome of both treatment options. Within the framework of a retrospective study that included 34 patients with an invasive vagus nerve stimulator and ten with a transcutaneous vagus nerve stimulator, all of whom were treated at the Marburg Epilepsy Center (Epilepsiezentrum Marburg), the necessary information was collected using medical reports, questionnaires and interviews. iVNS and tVNS patients were treated for a mean of 60 and 48 months, respectively. The maximum follow-up was ten years for individuals with iVNS and five years for those with tVNS. Thirty percent of those treated with vagus nerve stimulation reported a seizure frequency reduction of at least 50%. Another 20% of the patients with iVNS and 10% of the patients with tVNS were observed to be completely free of seizures. Invasive vagus nerve stimulation was associated with a higher rate of adverse events in comparison to those with transcutaneous vagus nerve stimulation (84,85% vs. 41,67%). The most frequent adverse effect of invasive stimulation was hoarseness. In comparison to invasive stimulation, the patients with transcutaneous stimulators suffered only local side effects resulting from the device. With an average of one side effect per person both treatment options can be perceived as well-tolerated. Under therapy with iVNS our study recorded improvements in mood and concentration. Those with tVNS also reported these effects, although to a lesser degree. Both devices resulted in a significant improvement in the quality of life by 20%. We concluded that both stimulators are a safe, tolerable and effective treatment option for therapy-resistant epilepsy in adults. For those candidates suitable for either the invasive or transcutaneous devices, we would suggest choosing the transcutaneous option. It offers a comparable efficacy and avoids the risk of significant surgical complications. Furthermore, it is more cost-efficient than invasive stimulation. If the impact is positive, the use of an invasive stimulator remains an option. Subsequent research opportunities are for example the implementation of comparatistics and the clarification of the detailed functioning of the vagus nerve stimulation., Weltweit leiden etwa 50 Millionen Menschen unter einer Epilepsie, von denen ein Drittel unter antiepileptischer Medikation nicht anfallsfrei wird. Für diese Patienten besteht die Möglichkeit einer invasiven oder transkutanen Vagusnervstimulation. Ziel unserer Studie war die Analyse sowie Beurteilung des Langzeit-Outcomes der beiden Stimulationsmöglichkeiten sowie ein Vergleich dieser. Im Rahmen einer retrospektiven Studie mit 34 adhärenten iVNS- sowie zehn adhärenten tVNS-Patienten, welche sich am Epilepsiezentrum Marburg einer Behandlung unterzogen, wurden die benötigten Daten mittels Arztbriefen, Fragebögen sowie Interviews erhoben. Die durchschnittliche Behandlungsdauer betrug bei den iVNS-Patienten 60 und bei den tVNS- Patienten 48 Monate. Das maximale Follow-Up wurde bei den iVNS-Nutzern nach zehn Jahren und bei den tVNS-Patienten nach fünf Jahren erhoben. 30% aller Patienten erfuhren unter Therapie eine Reduktion der monatlichen Anfallsfrequenzen um 50% und mehr. 20% der iVNS- sowie 10% der tVNS-Patienten wurden zudem anfallsfrei. Unter iVNS-Therapie wurden mehr Nebenwirkungen beobachtet als unter tVNS-Therapie (84,85% vs. 41,67%). Bei den iVNS-Patienten trat als häufigste Nebenwirkung Heiserkeit auf. Bei den tVNS-Patienten waren, im Gegensatz zum iVNS, lediglich lokale gerätebedingte Nebenwirkungen zu verzeichnen. Beide Geräte konnten mit durchschnittlich einer Nebenwirkung pro Person als sehr gut verträglich eingestuft werden. Unter iVNS-Therapie zeigten sich Verbesserungen der Stimmung und der Konzentration. Auch die tVNS-Nutzer bemerkten teilweise eine verbesserte Stimmung sowie Konzentration, wenn auch zu geringerem Anteil. Beide Stimulationsgeräte bewirkten eine signifikante Verbesserung der Lebensqualität um fast 20%. Wir kamen zu dem Entschluss, dass beide Geräte eine sichere, tolerable sowie effektive Möglichkeit der Behandlung der therapieresistenten Epilepsie Erwachsener darstellen. Bei einem für beide Geräte geeigneten Patienten sollte sich, aufgrund des guten Outcomes für iVNS und tVNS, jedoch zunächst für die transkutane Variante entschieden werden. Diese ist gleichermaßen effektiv, vermeidet jedoch ein chirurgisches Procedere mit sämtlichen Komplikationen und stellt sich zudem als kosteneffizienter dar. Im Falle einer Wirkung der transkutanen Stimulation besteht zusätzlich die weitere Möglichkeit einer Implantation eines invasiven Gerätes. Weitere Forschungsmöglichkeiten sind zum einen die Durchführung von sich anschließenden Vergleichsstudien und zum anderen die Klärung der genauen Funktionsweise der Vagusnervstimulation.
