ABSTRACT
INTRODUCTION: This study describes the specific neuropsychological abnormalities among children with epilepsy (CH-E) living in Georgia. METHODS: A cohort of CH-E and children without epilepsy (CH-NoE), aged 6-13â¯years, admitted to the epilepsy center of the Institute of Neurology and Neuropsychology from 1st January 2010 to 31st December 2015, was selected and investigated with a structured protocol. Neurological/epileptological assessments were made and neuropsychological testing was done on all study subjects. RESULTS: Abnormalities in praxis, verbal functions, verbal learning, visual-spatial matching, visual-motor ability, and fine motor skills, working memory, and phonological memory span were often revealed in CH-E as compared to CH-NoE. Early age of seizure onset, epilepsy duration, and anti-seizure medication (ASM) use, in combination with brain structural abnormalities on neuroimaging, and structural etiology were independent predictors of impaired functioning in various neuropsychological domains. DISCUSSION: More than half of children with epilepsy have a variety of cognitive impairments, which may increase with ASM therapy, especially when the cause of seizures is structural damage to the brain. Therefore, in the process of diagnosing epilepsy, evaluation of cognitive functions should become an integral part to ensure effective management of the disorder.
Subject(s)
Anticonvulsants/adverse effects , Cognitive Dysfunction/etiology , Cognitive Dysfunction/physiopathology , Epilepsy/complications , Adolescent , Child , Cognitive Dysfunction/chemically induced , Epilepsy/drug therapy , Epilepsy/pathology , Female , Georgia (Republic) , Humans , Longitudinal Studies , Magnetic Resonance Imaging , MaleABSTRACT
OBJECTIVE: To investigate the characteristics of focal EEG features in patients with juvenile absence epilepsy (JAE) and juvenile myoclonic epilepsy (JME), and to assess their possible influence on therapeutic response. METHODS: Focal EEG features were prospectively scored in 168 consecutive patients. Ninety-six patients were drug-naïve and 72 patients were already on antiepileptic drugs (AEDs): 38 on adequate medication and 34 on inadequate medication. Therapeutic response was assessed one year after starting adequate therapy. RESULTS: One-hundred-eighteen patients (70.2%) had focal EEG features: 89 patients (53%) had focal epileptiform discharges, and 80 patients (47.6%) had focal slowing. Most often, these were multifocal and localized in frontal and temporal regions. Among patients already on AEDs, patients with focal EEG features were more often treated with inadequate medication due to misdiagnosis, than patients without focal features. Data on therapeutic response were available for 118 patients; most of them (90.7%) were seizure free. None of the focal EEG features affected therapeutic response. CONCLUSION: Focal EEG features are common in patients with JME and JAE, but they do not influence the therapeutic response. SIGNIFICANCE: It is important that physicians are aware of the focal EEG features in order to avoid misdiagnosis and inadequate therapy.
Subject(s)
Anticonvulsants/therapeutic use , Electroencephalography/methods , Epilepsy, Absence/drug therapy , Epilepsy, Absence/physiopathology , Myoclonic Epilepsy, Juvenile/drug therapy , Myoclonic Epilepsy, Juvenile/physiopathology , Adolescent , Adult , Anticonvulsants/pharmacology , Child , Child, Preschool , Electroencephalography/drug effects , Epilepsy, Absence/diagnosis , Female , Humans , Male , Middle Aged , Myoclonic Epilepsy, Juvenile/diagnosis , Prospective Studies , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Data on the prevalence of epilepsy and the extent of its treatment gap are important for planning health care delivery for people with epilepsy. The prevalence of active epilepsy in Georgia prior to the social and political re-organization in the early 1990s was estimated at around 5.7 per 1000. Changes to the social structure of the country may have affected this. There is no previous estimate of the treatment gap. METHODS: A door-to-door survey was carried out using a validated screening questionnaire to determine the prevalence of epilepsy and the extent of the treatment gap amongst a population of about 10,000 people in Tbilisi, the capital of Georgia. The diagnosis of epilepsy amongst those who screened positive was confirmed by a multidisciplinary team. RESULTS: Lifetime prevalence was 11.4/1000. The prevalence of active epilepsy was estimated at 8.8/1000, and 5/1000 had seizures in the previous 12 months. About two thirds of people with active epilepsy had not received appropriate antiepileptic treatment in the month prior to the survey. 89% had focal epilepsy and two thirds had co-morbidity (neurological deficits, behavioral, psychiatric or somatic problems). CONCLUSION: The prevalence of epilepsy was higher than previously estimated and the treatment gap was substantial. Results should inform the planning of epilepsy care delivery in the country.