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- 2020
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34. Improved Visualization of Focal Cortical Dysplasia With Surface-Based Multiparametric Quantitative MRI
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Maiworm, Michelle, Nöth, Ulrike, Hattingen, Elke, Steinmetz, Helmuth, Knake, Susanne, Rosenow, Felix, Deichmann, Ralf, Wagner, Marlies, and Gracien, René-Maxime
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neuroimaging ,quantitative magnetic resonance imaging ,epilepsy ,brain imaging ,ddc:610 ,focal cortical dysplasia ,Neuroscience ,Original Research - Abstract
Purpose: In the clinical routine, detection of focal cortical dysplasia (FCD) by visual inspection is challenging. Still, information about the presence and location of FCD is highly relevant for prognostication and treatment decisions. Therefore, this study aimed to develop, describe and test a method for the calculation of synthetic anatomies using multiparametric quantitative MRI (qMRI) data and surface-based analysis, which allows for an improved visualization of FCD. Materials and Methods: Quantitative T1-, T2- and PD-maps and conventional clinical datasets of patients with FCD and epilepsy were acquired. Tissue segmentation and delineation of the border between white matter and cortex was performed. In order to detect blurring at this border, a surface-based calculation of the standard deviation of each quantitative parameter (T1, T2, and PD) was performed across the cortex and the neighboring white matter for each cortical vertex. The resulting standard deviations combined with measures of the cortical thickness were used to enhance the signal of conventional FLAIR-datasets. The resulting synthetically enhanced FLAIR-anatomies were compared with conventional MRI-data utilizing regions of interest based analysis techniques. Results: The synthetically enhanced FLAIR-anatomies showed higher signal levels than conventional FLAIR-data at the FCD sites (p = 0.005). In addition, the enhanced FLAIR-anatomies exhibited higher signal levels at the FCD sites than in the corresponding contralateral regions (p = 0.005). However, false positive findings occurred, so careful comparison with conventional datasets is mandatory. Conclusion: Synthetically enhanced FLAIR-anatomies resulting from surface-based multiparametric qMRI-analyses have the potential to improve the visualization of FCD and, accordingly, the treatment of the respective patients.
- Published
- 2020
35. Epilepsy Subtype-Specific Copy Number Burden Observed in a Genome-Wide Study of 17 458 Subjects
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Niestroj, Lisa-Marie, Perez-Palma, Eduardo, Howrigan, Daniel P., Zhou, Yadi, Cheng, Feixiong, Saarentaus, Elmo, Nürnberg, Peter, Stevelink, Remi, Daly, Mark J., Palotie, Aarno, Lal, Dennis, Feng, Yen-Chen Anne, Abbott, Liam E., Tashman, Katherine, Cerrato, Felecia, Churchhouse, Claire, Gupta, Namrata, Neale, Benjamin M., Berkovic, Samuel F., Lerche, Holger, Goldstein, David B., Lowenstein, Daniel H., Cavalleri, Gianpiero L., Cossette, Patrick, Cotsapas, Chris, Dixon-Salazar, Tracy, Guerrini, Renzo, Hakonarson, Hakon, Heinzen, Erin L., Helbig, Ingo, Kwan, Patrick, Marson, Anthony G., Petrovski, Slavé, Kamalakaran, Sitharthan, Sisodiya, Sanjay M., Stewart, Randy, Depondt, Chantal, Dlugos, Dennis J., Scheffer, Ingrid E., Striano, Pasquale, Freyer, Catharine, Krause, Roland, May, Patrick, McKenna, Kevin, Regan, Brigid M., Bellows, Susannah T., Leu, Costin, Bennett, Caitlin A., Johns, Esther C., Macdonald, Alexandra, Shilling, Hannah, Burgess, Rosemary, Weckhuysen, Dorien, Bahlo, Melanie, O’Brien, Terence J., Todaro, Marian, Weckhuysen, Sarah, Stamberger, Hannah, De Jonghe, Peter, Andrade, Danielle M., Sadoway, Tara R., Mo, Kelly, Krestel, Heinz, Gallati, Sabina, Papacostas, Savvas S., Kousiappa, Ioanna, Tanteles, George A., Šterbová, Katalin, Vlcková, Markéta, Sedlácková, Lucie, Laššuthová, Petra, Klein, Karl Martin, Rosenow, Felix, Reif, Philipp S., Knake, Susanne, Kunz, Wolfram S., Zsurka, Gábor, Elger, Christian E., Bauer, Jürgen, Rademacher, Michael, Pendziwiat, Manuela, Muhle, Hiltrud, Rademacher, Annika, van Baalen, Andreas, von Spiczak, Sarah, Stephani, Ulrich, Afawi, Zaid, Korczyn, Amos D., Kanaan, Moien, Canavati, Christina, Kurlemann, Gerhard, Müller-Schlüter, Karen, Kluger, Gerhard, Häusler, Martin, Blatt, Ilan, Lemke, Johannes R., Krey, Ilona, Weber, Yvonne G., Wolking, Stefan, Becker, Felicitas, Hengsbach, Christian, Rau, Sarah, Maisch, Ana F., Steinhoff, Bernhard J., Schulze-Bonhage, Andreas, Schubert-Bast, Susanne, Schreiber, Herbert, Borggräfe, Ingo, Schankin, Christoph J., Mayer, Thomas, Korinthenberg, Rudolf, Brockmann, Knut, Dennig, Dieter, Madeleyn, Rene, Kälviäinen, Reetta, Auvinen, Pia, Saarela, Anni, Linnankivi, Tarja, Lehesjoki, Anna-Elina, Rees, Mark I., Chung, Seo-Kyung, Pickrell, William O., Powell, Robert, Schneider, Natascha, Balestrini, Simona, Zagaglia, Sara, Braatz, Vera, Johnson, Michael R., Auce, Pauls, Sills, Graeme J., Baum, Larry W., Sham, Pak C., Cherny, Stacey S., Lui, Colin H. T., Barišic, Nina, Delanty, Norman, Doherty, Colin P., Shukralla, Arif, McCormack, Mark, El-Naggar, Hany, Canafoglia, Laura, Franceschetti, Silvana, Castellotti, Barbara, Granata, Tiziana, Zara, Federico, Iacomino, Michele, Madia, Francesca, Vari, Maria Stella, Mancardi, Maria Margherita, Salpietro, Vincenzo, Bisulli, Francesca, Tinuper, Paolo, Licchetta, Laura, Pippucci, Tommaso, Stipa, Carlotta, Muccioli, Lorenzo, Minardi, Raffaella, Gambardella, Antonio, Labate, Angelo, Annesi, Grazia, Manna, Lorella, Gagliardi, Monica, Parrini, Elena, Mei, Davide, Vetro, Annalisa, Bianchini, Claudia, Montomoli, Martino, Doccini, Viola, Marini, Carla, Suzuki, Toshimitsu, Inoue, Yushi, Yamakawa, Kazuhiro, Tumiene, Birute, Mameniskiene, Ruta, Utkus, Algirdas, Praninskiene, Ruta, Grikiniene, Jurgita, Samaitiene, Ruta, Sadleir, Lynette G., King, Chontelle, Mountier, Emily, Caglayan, S. Hande, Arslan, Mutluay, Yapici, Zuhal, Yis, Uluc, Topaloglu, Pinar, Kara, Bulent, Turkdogan, Dilsad, Gundogdu-Eken, Asli, Bebek, Nerses, Ugur-Iseri, Sibel, Baykan, Betül, Salman, Baris, Haryanyan, Garen, Yücesan, Emrah, Kesim, Yesim, Özkara, Çigdem, Sheidley, Beth R., Shain, Catherine, Poduri, Annapurna, Buono, Russell J, Ferraro, Thomas N, Sperling, Michael R., Lo, Warren, Privitera, Michael, French, Jacqueline A., Schachter, Steven, Kuzniecky, Ruben I., Devinsky, Orrin, Hegde, Manu, Khankhanian, Pouya, Helbig, Katherine L., Ellis, Colin A., Spalletta, Gianfranco, Piras, Fabrizio, Piras, Federica, Gili, Tommaso, Ciullo, Valentina, YÜCESAN, EMRAH, Niestroj L.-M., Perez-Palma E., Howrigan D.P., Zhou Y., Cheng F., Saarentaus E., Nurnberg P., Stevelink R., Daly M.J., Palotie A., Lal D, Epi 25 Collaborative, Bisulli F., Tinuper P., Licchetta L., and Epi25 Collaborative
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Developmental and epileptic encephalopathy ,Male ,0301 basic medicine ,DNA Copy Number Variations ,Disease ,Bioinformatics ,Genome ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,copy number variation ,developmental and epileptic encephalopathy ,epilepsy ,focal epilepsy ,genetic generalized epilepsy ,medicine ,Humans ,Genetic Predisposition to Disease ,Copy-number variation ,Generalized epilepsy ,DNA Copy Number Variation ,Copy number variation ,business.industry ,Breakpoint ,Focal epilepsy ,Original Articles ,medicine.disease ,3. Good health ,Genetic generalized epilepsy ,030104 developmental biology ,Female ,Human medicine ,Neurology (clinical) ,Personalized medicine ,business ,030217 neurology & neurosurgery ,Genome-Wide Association Study ,Human - Abstract
Cytogenic testing is routinely applied in most neurological centres for severe paediatric epilepsies. However, which characteristics of copy number variants (CNVs) confer most epilepsy risk and which epilepsy subtypes carry the most CNV burden, have not been explored on a genome-wide scale. Here, we present the largest CNV investigation in epilepsy to date with 10 712 European epilepsy cases and 6746 ancestry-matched controls. Patients with genetic generalized epilepsy, lesional focal epilepsy, non-acquired focal epilepsy, and developmental and epileptic encephalopathy were included. All samples were processed with the same technology and analysis pipeline. All investigated epilepsy types, including lesional focal epilepsy patients, showed an increase in CNV burden in at least one tested category compared to controls. However, we observed striking differences in CNV burden across epilepsy types and investigated CNV categories. Genetic generalized epilepsy patients have the highest CNV burden in all categories tested, followed by developmental and epileptic encephalopathy patients. Both epilepsy types also show association for deletions covering genes intolerant for truncating variants. Genome-wide CNV breakpoint association showed not only significant loci for genetic generalized and developmental and epileptic encephalopathy patients but also for lesional focal epilepsy patients. With a 34-fold risk for developing genetic generalized epilepsy, we show for the first time that the established epilepsy-associated 15q13.3 deletion represents the strongest risk CNV for genetic generalized epilepsy across the whole genome. Using the human interactome, we examined the largest connected component of the genes overlapped by CNVs in the four epilepsy types. We observed that genetic generalized epilepsy and non-acquired focal epilepsy formed disease modules. In summary, we show that in all common epilepsy types, 1.5–3% of patients carry epilepsy-associated CNVs. The characteristics of risk CNVs vary tremendously across and within epilepsy types. Thus, we advocate genome-wide genomic testing to identify all disease-associated types of CNVs.
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- 2020
36. Drug-Resistant Juvenile Myoclonic Epilepsy: Misdiagnosis of Progressive Myoclonus Epilepsy
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Martin, Sarah, Strzelczyk, Adam, Lindlar, Silvia, Krause, Kristina, Reif, Philipp Sebastian, Menzler, Katja, Chiocchetti, Andreas G., Rosenow, Felix, Knake, Susanne, Klein, Karl Martin, and Ferlazzo, Edoardo
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juvenile myoclonic epilepsy ,Neurology ,epilepsy ,genetics ,pharmacoresistance ,ddc:610 ,Lafora disease ,Neurology (clinical) ,Brief Research Report ,progressive myoclonus epilepsy - Abstract
Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome characterized by bilateral myoclonic and tonic-clonic seizures typically starting in adolescence and responding well to medication. Misdiagnosis of a more severe progressive myoclonus epilepsy (PME) as JME has been suggested as a cause of drug-resistance. Medical records of the Epilepsy Center Hessen-Marburg between 2005 and 2014 were automatically selected using keywords and manually reviewed regarding the presence of a JME diagnosis at any timepoint. The identified patients were evaluated regarding seizure outcome and drug resistance according to ILAE criteria. 87/168 identified JME patients were seizure-free at last follow-up including 61 drug-responsive patients (group NDR). Seventy-eight patients were not seizure-free including 26 drug-resistant patients (group DR). Valproate was the most efficacious AED. The JME diagnosis was revised in 7 patients of group DR including 6 in whom the diagnosis had already been questioned or revised during clinical follow-up. One of these was finally diagnosed with PME (genetically confirmed Lafora disease) based on genetic testing. She was initially reviewed at age 29 yrs and considered to be inconsistent with PME. Intellectual disability (p = 0.025), cognitive impairment (p < 0.001), febrile seizures in first-degree relatives (p = 0.023) and prominent dialeptic seizures (p = 0.009) where significantly more frequent in group DR. Individuals with PME are rarely found among drug-resistant alleged JME patients in a tertiary epilepsy center. Even a very detailed review by experienced epileptologists may not identify the presence of PME before the typical features evolve underpinning the need for early genetic testing in drug-resistant JME patients.
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- 2019
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37. Informed DEcision for cerebrospinal fluid analysis after epiLeptic seizures- the IDEAL-score: A development and validation study.
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Süße, Marie, Gag, Konrad, Hannich, Malte J., Hamann, Laura, Nass, Robert D., Malter, Michael P., Quesada, Carlos M., Remi, Jan, Möddel, Gabriel, Knake, Susanne, Schmitt, Friedhelm C., Hirsch, Martin, Kunze, Albrecht, Strzelczyk, Adam, and von Podewils, Felix
- Abstract
Background: This observational study was done to develop a score based on clinical predictors that enables a guided decision for the necessity of cerebrospinal fluid (CSF) analysis after first unprovoked epileptic seizures and to validate this score in a retrospective patient cohort.Methods: Clinical predictors were identified by two panels of epilepsy experts and selected according to content validity ratios. Based on these predictors a score was created and applied to a cohort of patients with first epileptic seizures.Results: The "IDEAL score" consists of 9 items (fever, prolonged disturbance of consciousness, headache, imaging results, cognitive dysfunction, status epilepticus, malignancy, autoimmune encephalitis symptoms) that are collected at two different time points (< 3 h [A-score]; > 3 h [B-score] after hospital admittance). A CSF analysis is recommended, if at least one clinical finding is present, either one of the items evaluated during the acute phase (A-score) or later in the diagnostic process (B-score). In 41 patients (13%) CSF analysis provided essential clues to the cause of the seizure. The combined IDEAL score reached a sensitivity of 98%, a specificity of 53%, a positive predictive value of 24% and a negative predictive value of 99% in this patient cohort.Conclusions: A CSF analysis after first epileptic seizures provided decisive etiological findings in only 13% of all investigated patients. The IDEAL score offers clinicians a simple and easy-to-implement algorithm to assess the necessity of a CSF analysis, and to prevent unnecessary diagnostic procedures. [ABSTRACT FROM AUTHOR]- Published
- 2021
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38. Prescription patterns of antiseizure drugs in tuberous sclerosis complex (TSC)-associated epilepsy: a multicenter cohort study from Germany and review of the literature.
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Strzelczyk, Adam, Grau, Janina, Bast, Thomas, Bertsche, Astrid, Bettendorf, Ulrich, Hahn, Andreas, Hartmann, Hans, Hertzberg, Christoph, Hornemann, Frauke, Immisch, Ilka, Jacobs, Julia, Klotz, Kerstin A., Kluger, Gerhard, Knake, Susanne, Knuf, Markus, Kurlemann, Gerhard, Marquard, Klaus, Mayer, Thomas, Meyer, Sascha, and Muhle, Hiltrud
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TUBEROUS sclerosis ,EVEROLIMUS ,EPILEPSY ,ADULTS ,LITERATURE reviews ,COHORT analysis - Abstract
Seizures are a primary and early disease manifestation of Tuberous Sclerosis Complex (TSC). We aimed to describe the age-stratified patterns of antiseizure drug (ASD) treatments among children, adolescents, and adults with TSC in Germany. Additionally, we reviewed real-world and clinical study evidence regarding ASD utilization in patients with TSC. We evaluated the pattern of routine ASD use and everolimus prescriptions based on a 2019 multicenter survey of 268 individuals with TSC-associated epilepsy. We contextualized the results with a structured review of real-world and clinical study evidence. TSC-associated epilepsy treatment comprises a wide variety of ASDs. In this German sample, the majority of patients were treated with polytherapy, and lamotrigine (34.7%), valproate (32.8%), oxcarbazepine (28.7%), vigabatrin (19.0%), and levetiracetam (17.9%) were identified as the most-commonly used ASDs. In addition, everolimus was used by 32.5% of patients. In adherence to current TSC guidelines, the disease-modifying ASD vigabatrin was widely used in children (58% below the age of 5 years), whereas treatment in adults did not necessarily reflect guideline preference for (partial) GABAergic ASDs. The selection of ASDs for patients with TSC-associated epilepsy follows well-evaluated recommendations, including the guidelines regarding vigabatrin use in children. Several characteristics, such as the comparatively high frequency of valproate use and polytherapy, reflect the severity of TSC-associated epilepsy. [ABSTRACT FROM AUTHOR]
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- 2021
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39. Efficacy, retention, and tolerability of Brivaracetam in patients with epileptic encephalopathies : a multicenter cohort study from Germany
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Willems, Laurent M., Bertsche, Astrid, Bösebeck, Frank, Hornemann, Frauke, Immisch, Ilka, Klein, Karl M., Knake, Susanne, Kunz, Rhina, Kurlemann, Gerhard, Langenbruch, Lisa, Möddel, Gabriel, Müller-Schlüter, Karen, von Podewils, Felix, Reif, Philipp S., Steinhoff, Bernhard J., Steinig, Isabel, Rosenow, Felix, Schubert-Bast, Susanne, Strzelczyk, Adam, and Cendes, Fernando
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Neurology ,levetiracetam ,seizure ,epileptic encephalopathies ,anticonvulsants ,epilepsy ,ddc:610 ,Original Research - Abstract
Objective: To evaluate the efficacy and tolerability of brivaracetam (BRV) in a severely drug refractory cohort of patients with epileptic encephalopathies (EE). Method: A multicenter, retrospective cohort study recruiting all patients treated with EE who began treatment with BRV in an enrolling epilepsy center between 2016 and 2017. Results: Forty-four patients (27 male [61%], mean age 29 years, range 6 to 62) were treated with BRV. The retention rate was 65% at 3 months, 52% at 6 months and 41% at 12 months. A mean retention time of 5 months resulted in a cumulative exposure to BRV of 310 months. Three patients were seizure free during the baseline. At 3 months, 20 (45%, 20/44 as per intention-to-treat analysis considering all patients that started BRV including three who were seizure free during baseline) were either seizure free (n = 4; 9%, three of them already seizure-free at baseline) or reported at least 25% (n = 4; 9%) or 50% (n = 12; 27%) reduction in seizures. An increase in seizure frequency was reported in two (5%) patients, while there was no change in the seizure frequency of the other patients. A 50% long-term responder rate was apparent in 19 patients (43%), with two (5%) free from seizures for more than six months and in nine patients (20%, with one [2 %] free from seizures) for more than 12 months. Treatment-emergent adverse events were predominantly of psychobehavioural nature and were observed in 16%. Significance: In this retrospective analysis the rate of patients with a 50% seizure reduction under BRV proofed to be similar to those seen in regulatory trials for focal epilepsies. BRV appears to be safe and relatively well tolerated in EE and might be considered in patients with psychobehavioral adverse events while on levetiracetam.
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- 2018
40. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study
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Willems, Laurent M., Watermann, Nina, Richter, Saskia, Kay, Lara, Hermsen, Anke M., Knake, Susanne, Rosenow, Felix, and Strzelczyk, Adam
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Neurology ,seizure ,falls ,laceration ,epilepsy ,accident ,Neurology (clinical) ,Original Research - Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18–86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
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- 2018
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41. Efficacy and safety of adjunctive lacosamide in the treatment of primary generalised tonic-clonic seizures: a double-blind, randomised, placebo-controlled trial.
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Vossler, David G., Knake, Susanne, O'Brien, Terence J., Watanabe, Masako, Brock, Melissa, Brach, Björn Steiniger, Williams, Paulette, Roebling, Robert, Steiniger-Brach, Björn, SP0982 trial investigators, and SP0982 co-investigators
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PARTIAL epilepsy ,SEIZURES (Medicine) ,VIMPAT ,ANTICONVULSANTS ,RESEARCH ,COMBINATION drug therapy ,EPILEPSY ,DIZZINESS ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,TREATMENT effectiveness ,COMPARATIVE studies ,RANDOMIZED controlled trials ,BLIND experiment ,KAPLAN-Meier estimator ,HEADACHE ,PROPORTIONAL hazards models - Abstract
Objective: To evaluate efficacy and safety of lacosamide (up to 12 mg/kg/day or 400 mg/day) as adjunctive treatment for uncontrolled primary generalised tonic-clonic seizures (PGTCS) in patients (≥4 years) with idiopathic generalised epilepsy (IGE).Methods: Phase 3, double-blind, randomised, placebo-controlled trial (SP0982; NCT02408523) in patients with IGE and PGTCS taking 1-3 concomitant antiepileptic drugs. Primary outcome was time to second PGTCS during 24-week treatment.Results: 242 patients were randomised and received ≥1 dose of trial medication (lacosamide/placebo: n=121/n=121). Patients (mean age: 27.7 years; 58.7% female) had a history of generalised-onset seizures (tonic-clonic 99.6%; myoclonic 38.8%; absence 37.2%). Median treatment duration with lacosamide/placebo was 143/65 days. Risk of developing a second PGTCS during 24-week treatment was significantly lower with lacosamide than placebo (Kaplan-Meier survival estimates 55.27%/33.37%; HR 0.540, 95% CI 0.377 to 0.774; p<0.001; n=118/n=121). Median time to second PGTCS could not be estimated for lacosamide (>50% of patients did not experience a second PGTCS) and was 77.0 days for placebo. Kaplan-Meier estimated freedom from PGTCS at end of the 24-week treatment period (day 166) for lacosamide/placebo was 31.3%/17.2% (difference 14.1%; p=0.011). More patients on lacosamide than placebo had ≥50% (68.1%/46.3%) or ≥75% (57.1%/36.4%) reduction from baseline in PGTCS frequency/28 days, or observed freedom from PGTCS during treatment (27.5%/13.2%) (n=119/n=121). 96/121 (79.3%) patients on lacosamide had treatment-emergent adverse events (placebo 79/121 (65.3%)), most commonly dizziness (23.1%), somnolence (16.5%), headache (14.0%). No patients died during the trial.Conclusions: Lacosamide was efficacious and generally safe as adjunctive treatment for uncontrolled PGTCS in patients with IGE. [ABSTRACT FROM AUTHOR]- Published
- 2020
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42. Brivaracetam substituting other antiepileptic treatments: Results of a retrospective study in German epilepsy centers.
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Lerche, Holger, Knake, Susanne, Rosenow, Felix, Schulze‐Bonhage, Andreas, Hellot, Scarlett, Leunikava, Iryna, Schulz, Anne‐Liv, and Hopp, Peter
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EPILEPSY ,RETROSPECTIVE studies ,ANTICONVULSANTS ,PHENOBARBITAL - Abstract
Objective: To evaluate the success of initiation of adjunctive brivaracetam in patients who required a change in antiepileptic drug (AED) regimen and substituted at least one AED with brivaracetam. Methods: In this retrospective noninterventional study conducted in specialized epilepsy centers across Germany, patients initiated adjunctive brivaracetam between February 15, 2016, and August 31, 2016, as part of an intended change in AED regimen. The primary effectiveness variable was the proportion of patients who continued on brivaracetam after 3 months, and withdrew at least one AED either before or within 6 months after brivaracetam initiation. Results: Five hundred and six patients had at least one brivaracetam dose and were included in the safety set (SS). Four hundred and seventy patients started to reduce the dose of one AED before/after brivaracetam initiation, had at least one concomitant AED at brivaracetam initiation, and were included in the full analysis set (FAS) for effectiveness analyses. At baseline, patients had a median of seven lifetime AEDs and a median of 3.8 seizures/28 days. In the SS, 85.2% of patients withdrew one AED before/after initiation of brivaracetam, most commonly levetiracetam (49.4%). 46.2% of patients substituted another AED with brivaracetam within 24 hours (fast withdrawal). The proportions of patients (FAS) who continued on brivaracetam after 3 and 6 months and withdrew one AED were 75.5% and 46.6%, respectively. After 6 months, 32.1% of patients were 50% responders; 13.0% were seizure‐free. In the SS, 34.6% of patients reported treatment‐emergent adverse events (TEAEs); 21.9% had TEAEs that were assessed by the treating physician as drug‐related. Incidences of behavioral AEs before (3‐month baseline) and after brivaracetam initiation in patients who withdrew levetiracetam were 19.2% and 8.0%, respectively (5.0% and 7.7% in patients who withdrew other AEDs). Significance: Brivaracetam was effective and well‐tolerated in patients who required a change in AED drug regimen and initiated adjunctive brivaracetam in German clinical practice. [ABSTRACT FROM AUTHOR]
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- 2020
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43. Prone, lateral, or supine positioning at seizure onset determines the postictal body position: A multicenter video-EEG monitoring cohort study.
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Mahr, Katharina, Bergmann, Marc-Philipp, Kay, Lara, Möller, Leona, Reif, Philipp S., Willems, Laurent M., Menzler, Katja, Schubert-Bast, Susanne, Klein, Karl Martin, Knake, Susanne, Rosenow, Felix, Zöllner, Johann Philipp, and Strzelczyk, Adam
- Abstract
Purpose: Most patients who die from sudden unexpected death in epilepsy (SUDEP) are found in the prone position. We evaluated whether changes in body position occur during generalized convulsive seizures (GCSs).Method: GCSs in patients undergoing video-EEG-monitoring between 2007 and 2017 at epilepsy centers in Frankfurt and Marburg were analyzed in relation to changes in body position.Results: A total of 494 GCSs were analyzed among 327 patients. At seizure onset, positions included supine (48.2 %), right lateral (19.0 %), left lateral (15.6 %), sitting or standing (14.0 %), and prone (3.2 %). Between seizure onset and the start of generalization, 57.5 % of participants altered body positions. During four seizures, patients adopted a prone position, while, in five seizures, patients moved from a prone position. Patients who experienced GCS onset while in a nonprone position had a 2.1 % risk of entering the prone position by the end of their seizure. In contrast, 56.2 % of those in an initial prone position remained so at the end of the GCS, with an odds ratio for maintaining that position of 60.2 (95 % confidence interval: 29.1-124.3; p < 0.001). The likelihood of ending up in the prone position post-GCS did not vary among patients with different nonprone starting positions (p = 0.147).Conclusions: Seizures in prone position occur during sleep and the highest risk for postictal prone positioning appears to be being in the prone position at GCS onset. Epilepsy patients should therefore be advised to go to sleep in a supine or lateral position to reduce their SUDEP risk. [ABSTRACT FROM AUTHOR]- Published
- 2020
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44. Predicting outcome of epilepsy surgery in clinical practice: Prediction models vs. clinical acumen.
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Fassin, Anne Katharina, Knake, Susanne, Strzelczyk, Adam, Josephson, Colin B., Reif, Philipp S., Haag, Anja, Carl, Barbara, Hermsen, Anke M., Gorny, Iris, Möller, Leona, Pagenstecher, Axel, Nimsky, Christopher, Bauer, Sebastian, Sure, Ulrich, Menzler, Katja, Rosenow, Felix, and Klein, Karl Martin
- Abstract
• Preoperative estimates corresponded well to observed outcome after epilepsy surgery. • Patient counselling about expected outcome in clinical practice was appropriate. • The use of prediction models did not improve the accuracy of clinical predictions. Epilepsy surgery is an evidence-based treatment for drug-refractory focal epilepsy. We aimed to evaluate how well preoperative outcome estimates of epilepsy surgery in clinical practice correlated with postoperative outcome and to compare prediction by the clinical team with available scores (m-SFS, ESN). Retrospective cohort study including patients with drug-refractory focal epilepsy who underwent resective epilepsy surgery at Epilepsy Center Hessen, Marburg, between 1998-2016. Patients were categorized into four groups based on their estimated chance of postoperative seizure freedom documented in preoperative medical records. Variables required for calculation of m-SFS and ESN were also extracted from presurgical medical records. Seizure outcome using Engel/ILAE classifications was extracted from postoperative medical records. 148 patients were included and 98 had follow-up at 5 years. 69 (70%) had Engel I and 50 (51%) ILAE 1 outcome. Observed 5-year outcome for very good candidates was 20/22 (91%) Engel I and 14/22 (64%) ILAE 1, for good candidates 29/40 (73%) Engel I and 21/40 (53%) ILAE 1, for candidates with slightly reduced chance 11/18 (61%) Engel I and 9/18 (50%) ILAE 1 and for candidates with considerably reduced chance 1/5 (20%) Engel I and 1/5 (20%) ILAE 1.There were no significant differences in discrimination or overall performance between predictions by the clinical team, ESN and m-SFS. Preoperative outcome estimates corresponded well with observed outcome indicating adequate patient counseling. [ABSTRACT FROM AUTHOR]
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- 2020
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45. Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature.
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Fechner, Anne, Hubert, Kristina, Jahnke, Kolja, Knake, Susanne, Konczalla, Jürgen, Menzler, Katja, Ronellenfitsch, Michael W., Rosenow, Felix, and Strzelczyk, Adam
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STATUS epilepticus ,LITERATURE reviews ,COHORT analysis ,ANTICONVULSANTS ,MEDICAL records - Abstract
Objective: Novel treatments are needed to control treatment‐resistant status epilepticus (SE). We present a summary of clinical cases where oral topiramate (TPM) was used in refractory SE (RSE) and superrefractory SE (SRSE). Methods: A review of medical records was carried out to detect TPM administration in SE patients treated in Frankfurt and Marburg between 2011 and 2016. The primary outcome question concerned SE resolution after TPM initiation. Results: In total, TPM was used in 106 of 854 patients having a mean age of 67.4 ± 18.1 years, 61 of whom were female (57.5%). The median latency from SE onset to TPM initiation was 8.5 days. Patients with SE had previously failed a median of five other antiepileptic drugs. The median initial TPM dose was 100 mg/d, which was uptitrated to a median maintenance dose of 400 mg/d. Treatment with TPM was continued for a median time of 12 days. TPM was the last drug provided to 42 of 106 (39.6%) patients, with a resultant response attributed to TPM observed in 29 of 106 (27.4%) patients. A response was attributed to TPM in 21 (31.8%) of 66 RSE cases and eight (20%) of 40 SRSE cases. Treatment‐emergent adverse events were attributed to TPM usage in two patients, one each with pancreatitis and hyperchloremic acidosis, and in 38 patients (35.8%), hyperammonemia was seen. Thirty‐four of these patients received a combination of TPM and valproate and/or phenobarbital. The intrahospital mortality rate was 22.6% (n = 24). Significance: The rate of SE cessation attributed to TPM treatment (27.4%) represents a relevant response given the late treatment position of TPM and the treatment latency of more than 8 days. Based on these results and in line with the findings of other case series, TPM can be considered an alternative option for treating RSE and SRSE. [ABSTRACT FROM AUTHOR]
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- 2019
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46. Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy.
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Verboket, René Danilo, Söhling, Nicolas, Marzi, Ingo, Paule, Esther, Willems, Laurent Maximilian, Rosenow, Felix, Strzelczyk, Adam, and Knake, Susanne
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ACCIDENT prevention ,PREVENTION of injury ,INJURY risk factors ,ACCIDENTS ,ANXIETY ,EPILEPSY ,OSTEOPOROSIS ,QUALITY of life ,WOMEN ,WOMEN'S health ,WOUNDS & injuries ,DISEASE prevalence ,DESCRIPTIVE statistics ,DISEASE complications - Abstract
Background: Epilepsy-related injuries and accidents (ERIA) are a frequent cause of hospitalisation and represent a relevant burden for patients with epilepsy. In particular, osteoporosis and other gender-specific aspects may increase the risk of seizure-related fractures and injuries in women with epilepsy. Aim and scope: The aim of this analysis is to determine the prevalence and clinical nature of ERIA in a cohort of women with epilepsy, to identify possible determinants including osteoporosis and to give an overview of the current knowledge of clinically important prophylactic and therapeutic aspects. Results: In total, 167 women (mean age 39.0 years, range 18–67 years) with established diagnosis of epilepsy (mean disease duration 18.2 years, range 0–64) were analysed for the occurrence of ERIA. Overall, 22 patients (13.2%) reported at least one ERIA (mean number 3.4, ± 3.1) during the last three months prior to enrollment. The most frequent types of ERIA were lacerations (n = 7/22; 31.8%), abrasions, cuts, bruises or hematoma (n = 6/22, 27.3%), burns (n = 3/22, 13.6%), and fractures (n = 3/22, 13.6%). Moreover, one seizure-related road traffic accident with consecutive trauma (4.5%) was reported. Ictal falls, periictal abnormalities of behaviour and missing seizure freedom were associated with ERIA. Furthermore, female patients with ERIA had a significantly reduced quality of life (QoL, p = 0.002) and increased anxiety (p = 0.008) compared to patients without ERIA. A review of the pertinent literature suggests decreased bone mineral density and use of enzyme-inducing AEDs to be risk factors for ERIA in women with epilepsy. Conclusion: ERIA represent relevant complications for women with epilepsy and are associated with a lower QoL and anxiety compared with non-affected controls. Improvement of anticonvulsive treatment and therapy for osteoporosis or osteomalacia may help to decrease ERIA and the associated burden. [ABSTRACT FROM AUTHOR]
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- 2019
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47. Critique of the 2017 epileptic seizure and epilepsy classifications.
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Lüders, Hans, Amina, Shahram, Bozorgi, Alireza, Devereaux, Michael, Fernandez‐Baca Vaca, Guadalupe, García Losarcos, Naiara, Jamal Omidi, Shirin, Lacuey, Nuria, Lhatoo, Samden, Miller, Jonathan, Park, Jun, Shahid, Asim, Hamer, Hajo, Holthausen, Hans, Kalamangalam, Giridhar, Kanner, Andrés, Knake, Susanne, Lim, Shih‐Hui, Mani, Jayanthi, and Matsumoto, Riki
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EPILEPSY ,STATUS epilepticus ,CLASSIFICATION - Abstract
Summary: This article critiques the International League Against Epilepsy (ILAE) 2015‐2017 classifications of epilepsy, epileptic seizures, and status epilepticus. It points out the following shortcomings of the ILAE classifications: (1) they mix semiological terms with epileptogenic zone terminology; (2) simple and widely accepted terminology has been replaced by complex terminology containing less information; (3) seizure evolution cannot be described in any detail; (4) in the four‐level epilepsy classification, level two (epilepsy category) overlaps almost 100% with diagnostic level one (seizure type); and (5) the design of different classifications with distinct frameworks for newborns, adults, and patients in status epilepticus is confusing. The authors stress the importance of validating the new ILAE classifications and feel that the decision of Epilepsia to accept only manuscripts that use the ILAE classifications is premature and regrettable. [ABSTRACT FROM AUTHOR]
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- 2019
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48. Brivaracetam in the Treatment of Patients with epilepsy--First clinical experiences.
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Zahnert, Felix, Krause, Kristina, Immisch, Ilka, Habermehl, Lena, Gorny, Iris, Chmielewska, Izabella, Möller, Leona, Weyand, Anna M., Mross, Peter M., Wagner, Jan, Menzler, Katja, and Knake, Susanne
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TREATMENT of epilepsy ,SIDE effects of anticonvulsants ,DRUG efficacy - Abstract
Methods: Data on patients treated with BRV from February to December 2016 and with at least one clinical follow-up were collected from electronic patient records. Data on safety and efficacy were evaluated retrospectively. results: In total, 93 patients were analyzed; 12 (12.9%) received BRV in monotherapy. The mean duration to follow-up was 4.85 months (MD = 4 months; SD = 3.63). Fiftyseven patients had more than one seizure per month at baseline and had a follow-up of more than 4 weeks; the rate of ≥50% responders was 35.1% (n = 20) in this group, of which five (8.8%) patients were newly seizure-free. In 50.5% (47/93), patients were switched from levetiracetam (LEV) to BRV, of which 43 (46.2%) were switched immediately. Adverse events (AE) occurred in 39.8%, with 22.6% experiencing behavioral and 25.8% experiencing non-behavioral AE. LEV-related AE (LEV-AE) were significantly reduced by switching to BRV. The discontinuation of BRV was reported in 26/93 patients (28%); 10 of those were switched back to LEV with an observed reduction of AE in 70%. For clinical reasons, 12 patients received BRV in monotherapy, 75% were seizure--free, and previous LEV-AE improved in 6/9 patients. BRV-related AE occurred in 5/12 cases, and five patients discontinued BRV. conclusion: BRV seems to be a safe, easy, and effective option in the treatment of patients with epilepsy, especially in the treatment of patients who have psychiatric comorbidities and might not be good candidates for LEV treatment. BRV broadens the therapeutic spectrum and facilitates personalized treatment. [ABSTRACT FROM AUTHOR]
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- 2018
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49. Socioeconomic Outcome and Quality of Life in Adults after Status Epilepticus: A Multicenter, Longitudinal, Matched Case--Control Analysis from Germany.
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Kortland, Lena-Marie, Knake, Susanne, von Podewils, Felix, Rosenow, Felix, and Strzelczyk, Adam
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EPILEPSY ,SPASMS ,ANTICONVULSANTS - Abstract
Background: There is a lack of data concerning socioeconomic outcome and quality of life (QoL) in patients after status epilepticus (SE) in Germany. Patients and methods: Adult patients treated between 2011 and 2015 due to SE at the university hospitals in Frankfurt, Greifswald, and Marburg were asked to fill out a questionnaire regarding long-term outcome of at least 3 months after discharge. The SE cohort consisted of 25.9% patients with an acute symptomatic, 42% with a remote symptomatic and previous epilepsy, 22.2% with a new-onset remote symptomatic, and 9.9% with other or unknown etiology. A matched case--control analysis was applied for comparison with patients with drug refractory epilepsy and seizure remission, both not previously affected by SE. results: A total of 81 patients (mean age: 58.7 ± 18.0 years; 58% female) participated. A non-refractory course was present in 59.3%, while 27.2% had a refractory SE (RSE) and 13.6% had a superrefractory SE (SRSE). Before admission, a favorable modified Rankin Scale (mRS) of 0-3 was found in 82.7% (67/81), deteriorating to 38.3% (31/81) p = 0.003) at discharge. The majority returned home [51.9% (42/81)], 32.1% entered a rehabilitation facility, while 12.3% were transferred to a nursing home and 3.7% to another hospital. The overall mRS at follow-up did not change; 61.8% (45/74) reached an mRS of 0-3. In RSE and SRSE, the proportion with a favorable mRS increased from 45.5% at discharge to 70% at follow-up, while QoL was comparable to a non-refractory SE course. Matched epilepsy controls in seizure remission were treated with a lower mean number of anticonvulsants (1.3 ± 0.7) compared to controls with drug refractory epilepsy (1.9 ± 0.8; p < 0.001) or SE (1.9 ± 1.1; p < 0.001). A major depression was found in 32.8% of patients with SE and in 36.8% of drug refractory epilepsy, but only in 20.3% of patients in seizure remission. QoL was reduced in all categories (QOLIE-31) in SE patients in comparison with patients in seizure remission, but was comparable to patients with drug refractory epilepsy. Discussion: Patients after SE show substantial impairments in their QoL and daily life activities. However, in the long term, patients with RSE and SRSE had a relatively favorable outcome comparable to that of patients with a non-refractory SE course. This underlines the need for efficient therapeutic options in SE. [ABSTRACT FROM AUTHOR]
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- 2017
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50. Differenzialdiagnose paroxysmaler Bewusstseinsstörungen.
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Bergmann, Marc-Philipp, Belke, Marcus, Lüsebrink, Ulrich, Knake, Susanne, Rosenow, Felix, and Strzelczyk, Adam
- Abstract
Copyright of Zeitschrift für Epileptologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2017
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